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Inspection on 30/11/05 for Cedar Lodge Residential Home

Also see our care home review for Cedar Lodge Residential Home for more information

This inspection was carried out on 30th November 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home continues to provide residents with a welcoming and homely atmosphere. Residents and relatives spoke positively about the staff and about the care and service they receive. All residents spoke highly of the food and that they had plenty of choice. The home has responded well to some of the requirements and recommendations made at the last inspection in August 2005. They have had an occupational therapist assess the home to make recommendations for aids, adaptations and equipment to protect residents safety and welfare, however all the recommendations should be implemented to achieve this.

What has improved since the last inspection?

The home has made improvements in the management of medicines. They have implemented significant changes to the way in which medicines are now stored, transported around the home and administered. Staff have also been given information for the safe administration of medicines. All radiators within the home, with the exception of one small radiator opposite the new medication treatment/store room which is situated out of the way of residents communal space, were covered. A company specialising in employment law have supplied Cedar Lodge with new recruitment policies and procedures. The home is reissuing all staff with new up to date job descriptions, an employee handbook containing information of all work related policies and procedures and new contracts of employment. The home has produced policies and procedures to give guidance to staff for the management of medicines, the treatment of pressure areas and sores and falls, however where changes to resident`s condition is highlighted following a fall information must be updated to minimise the risk of the resident falling in the same circumstances again.

What the care home could do better:

Care plans have improved, however the daily routines and personal needs of the residents do not have sufficient detail to instruct staff how they should assist the resident or what level of support the resident needed, for example with their personal hygiene, dressing and eating. Residents and relatives spoken with felt there was a lack of opportunities for residents to be involved in recreational activities and spoke of being bored, isolated and excepting there was nothing to do. Residents were not critical of the staff and realised that it was a difficult task to put on activities to meet the needs of all residents living at the home, however several residents spoke of there not being enough staff on duty to undertake activities. One relative told the inspector that activities were available for their relative to attend, for example bingo and arts and crafts, however their relative does not have good vision and does not attend these sessions as they are unable to participate. Resident`s views must to be sought to identify activities that they would like to be involved in and that are compatible to their ages and ability to take part. The home and surrounding grounds are showing signs of wear and tear and a programme of maintenance to address the issues highlighted in the report needs to be completed. There must be access to a call bell in every room used by residents as recorded in the occupational therapist report.

CARE HOMES FOR OLDER PEOPLE Cedar Lodge Residential Home Hengrave Road Culford Bury St. Edmunds Suffolk IP28 6DX Lead Inspector Deborah Seddon Unannounced Inspection 30th November 2005 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.V262661.R01.S.doc Version 5.0 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.V262661.R01.S.doc Version 5.0 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.V262661.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include one named person under the age of 65 with a mental disability 18th August 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 had involvement 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. Cedar Lodge Residential Home DS0000045594.V262661.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by both a regulatory inspector and pharmacist inspector for the commission for Social Care Inspection to follow up the requirements and recommendations made at the last visit on the 18th August 2005. The inspection was unannounced starting at 9.45 and took place over six and a quarter hours during a weekday. The report includes the findings of the pharmacy inspector who conducted an audit trail of medicines in the home. The inspector spoke individually and collectively to service users and staff. The proprietors were on annual leave the week of the inspection. The inspector spent time with a member of staff appointed to be in charge in their absence. Staff and service users records, policies and procedures were examined as part of the inspection and a tour of the premises was made. What the service does well: What has improved since the last inspection? The home has made improvements in the management of medicines. They have implemented significant changes to the way in which medicines are now stored, transported around the home and administered. Staff have also been given information for the safe administration of medicines. All radiators within the home, with the exception of one small radiator opposite the new medication treatment/store room which is situated out of the way of residents communal space, were covered. A company specialising in employment law have supplied Cedar Lodge with new recruitment policies and procedures. The home is reissuing all staff with new up to date job descriptions, an employee handbook containing information of all work related policies and procedures and new contracts of employment. Cedar Lodge Residential Home DS0000045594.V262661.R01.S.doc Version 5.0 Page 6 The home has produced policies and procedures to give guidance to staff for the management of medicines, the treatment of pressure areas and sores and falls, however where changes to resident’s condition is highlighted following a fall information must be updated to minimise the risk of the resident falling in the same circumstances again. 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.V262661.R01.S.doc Version 5.0 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.V262661.R01.S.doc Version 5.0 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, 3, Prospective service users will be given information about the home to be able to make an informed choice of where to live and can expect to have a detailed assessment of their needs identifying the level of support they require when they move into the home. EVIDENCE: The statement of purpose and service user guide seen meets the requirements set out in the national minimum standards. Two residents have moved into the home within the last six months. Both care plans seen showed evidence that a pre assessment had been completed prior to the residents moving into the home. Both gave detailed information of the resident’s background, assessment of their present condition, what level of support they required and the need to move into residential care. Cedar Lodge Residential Home DS0000045594.V262661.R01.S.doc Version 5.0 Page 9 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, 9, Residents can expect to have their needs identified in their individual plan of care, however these need to be further developed through consultation with the resident to reflect the level of support the individual requires. The home has made improvements to monitor the needs of residents and implemented policies and procedures for the management of medicines, treatment of pressure sores and falls, however the falls risk assessments need to reflect changes to prevent similar accidents reoccurring. EVIDENCE: The care plans of two residents were inspected. At the front of each plan was an identification sheet with photographic identification and the details of the resident’s next of kin and general practitioner (GP). The care plans were made up of different sections, which included issues around the resident’s social and health and personal care needs. Each of the care plans had a daily care plan setting out the routine of each resident however there was no detail of how staff should assist this resident or what level of support the resident needed. For example one resident’s plan stated the time they got up and what time they had their breakfast, however there was no assessment for the support the resident needed with personal hygiene, dressing and eating. Cedar Lodge Residential Home DS0000045594.V262661.R01.S.doc Version 5.0 Page 10 Evidence was seen that moving and handling and falls risk assessments had been completed for both residents. These were being reviewed on a regular basis and reflected the individual goals and objectives for the resident. For example, one resident who moved into the home from hospital following a fall had a detailed action plan in place detailing the support for the resident to be able to walk independently. The plan included staff support to enable them to use a walking frame to improve mobility. The plan had been reviewed and updated to show that the resident was now able to be independently mobile. Another resident had fallen from the toilet when trying to stand. They were admitted to hospital with a fractured hip. The inspector was able to track all documentation kept by the home of the incident. The incident had been recorded in the accident book and the moving and handling and falls risk assessments had been updated on their return. The falls assessment had been reviewed from medium to a high risk of falls and reflected the need for the resident to be encouraged to walk to help their hip from becoming immobile, however the falls assessment did not take into account precautions to prevent the resident from falling in the same circumstances again. During the inspection a member of staff was observed supporting the resident to walk using the Zimmer frame. The inspector observed the member of staff encouraging and supporting the resident, whilst demonstrating care and patience. Residents care plans are being regularly reviewed and updated and evidence showed that one resident’s plan had been reviewed and signed by the resident. A comment had been made that “Cedar lodge is still able to maintain all of the residents needs” however a discussion followed with the person in charge that comments would be better made in the first person as their comment to show they have been fully involved in the review of their plan of care. To ensure the health and welfare of residents is protected the home has developed a pressure sore policy and procedure setting out objectives for the management of pressure areas. They have included key functions of the skin, what a pressure sore is, how they are caused and common sites that are susceptible to pressure sores, including a body map. The procedure also describes the risk assessment process and prevention and management of pressure sores. One of the residents tracked on the day of the inspection had a pressure area on their heel, a risk assessment had been completed and evidence was seen that the district nurse was visiting the resident on a regular basis to monitor and dress the sore. This was also confirmed by the resident. The inspector found that the home had implemented significant changes to the way in which medicines are now stored, transported around the home, administered and information had been made available for the safe administration of medicines. On conducting sample audit trails of medicines from current records all medicines were noted to be accounted for and there Cedar Lodge Residential Home DS0000045594.V262661.R01.S.doc Version 5.0 Page 11 were intact-recorded audit trails in all cases. Controlled drugs are now properly stored and recorded in a controlled drug register. The inspector was informed of the ongoing training programme for staff on medication management, however the home has still been unable to arrange further training for staff administering insulin by injection. During this inspection, the inspector did not observe medicine administration. They also observed that the room in which a service user was storing medicines for self-administration was not accessible to enable the monitoring of compliance with a previous requirement made in respect of the secure storage of medicines. A requirement from the previous inspection in August 2005 was for the home to inform the Commission for Social Care Inspection (CSCI) in the event of the death of a service user and to include this in their policy for staff guidance on death and dying. The home has sent notice to the CSCI as requested, however the policy was not seen during the inspection and will be reviewed next time. Cedar Lodge Residential Home DS0000045594.V262661.R01.S.doc Version 5.0 Page 12 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, 15, Residents cannot expect to have activities available that meet their expectations, preferences and recreational interests, however they can expect to have a good meal in surroundings of their choice. EVIDENCE: The inspector spoke with several residents throughout the inspection and a general consensus from residents and relatives was that there was a lack in appropriate activities. Residents felt that there was not enough staff on duty to undertake activities. This was not a criticism of the staff, residents spoke of staff being very good. One resident said, “I don’t do much in the way of activities, so little going on, I have accepted that there is not much to do”. One resident spoke of being isolated at the home and had to rely on taxis to go out anywhere, which was very expensive. Another resident told the inspector “I don’t know about activities I am happy staying in my room”. One relative spoken with suggested there were activities available for they’re relative to attend such as bingo and arts and crafts, however their relative does not have good vision and therefore feels they are unable to participate and does not attend. Residents did however feel that the home has an impossible task to suit every bodies needs. Cedar Lodge Residential Home DS0000045594.V262661.R01.S.doc Version 5.0 Page 13 An activities board is situated in the entrance hallway and had a poster advertising musical entertainment a band called ‘yesteryears’ that have been booked on a monthly basis. The arts and crafts session was advertised for every Wednesday afternoon and a notice about a hairdresser that visits the home, there were no other activities being displayed. Residents told the inspector that school children from a local school visit the home to spend time talking with the residents, however one resident felt this was a little embarrassing at times as the children ask the same questions, and felt it would be more appropriate if they entertained them in some way such as carol singing. Residents were asked if they had a committee where they could discuss their ideas of activities they would like to have in the home. They informed the inspector that they do not have residents meetings but felt this would be a good idea. The inspector discussed the issue of activities with the member of staff in charge who felt that residents were offered activities, but frequently refused. It was discussed that perhaps this was because the activities offered were not suitable to meet the resident’s recreational preferences and capacities and it was suggested that a formation of a committee to enable residents to have the opportunity to discuss what activities they would like to meet their interests. The care plans seen had a record of activities that residents had attended and it was suggested that staff also record when a resident is offered an activity but refuses. The inspector had the opportunity to speak with a couple of relatives who were visiting the home during the day, both very positive about the service their relatives receive. They generally commented that their relatives have nice rooms and that the staff are very caring and look after their relatives well. One relative told the inspector that their relative sometimes complains that staff don’t help them but felt this was more to do with staff encouraging their relative to maintain some independence. Both relatives felt that they are kept informed about their relative’s welfare and are notified by the home if there are any problems. Residents and relatives felt that the home offer good food. Comments ranged from “food is very good, as well as “good breakfast, I am looking forward to lunch” and “I enjoy eating in the dining room, there is good company and food is very good”. One resident who had had recent operation to remove their fingers due to necrosis of their hands and feet (a condition they had prior to moving into the home) told the inspector they had been supported to maintain a degree of independence when having their meal. The home had provided them with especially adapted cutlery and a mug. Cedar Lodge Residential Home DS0000045594.V262661.R01.S.doc Version 5.0 Page 14 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): 18, Residents can not expect to be protected from abuse until the homes policy and procedures direct staff to the appropriate agencies in the event of an allegation of abuse. EVIDENCE: The home has updated the policy and procedure for the protection of vulnerable adults and the policy on the abuse procedure, however there a couple of adjustments that still needs to be made for the documents to comply with the department of health guidelines “No secrets”. The policy and procedure for the protection of vulnerable adults under the section relative’s rights makes reference to the National Care Standards Commission (NCSC) and should read the Commission for Social Care Inspection (CSCI) The policy/abuse procedure states all allegations of abuse will be refered to social care services and should direct staff to the vulnerable adult protection committee (VAPC) Suffolk inter agency policy and also states that the CSCI is notified as well. Cedar Lodge Residential Home DS0000045594.V262661.R01.S.doc Version 5.0 Page 15 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, 22, 25, 26, Residents can expect to have access to indoor and outdoor communal facilities however a programme of maintenance and decoration of the premises and grounds needs to implemented to ensure that the home is well maintained. To provide a safe environment for the residents the recommendations made by the occupational therapist need to be implemented. EVIDENCE: A recommendation from the previous inspection, in August 2005, was for the home to have a programme of maintenance for decoration of the premises. Some improvements have been made, the inspector observed that the downstairs bathroom was in the process of being decorated, however the cracks in the plaster work on the stairwell and landing to the rear of the building still need to be investigated and repaired. During a tour of the building it was noticed that in toilet number 4 the paint was peeling off on the boxing around the pipe work and the walls, also in the shower room number 1 there was a large damp patch around the ceiling skylight. This was as a result of a leak that had been repaired prior to the last inspection and is still in need of decorating. Cedar Lodge Residential Home DS0000045594.V262661.R01.S.doc Version 5.0 Page 16 The carpet on the stairs leading to the first floor near the front entrance has not been repaired or replaced where it has frayed; this presents a tripping hazard to residents and staff, in particular those with a visual impairment. A new bath and bath chair have been installed in bathroom number 5, however work undertaken to fit the new bath has left the boxing around the pipe work cracked and there are several missing and cracked tiles. The grounds to the side of the home and in front of the adjoining bungalow are looking unkempt and need to be kept tidy, safe, attractive and accessible to residents. The door to the machinery of the lift had a keep locked sign, however the door was open and had the key in door. An assessment of the home has been completed by an independent occupational therapist (OT). The OT has produced a report of their assessment and a copy was forwarded to the inspector. The assessment is based on a two hour visit at the request of the manager for advice on fixtures and fittings in order to improve the safety of the residents. The OT has made several recommendations to make safe fire exits with the use of grab rails, removal of door mats and to make good the level of the ground at the base of the fire exit. They have made several recommendations for the removal of towel and toilet roll holders in the toilets and bathrooms and to have grab rails fitted. The OT has also recommended a risk assessment be undertaken for the stair gate at the top of the rear stairs. A requirement from the last inspection was for all residents to have access to a call bell at all times. The OT report reflects that there is no call bell in toilet number 1 and no alarm system in the communal lounge and the sunroom upstairs. The home had informed the OT that they had had an assessment on the alarm system which was deemed to be adequate, however the standards are clear that call systems have an accessible alarm facility provided in every room. The home has had radiator covers fitted to all exposed radiators with the exception of a small radiator opposite the medication cupboard. In bathroom number 5 a commode chair with a persons name on appeared to be in general use, however the inspector was told the resident no longer lived at the home. A discussion took place about the sharing of commodes which presents a risk of spreading infection and requires good environmental hygiene. A raised toilet seat also looked dirty and stained. In shower room number 1 the shower chair had rusty back and arms and needed replacing. Cedar Lodge Residential Home DS0000045594.V262661.R01.S.doc Version 5.0 Page 17 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, Residents can expect to be cared for by a team of staff who receive ongoing training and have the appropriate skills to do their job, however the staff rota does not present an accurate staffing picture. EVIDENCE: A requirement from the inspection in August 2005 was for the rota to be amended to accurately reflect the hours to be worked by staff, actually worked and dated correctly. The rota had been amended but still did not reflect the day and date. The rotas are over a four-week rolling period and require reference to a calendar to match up the day and the week. Each of the rotas had been laminated so that they are unable to be used as a working document to reflect changes, for example the proprietors were on annual leave but were still showing hours to be worked and the cook had gone home sick. The rota was therefore not reflecting staff sickness. The member of staff in charge informed the inspector that the former owner of Cedar Lodge no longer works on a regular basis in the home, however the rota shows them working 3 shifts per week on alternate weeks. The staffing ratio was discussed with the person in charge. The rota was showing 3 staff on duty between 8-5, 1 staff between 8-2, the cook would have worked 9-6 but had gone home sick and been covered by a member of staff working 9.30-2pm and then returning on care between the hours of 4-10 with another member of staff working 5-10pm. Two night staff work between the hours of 10pm -9am. Cedar Lodge Residential Home DS0000045594.V262661.R01.S.doc Version 5.0 Page 18 The home normally operates with 6 staff on the morning shift and 2 on the late shift and it was discussed whether or not this was an appropriate use of resources and that residents may benefit from a more even staffing ratio which could look to offering more activities. Three staff files were inspected; all information and documents in respect of persons working in the home were seen and all had a criminal records bureau check (CRB) including a volunteer who visits the home and the relatives of the responsible individual. All staff has now received training in the protection of vulnerable adults. The home have started using a long distance learning company Mulberry House to undertake a lot of in house training. These are correspondence courses and a selection of completed courses was seen showing that they had been completed by staff and are marked externally. Topics include administration of medication, protection of vulnerable adults and food hygiene. Training records show that staff have also received training in infection control, moving and handling, foot health care through Suffolk primary trust and control of substances hazardous to health (COSHH) through a company called Chemix. Cedar Lodge Residential Home DS0000045594.V262661.R01.S.doc Version 5.0 Page 19 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, 36, 37, Implementation of a deputy manager to support the existing manager will further enhance the running of the home. Residents can expect to be cared for by a staff team that receive supervision and support and have the appropriate information about their roles to work within the home’s policies and procedures. EVIDENCE: The registered provider and manager were on vacation on the day of the inspection and had left an experienced member of staff in charge of the home. They informed the inspector that there are plans for them to become the deputy manager and a new job description was in the process of being written. They are in the process of undertaking National Vocational Qualification (NVQ) 4 at Cambridge Regional College. It is a two-year course consisting of studies around specific issues and reports in the form of storyboards. They have completed seven reports to date. Cedar Lodge Residential Home DS0000045594.V262661.R01.S.doc Version 5.0 Page 20 A recommendation made at the previous inspection in August 2005 was that formal supervisions take place at least six times a year, files seen showed that supervision is taking place, however although improved the feedback from the manager still needs be more specific. For example, on one staff file supervision covered a range of issues including general performance, volume and speed and quality of work, the staffs initiative and reliability. There was a comment from the member of staff “progress being made” and the comment from the manager was “I agree”. There were no details of performance and goals to monitor and improve performance. The supervision notes of the member of staff in charge were seen and in view of their position and future position of the deputy manager there were no clear objectives set specific to the role and management and care of older people. The home has purchased new policies for the recruitment and employment of staff through a company called Peninsula, who specialise in employment law. All staff are to be reissued with new job descriptions and contracts of service supported by an employee handbook. The handbook has been designed specifically for Cedar Lodge and will contain details of policies and procedures, for example health and safety, equal opportunities, grievance, disciplinary, holidays and sickness. Cedar Lodge Residential Home DS0000045594.V262661.R01.S.doc Version 5.0 Page 21 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 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 X X 2 X X 3 X 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 3 X X X X 2 3 2 Cedar Lodge Residential Home DS0000045594.V262661.R01.S.doc Version 5.0 Page 22 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 OP7 Regulation 15 Requirement 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 short and long term goals. Risk assessments must be continually monitored to reflect changes in service users mobility and risk of falls. Appropriate intervention must be taken and recorded to prevent further accidents occurring. The home must consult with service users about their interests and programme of activities so that service users are provided with recreational activities within the home and socially within the community. The home’s abuse policy for the protection of vulnerable adults under the section relative’s rights makes reference to NCSC and must have CSCI as a point DS0000045594.V262661.R01.S.doc Timescale for action 28/02/06 2 OP8 8 Sch 3 (3)(o) 31/01/06 3 OP12 16 (2)(m)(n) 28/02/06 4 OP18 13 (6) 31/01/06 Cedar Lodge Residential Home Version 5.0 Page 23 5 OP19 23 (2) (o) 6 OP22 13 (4) 7 OP27 17 (2) Sch 4 (7) of contact. The policy/abuse procedure states all allegations of abuse will be refereed to social care services and must direct staff to the vulnerable adult protection committee (VAPC) Suffolk inter agency policy and must also state that the CSCI is notified. The registered person must make sure that all parts of the home are reasonably decorated and the external grounds are suitable, safe and appropriately maintained. Where the home has had an OT assessment all the recommendations must be implemented to ensure the health, safety and welfare of the residents. 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. 31/03/06 31/03/06 31/01/06 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 OP 9 Good Practice Recommendations Keys to the storage of medicines should held by the senior carer on duty and not located within the locked treatment room. Separate arrangements for duplicate keys are also advised. Steps should be taken to ensure that all written medication administration record(MAR) chart medicine entries include full written dose directions against which medicines can be safely administered. Steps should be taken to ensure medicines brought into the home by service users receiving respite remain in DS0000045594.V262661.R01.S.doc Version 5.0 Page 24 2 OP 9 3 OP 9 Cedar Lodge Residential Home containers prepared by the pharmacy at all times. 4 5 6 OP 9 OP 9 OP 9 Care plans for diabetic service users should include the names of carers authorised to undertake related tasks such as the administration of insulin by injection. All carers receiving copies of the revised medication policy document should read, understand and acknowledge its contents. The risk assessment for a service user self-administering medicines should include records of regular checks that medicines are being stored appropriately within the service users room. Staff should receive formal supervision at least 6 times a year, which covers all aspects of practice and philosophy of care in the home. Staff’s performance and development should be monitored in relation to personal and career development and objectives set relating to their specific roles and for the care of older people. 7 OP 36. 2, 3 Cedar Lodge Residential Home DS0000045594.V262661.R01.S.doc Version 5.0 Page 25 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.V262661.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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