Inspection on 24/04/06 for Cedar Lodge Residential Home

This inspection was carried out on 24th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cedar Lodge Residential Home 06/05/09

Cedar Lodge Residential Home 10/04/08

Cedar Lodge Residential Home 10/04/07

Cedar Lodge Residential Home 06/10/06

Cedar Lodge Residential Home 30/11/05

Cedar Lodge Residential Home 18/08/05

Cedar Lodge Residential Home 08/06/05

Cedar Lodge Residential Home 20/09/04

Cedar Lodge Residential Home 10/06/04

Similar services:

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Claremont House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cedar Lodge Residential Home Hengrave Road Culford Bury St. Edmunds Suffolk IP28 6DX Lead Inspector Deborah Seddon Unannounced Inspection 24th April 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Cedar Lodge Residential Home Address Hengrave Road Culford Bury St. Edmunds Suffolk IP28 6DX 01284 728744 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Sandra Spendley Mr Michael Lewis Spendley Mrs Sandra Spendley Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include one named person under the age of 65 with a mental disability 30th November 2005 Date of last inspection Brief Description of the Service: Cedar lodge is a residential care home that has provided care and accommodation to older people since 1984. There is currently a condition of registration which allows the home to support and care for one service user under the age of 65 with mental health needs. The home is situated in a rural setting within its own grounds and adjoining woodlands on the outskirts of Culford, which is approximately five miles from Bury St Edmunds. There are no community facilities nearby and the nearest shop is in the village of Ingham. The home is spread over two floors with service users being able to access both floors by a central staircase or lift. There are 23 single bedrooms, eight of which are en-suite and one shared room, which also has en-suite toilet facilities. There is a lounge and a dining room and service users also have the use of a small sun lounge on the first floor. The homes office has been relocated to the gardens at the back of the home, in a wooden sun house type construction. The owners are currently making an additional exit from the building for service users to access the new office. Mr and Mrs Spendley became the Registered Providers of Cedar Lodge on the 1st September 2004, although both have been involved in the home for a number of years. Mr Spendleys mother owned the home prior to this date and Mrs Sandra Spendley became the registered manager on the 7th July 2003. The home has a statement of purpose providing information for prospective service users, which is available on request, however this needs to updated to reflect the current fee for each service user, which is currently £331.00 per week, reviewed annually on the 1st April. Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over seven and quarter hours. This was a key inspection, undertaken simultaneously between two inspectors and the pharmacy inspector, which focused on the core standards relating to the older people and issues raised during previous inspections. The report has been written using accumulated evidence gathered prior to and during the inspection. This included reviewing the progress of the requirements made at the last inspection in November 2005, and other documents required under the Care Homes Regulations. Additionally a number of records held at the home were looked at during the inspection including those relating to residents, staff training, staff roster and policies and procedures. Time was spent talking with the responsible individual and the registered manager, ten residents and two staff. A copy of the full pharmacy report has been sent to the Registered Provider and is available subject to request. What the service does well: What has improved since the last inspection? The home have made some improvement developing the care plans, however further work needs to be undertaken to accurately reflect residents care needs. The home has obtained a copy of the Suffolk inter agency policy for the protection of vulnerable adults, but the home’s policy needs to be updated to direct staff to the customer first team. The home has complied with some of the recommendations made by the occupational therapist report, but there are a number of concerns outstanding that require action and are detailed in this report. Overall, the pharmacy inspector found that the home continues to make progress in safe medicine management. There are clear systems in place for medicine administration to residents and the quality of record-keeping overall Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 6 continues to have improved, however, there were noted to be some discrepancies in liquid medicines identifiable by undertaking audits during the inspection. In addition, there was noted to be a medicine stored at room temperature, which should have been stored in the refrigerator. The inspector made recommendations relating to the safe handling of ophthalmic medicines, more frequent risk assessment for a resident selfadministering medicines, improved record-keeping for GP changes made to residents medication and the provision of further training in medication for some members of care staff. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6, Prospective service users can expect to have information about the home and have the opportunity to visit prior to making a decision where to live. However, the contract between the resident and the home must be completed on admission and reflect the current amount and method of payment of fees. Residents can expect to have their needs identified and where a resident is diagnosed terminally ill, they can expect to be supported during the last stages of their life. EVIDENCE: The statement of purpose and service user guide was reviewed at the last inspection and was found to meet the requirements of the national minimum standards. However, the statement of purpose quotes a scale of charges from April 2005 between £300 and £375 per week. The manager informed the inspector that all service users were charged a blanket fee of £331 per week. The statement of purpose needs to be amended to reflect these charges. Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 9 Three residents files were inspected, two had completed contracts; the third resident had recently moved into the home and did not yet have a contract in place. Both completed contracts had been signed and dated, however, only one contract reflected the fee of £331, the other contract needs to be amended with the current fee and the resident provided with a new contract. The inspector spent time talking with one resident who had recently moved into the home. They had not personally been to view the home but stated that a relative had visited the home on their behalf. They also confirmed that the manager had visited them in hospital to discuss their needs and gave them information about the Cedar Lodge. Evidence was seen on each of the care plans that a pre admission needs assessment had been completed covering all aspects of the resident’s health, personal and social care needs. The home provides care for people with terminal illness and evidence confirmed that the home has a very detailed policy and procedure for supporting residents in the last stages of illness. The responsible individual showed the inspector some compliment cards from relatives of residents that had recently passed away thanking the home and the staff for their support and kindness to their relative in the last stages of their lives. The manager informed the inspector that staff have received training for providing palliative care and some have attended a course expelling the myths of death. The home does not provide intermediate care. Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,10,11, Standard 9 was inspected by the Commission for Social Care Inspection (CSCI) pharmacist, their report has been written separately and is attached to this inspection report. Residents do not have care plans that accurately reflect their care needs and do not distinguish between short and long term goals, however residents can be assured that they are treated with dignity and respect. EVIDENCE: The care plans of three residents were inspected to track their care and the level of support they required. A requirement from the inspection in November 2005 was for the care plans to be expanded to identify the level of support required by each resident. The daily care plan makes reference to the resident’s preferred daily routines; they each have a hygiene grooming profile outlining their needs. Although these identified areas of need, there was still no information about the assistance care staff should provide. For example, one resident’s care plan seen, was assessed as needing help with personal hygiene and dressing. There was no detail of how staff should assist this resident or what level of support the resident needed. Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 11 Another person’s assessment showed that they had communication difficulties and it was therefore difficult to understand their needs. There was no information as to how the communication needs of this resident were being met. The care plans did not distinguish between short and long term goals. Evidence was seen that the care plans were being reviewed on a monthly basis, which included feedback from the resident on how the home was meeting their needs and any changes made to their plan of care. However the inspector spent time talking with one resident about their care plan who had no knowledge of it’s existence or it’s contents, informing the inspector that their relative deals with all their paperwork. Although the care plans were being reviewed, not all information was being updated; one resident was having regular visits 2-3 times a week from the district nurse. The district nurse had made a note to say that they no longer needed to visit unless the resident’s condition changed. This had not been amended in the resident’s daily care plan. The resident no longer used their walking aid, however the risk assessment and moving and handling assessment still makes reference to the use of this equipment. These require updating to reflect the resident can walk well with staff assistance. Daily recording and observation records are being completed. Consideration must be given to the written language being used to describe issues about personal hygiene, as the current terminology is not respectful to resident’s dignity. One entry related to the reoccurrence of a health issue for a resident over a period of seven days but there was no evidence to suggest that advice had been sought from the doctor, district nurses or the manager on the resident’s condition. In the case of the most recent resident’s admission into the home, not all sections of their care plan had been completed. The front sheet did not have the residents name, admission date, photograph for identification or their room number. The pre admission assessment noted that the resident has a history of falls, but no further details had been recorded, other than a head injury sustained at the most recent fall. A falls assessment had been carried out with the resident scoring a high risk, the resident had had a fall three days after moving into the home, there was no moving and handling assessment completed; despite the fact the resident had a history of falls and needed support to walk. A record of falls was being kept in each resident’s file and entered into the accident book. There was nothing recorded about how the home would meet their social and leisure interests and all three care plans did not have the inventory sheets completed identifying what items belonged to the resident. Evidence was seen that resident’s are supported to access health professionals. One resident had requested a Doctors appointment for pain in their right knee; the manager telephoned the surgery to request a home visit on behalf of the resident. Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 12 Another resident with a hearing impairment told the inspector they had been supported to visit hospital a fortnight ago to obtain two new hearing aids. During the course of the inspection staff were observed respecting residents dignity and privacy and this was confirmed during conversation with residents. One resident told the inspector “I am well looked after and staff are very kind”. Interactions between residents and staff were observed to be friendly and appropriate. Resident’s wishes in the event of their death and dying are recorded in the care plan and include the contact details of next of kin and funeral directors. In some cases they also contained the express wishes of the resident. The home has a policy on death and dying and terminal illness, which gives very clear instructions and guidance for staff dealing with residents in the last stages of their life. Instructions include keeping relatives and health professionals informed of the resident’s condition and in the event of the resident’s death notifying the Commission for Social Care Inspection (CSCI). Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Residents living in the home cannot expect to have activities that satisfy their social, recreational and religious interests and needs. Residents can expect to have a good range of home cooked food, with plenty of choice, however some residents cannot expect to have their breakfast at a convenient time. EVIDENCE: A requirement was made at the November 2005 inspection for the home to consult with service users about their interests and develop a programme of activities. This was to ensure that residents are provided with recreational activities, which meet their expectations and interests within the home, socially and within the community. The home was also advised to review their staffing levels to provide staff that would be able to facilitate activities of an evening. Discussion with the manager and the responsible individual confirmed this has not happened. The home’s policy on activities state that they “endeavour to create a programme of activities and entertainment that will best suit each individual” Observation throughout the inspection and from discussions with residents provided clear evidence to show that the home does not meet this objective. Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 14 Residents spoken with described their daily routine as spending time in their rooms or in the lounge, one referred to being bored with nothing to do. Another resident commented, “ I have a dreary old life”. Resident’s interests are recorded in the pre admission assessment. One residents assessment seen reflected that the resident enjoyed chatting to people, reading the Daily Express and watching television, they were observed seated in the lounge at the farthest point away from the television on their own with out any one to talk to, other than the staff and manager who came in from time to time. Another resident spoken with when asked about activities, spoke of attending Bingo, but was unable to fully participate due to their disability, as they were unable to move the counters without help. Another resident commented that they moved into Cedar Lodge from another care home where they had more activities, which included playing cards and access to a library visit. The activities record held in one residents file showed that between October 2005 and February 2006 they had attended a Halloween party, a Carol service and a ‘yesteryears’ music session on two occasions. Other entries were for refusals; they had refused bingo, arts and crafts and communion on a regular basis since July 2005. Discussion with other residents and looking at their records reflect a similar theme that residents have ceased to attend these activities due to their repetitive nature. One resident did talk of a river trip, which they had been on for the last two years, which they had enjoyed, but did not think they would go again this year. The home offers communion one day a week, only three residents attend on a regular basis, one resident spoken with said they did not attend as this was not their religion. Another resident who does attend communion said “communion is poorly attended, possibly due to residents finding it difficult to get to the upstairs sun lounge without help”. Information obtained from the quality assurance questionnaires for April, July and October 2005 and January 2006 reflected a 100 feedback on all aspects of the service with the exception of activities, all residents’ responses were that they wanted more activities, including music and outings. Residents are able to receive visitors in the privacy of their own rooms; there are no restrictions on visiting times. Residents spoke of having regular contact with their relatives; one resident told the inspector that they had recently been out with their family to celebrate their 94th birthday. Another resident informed the inspector it was their birthday tomorrow and that their relatives were coming to see them. Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 15 During the inspection the inspector observed a resident requesting a cigarette, they were informed that they could not have a cigarette and that their coffee would be coming soon. The manager was asked about arrangements for residents to smoke; residents can smoke but this particular resident required supervision. There was no plan of action to support the resident within their care plan to enable them to exercise their right and choice to smoke. The home has a smoking policy for staff only. The home does not have involvement with any resident’s money. If they do purchase an item on a resident’s behalf they provide a receipt to the relative who reimburses the money. None of the residents manage their finances; relatives deal with their personal monies. One resident spoken with told the inspector that they still have their own home and by choice have been supported to return for the weekend on several occasions to stay with a friend that is currently living there. The resident spoken with was happy with this arrangement, but expressed their wish to return home on a permanent basis. Night staff make and serve breakfasts, two resident’s spoken with commented that they have their breakfast brought to them at 6am and 6.30am which is too early and both said this was not their choice. However both commented that they thought the food was of a good standard with plenty of choice and they could eat their other meals in their rooms if they wanted to. One inspector spent time talking with the cook, discussing the menus and food offered to the residents. They cater for individual’s requests wherever possible and make homemade soups and cakes for supper. Supper choices seen were salad sandwiches, cheese or egg on toast. The home had a good store of food available. The lunchtime menu seen was lamb casserole or cauliflower cheese with potatoes and carrots, followed by fresh fruit salad and custard. The menu for the following day was fresh salmon or sweet and sour pork with rice and cabbage. Residents spoken with following lunch were very positive about the food commenting, “ I had a lovely lunch, it was very good” and “ I had lovely food for lunch”. Each resident has a food profile indicating the resident’s ability to feed themselves and highlighted preferences of where they chose to eat, portion size and what equipment they needed to maintain their independence. Weight charts were being maintained and residents were being weighed monthly. One resident, unable to hold a conventional knife and fork showed the inspectors their own adapted cutlery to enable them to feed themself. Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 The home’s policies and procedures for complaints and reporting allegations of concern or abuse are not accurate; therefore residents cannot expect to be protected from abuse. Residents can expect to have plans in place to help them manage incidents of verbal and physical aggression. EVIDENCE: The complaints policy was seen displayed on the notice board in the entrance hallway. The policy refers to the joint inspection unit and should reflect the Commission for Social Care Inspection (CSCI). The address for Social Services is incorrect. The complaints log was seen, the last two incidents recorded were in 2004, these were investigated by the manager. There have been recent complaints and protection of vulnerable adult investigations made about the home; these were not recorded in the complaints log. Through discussion with the residents they confirmed that they are supported to participate in the legal process of registering their vote. One resident spoken with confirmed they had chosen not to vote. A requirement was made at the previous inspection for the home to obtain a copy of the Suffolk policy for reporting concerns and allegations of abuse. The home has obtained a copy and amended their policy, however this must be altered to direct staff to the Customer First team, Social Care Services in line with the Suffolk Vulnerable Adults Protection Committee (VAPC) inter agency policy, not directly to VAPC. Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 17 Evidence was seen that the home had written an action plan for one resident, which identified areas of concern about changes in their behaviour. The plan described the resident as a “fiercely independent person, who was finding getting older very difficult to come to terms with and the need to accept help and support from staff” and that they had a tendency to become abusive and uncooperative. The plan identified that the resident needed space to calm down ad then staff needed to offer them reassurance and only provide assistance when necessary to support the resident to maintain their independence. The home has a policy on the use of restraint, which states that restraint is “never carried out” however, if it is absolutely necessary there must be a record of restraint in the care plans. Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,25,26, Residents cannot expect to live in a safe, well-maintained environment. EVIDENCE: The registered providers had been given several requirements at the previous inspection to make improvements to the maintenance and decoration of the interior and exterior of the home. A tour of the premises was made and a number of concerns were raised with the manager and responsible individual. Bathroom 1 on the first floor has very poor lighting and where decoration has taken place there is only a hard board panel on the side of the bath. The bath is an odd size and the inspectors were informed that a bath panel is being made to fit. The light cord was tied up out of reach. Toilet 1 had poor lighting and poor decoration and there was no light cord. Shower room 1 has a damp patch around ceiling skylight which has been pointed out to the home at the last two inspections. The inspector had raised previous concerns about the stair well at the rear of the building where large cracks had develped in the wall around the window and down the stair wall, the home were advised to investigate sound construction of building. Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 19 The inspector observed during this inspection that these cracks have been filled with pollyfilla. Also the gate at the top of the stairs did not close properly, the catch was broken. The gardens are looking over grown and unkempt to the rear and side of the property, however some improvments have been made. The dining room has been redecorated and the maintanence sheet in one residents care plan showed their bedroom had been redecorated. New curtains and bedding had been povided prior to the resident moving into the home. A number of health and safety concerns were raised. There were no fire exits signs in the sunroom, or in back stairwell. The fire sign in the main lounge directs people back into the house. The fire exit near the lift was not level. An area highlighted by the OT at the foot of the fire escape was still rough and uneven. The fire exit from the dining room was not level, a raised threshold creating a difficult means of escape for residents in wheelchairs or using walking aids. The fire exit at foot of back stairwell did not open when the panic bar was pushed. This was attended to immediately by the responsible individual and was functioning properly before the inspection finished but indicates a need to monitor fire exits to ensure they are functioning at all times. The carpet on the stairs leading to first floor near the entrance is frayed presenting a tripping hazard, particularly for residents with a visual impairment. This has been an ongoing concern highlighted at the last two inspections. A butane gas refill aerosol was found in the drawer in the sun lounge and a cupboard was full of redundant equipment for example, old telephone and radio parts. All radiator covers are now in place with the exception of one small radiator near the medication room and one in the back corridor. The manager informed the inspector the radiator in the back corridor is to be removed. The inspector observed a convector heater in use in the lounge but there was no evidence to suggest the heater had been checked in accordance with portable appliance testing to ensure it’s safety. The convector was not guarded and is a potential danger to residents falling and burning themselves. The responsible individual informed the inspectors this was only used by night staff, however, the heater had been left switched on all day. The home has 23 single bedrooms, eight of which are en-suite and one shared room, which also has en-suite toilet facilities. Currently the home has 23 residents at the home. All service users have their own room; evidence was seen that the rooms were nicely decorated, clean tidy and personalised to suit the individual. Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 20 An assessment of the home was carried out by an independent Occupational Therapist (OT), they produced a report making several recommendations to improve the safety of the residents. The home had complied with most of these recommendations, however the grab rails in toilet 5 and 6 had not been moved to a vertical position. The OT report reflects that there is no call system in toilet 1, the communal lounge or sunroom upstairs. The manager informed inspectors there is a call bell in the sun room, however when checked there was a plaque for a call bell but no cord or means for residents to summon assistance. The plaque was also obscured by the sofa. The manager advised the inspectors they were having the call bell system serviced next week and would ask the engineer to install call bells in these areas. A cupboard by room 3 on the first floor used for storing cleaning products was found unlocked. The responsible individual commented that staff had reported the lock broken yesterday and this was in the process of being fixed. The laundry is situated on the first floor, with a sluice machine and tumble dryer in place. The inspector discussed with a member of staff the process of taking soiled laundry from the ground floor to the upstairs. The soiled linen is placed in a portable trolley holding red cloth bags. Gloves and aprons are provided for staff to transfer the soiled linen from the bag to the washing machine. A discussion took place with the manager about the use of red dissolvable alginate bags, which are placed directly into the washing machine minimising contact with soiled items and the potential to spread infection. Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, The staffing ratio in the home needs to be calculated to ensure that residents are supported by adequate numbers of staff. However residents can expect that the staff have appropriate training and are protected by the home’s recruitment procedures. EVIDENCE: A requirement was made at the previous inspection for the manager to have a duty roster that showed the day and date and reflected staff changes. The roster seen at today’s inspection did not reflect the staff on duty. The manager and responsible individual were shown as ‘off’ and the deputy manager as working 8am to 5pm, however the inspectors were informed that the deputy was on annual leave. The roster did not have the full names of the staff team or their designated roles. There was no clear indication of the overall number of staff on duty; the inspector calculated 7 staff on early shift and 2 staff on duty between 5 and 10pm. A discussion was held with the manager and the responsible individual about the ratio of staff on early and late shifts, how this was calculated and if there were sufficient staff on duty on a late shift to meet the needs of the residents. Three staff files were inspected and each had a job description, job application and two written references. The files also contained a contract of employment and a criminal records bureau (CRB) check. All three staff have been employed with the home for a long time, the home had taken up the CRB checks in 2004. Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 22 Each member of staff had a signed record to say they had read and agreed to the homes policies and procedures with regards to their employment, for example, harassment, disciplinary and confidentiality. Evidence was seen that staff had completed an induction programme. The files showed that staff were receiving regular training covering a range of topics. Discussions with staff confirmed that they had undertaken training in first aid, fire safety, control of substances hazardous to health (COSHH), basic food hygiene, infection control, health and safety, protection of vulnerable adults (POVA), drug administration and moving and handling. One of the three staff had completed the National Vocational Qualification (NVQ) level 2 in December 2005. Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,38, People living in the home cannot be assured that the present management will protect their health, safety and welfare. EVIDENCE: A discussion took place with the manager about their qualifications and what training they had undertaken to keep up to date their knowledge, skills and competence to manage the home. The manager has completed National Vocational Qualification (NVQ) level 4 and has 19 years experience working in the home. They informed the inspector that they attend all mandatory training and had recently attended an expelling the myths of death course. The manager could not find their certificates and will forward them to the inspector at the Commission for Social Care Inspection (CSCI). The manager discussed other sources of training that they would be attending in future, which included refresher training for managers and supervising others. Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 24 The home has introduced the post of deputy manager who is in the process of undertaking their NVQ level 4. Their role is to provide support to the manager and take charge of the home in their absence. However, it was apparent that the manager relies heavily on the deputy in the day-to-day administration and running of the home. The deputy manager was on annual leave on the day of the inspection, the manager was unable to locate or find a number of records and documents required by the inspectors. The home seeks to ensure that the home is run in the best interests of the residents by obtaining feedback in the form of service user surveys, these are produced quarterly. The feedback sheets scored a 100 on all aspects of the service with the exception of activities. The home had a range of policies and procedures covering aspects of care for the resident group, and employment issues. These have recently been reviewed and updated. The financial and accounting procedures of the home were discussed with the responsible individual; they do not have a current business plan in place to account for the financial viability of the home. The responsible individual has assured the inspector they will prepare a business plan and forward to the Commission for Social Care Inspection (CSCI). Whilst discussing financial procedures the manager informed the inspector that they do not have any involvement with resident’s personal monies these are handled by their relatives. Evidence was seen in the staff files that staff were having an appraisal twice yearly and regular supervision. The supervisions were based on observing staff undertake a task and then feedback was given on their performance. A general discussion took place with the manager on the purpose and process of supervision, which is to provide an opportunity for staff to discuss their work role, any concerns they may have and future development and training needs. The fire logbook was seen which showed the home were testing the fire alarm system including the automatic door releases weekly. Fire instruction and drills were being held monthly. A range of risk assessments were seen in place for radiators, window restrictors on first floor, a fire risk assessment for the home, electrical equipment, smoking, control of substances hazardous to health (COSHH), water temperatures and individual risk assessments for service users, use of equipment, special medications and accessing activities. Evidence was seen that these were being reviewed and updated on a regular basis. During a tour of the premises the inspector looked at the documentation for the management of food hygiene. The temperature log had not been completed for the previous day at 9am and 1pm. Some frozen food stocks seen were not dated and there was food items not labelled. A fridge in the sun lounge area on the first floor contained 90 eggs and a red pepper. There were no temperature recordings for the fridge. Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 2 1 3 3 2 X 3 1 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 1 3 2 X 2 Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement The statement of purpose needs to be updated to reflect the current charges made by the home. Contracts between the home and the residents need to be amended with the current fee and the resident provided with a new contract. Staff must ensure that the homes care plans include the level and support required to meet the needs of the service users and reflect their long and short-term goals. This is a repeat requirement from inspection 30/11/05 4. OP8 14 (2) 15 (2) The registered person must ensure that service users are involved in the review of their care plans. Any changes in respect of their health and welfare must be updated and reflected in the care plan. This is a repeat requirement from inspection 18/08/05 Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 27 Timescale for action 26/05/06 2. OP2 5 26/05/06 3. OP7 15 26/05/06 19/05/06 5. OP12 16 (2)(m)(n) The home must consult with service users about their interests and programme of activities so that service users are provided with recreational activities providing stimulation and inclusion within the home and socially within the community. A copy of the consultation and programme of activities for all resident must be forwarded to the CSCI This is a repeat requirement from 30/11/05 26/05/06 6. OP16 22 The complaints policy refers to 19/05/06 the joint inspection unit and should reflect the Commission for Social Care Inspection (CSCI). The address for Social Services is incorrect. The complaints log must be kept up to date. The home’s abuse policy for the protection of vulnerable adults needs amending to direct staff to the Customer first team in line with the Suffolk inter agency policy. 7. OP18 13 (6) 19/05/06 8. OP19 23,2,b,o,1 2,1,a The updated policy must be forwarded to the CSCI. 26/05/06 An action plan with timescales must be forwarded to the CSCI for all areas of concern regarding the environment highlighted in this report to make sure that all parts of the home are reasonably decorated and are suitable, safe and appropriately maintained. This is a repeat requirement from inspections 18/08/05 and 30/11/05 Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 28 9. OP22 13 (4) (a)(b)(c ) Where the home has had an OT assessment all the recommendations must be implemented to ensure the health, safety and welfare of the residents. This is a repeat requirement form inspection 30/11/05 26/05/06 10. OP25 13 (4) (a)(b)(c ) Remove or risk assesses remaining unguarded radiators and assess the use of the convector heater. Appropriate actions must be taken to protect the safety of residents. A safe system of dealing with soiled laundry must be introduced to minimise staff contact with soiled items and the potential to spread infection. The rota must reflect the day and date and must be able to be used as a working document to reflect any changes that occur to staffing in the home daily. This is a repeat requirement from inspections 18/08/05 and 30/11/05 26/05/06 11. OP26 13 (3) 19/05/06 12. OP27 17 (2) Sch 4 (7) 19/05/06 13. 9 (2)(a) The manager must provide evidence that they have the skills, competence and experience to manage the home. The managers must send their training certificates to the CSCI. 19/05/06 14. OP34 25 The responsible individual must prepare a business plan demonstrating the homes financial viability and forward to the CSCI. DS0000045594.V290792.R01.S.doc 26/05/06 Cedar Lodge Residential Home Version 5.1 Page 29 15. OP38 16 (2)(j) The home must make suitable 19/05/06 arrangements for maintaining satisfactory standards of hygiene in line with Food hygiene legislation changes introduced on 1st January 2006 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP14 Good Practice Recommendations Residents need to be supported to have choice and control over their lives, for example a resident choosing to smoke must be supported in accordance with the homes policies and procedures and a plan of support built into their care plan. The manager must communicate a clear sense of direction and leadership Supervision sessions need to be undertaken with a proper agenda providing an opportunity for staff to discuss their work role, any concerns they may have, future development and training needs. 2. 2. OP32 OP36 Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cedar Lodge Residential Home DS0000045594.V290792.R01.S.doc Version 5.1 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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