Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 06/10/06 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 6th October 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.

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

Residents continue to benefit from the homely and friendly atmosphere created by the staff. Residents spoken with were happy with the care they receive. One resident commented, "I am happy here, I can access communion and the hairdresser regularly, the staff are very good and friendly". Five health professional and seven relatives/visitors comment cards were received prior to the inspection. One relative commented "The manager and staff always treat us and the residents with the utmost respect, as a regular visitor to the home, I would not hesitate to recommend it to anyone". Another relative commented" In recent hot weather staff encouraged residents to sit outside under the gazebo with lemonade and ice-lollies, which they really enjoyed - excellent" Residents spoken with confirmed that the home continues to offer a good standard of freshly prepared food.

What has improved since the last inspection?

The statement of purpose has been reviewed and amended to reflect the current charges made by the home. Residents have been issued with a new contract, which reflects their current fee. There has been a significant improvement made to the care plans which, now have sufficient details of the level of support and achievable goals to help resident`s to maintain their self respect, dignity and independence. Care plans show that residents are being encouraged to have input into their care plan, which are reviewed monthly. Two residents meetings have taken place to discuss activities and evidence was seen that the home was implementing some of the suggestions. The complaints policy and protection of vulnerable adults policy have been amended to reflect the correct names and addresses of Social Services and the Customer First Team. The duty roster is now being used as a working document and reflects any changes due to holidays and sickness and clearly reflects who is on duty. Certificates were provided to the Commission for Social Care Inspection (CSCI), which reflects recent training that they had completed. The deputy manager and a senior member of staff have completed their National Vocational Qualifications (NVQ). A new format for staff supervision has been implemented with, evidence that these sessions are now structured and provide an opportunity to discuss work performance, any concerns and future development and training needs. The responsible individual provided a draft of their business plan for the future management of the home. However this needs to be further developed to demonstrate that the home is financially viable. There has been good progress made to ensure that all parts of the home are reasonably decorated, safe and maintained. A new carpet has been fitted on the stairs at the front of the building and the crack in the wall on the stairwell to the rear has been plastered and painted. The dining area and hallway have been redecorated. Redecoration of the lounge was in progress during the inspection.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Cedar Lodge Residential Home Hengrave Road Culford Bury St. Edmunds Suffolk IP28 6DX Lead Inspector Deborah Kerr and Jane Offord Unannounced Inspection 6th October 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.V315444.R01.S.doc Version 5.2 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.V315444.R01.S.doc Version 5.2 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.V315444.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include one named person under the age of 65 with a mental disability 24th April 2006 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 and states the current range of fees charged by the home, which ranges from £331.00 to £375.00 per week. These figures are reviewed annually on the 1st April. Cedar Lodge Residential Home DS0000045594.V315444.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over six hours. This was the second key inspection, undertaken this year by two inspectors, which focused on the core standards relating to older people and the progress of fifteen requirements and three recommendations raised during the previous key inspection on 24th April 2006. The report has been written using accumulated evidence gathered prior to and during the inspection. Additionally a number of records held at the home were looked at including those relating to residents, staff, training, duty roster and policies and procedures. Time was spent talking with the responsible individual and the registered manager, deputy manager, two staff, two residents individually and a number of residents collectively. What the service does well: What has improved since the last inspection? The statement of purpose has been reviewed and amended to reflect the current charges made by the home. Residents have been issued with a new contract, which reflects their current fee. There has been a significant improvement made to the care plans which, now have sufficient details of the level of support and achievable goals to help resident’s to maintain their self respect, dignity and independence. Care plans show that residents are being encouraged to have input into their care plan, which are reviewed monthly. Two residents meetings have taken place to discuss activities and evidence was seen that the home was implementing some of the suggestions. The complaints policy and protection of vulnerable adults policy have been amended to reflect the correct names and addresses of Social Services and the Customer First Team. The duty roster is now being used as a working document and reflects any changes due to holidays and sickness and clearly reflects who is on duty. Cedar Lodge Residential Home DS0000045594.V315444.R01.S.doc Version 5.2 Page 6 Certificates were provided to the Commission for Social Care Inspection (CSCI), which reflects recent training that they had completed. The deputy manager and a senior member of staff have completed their National Vocational Qualifications (NVQ). A new format for staff supervision has been implemented with, evidence that these sessions are now structured and provide an opportunity to discuss work performance, any concerns and future development and training needs. The responsible individual provided a draft of their business plan for the future management of the home. However this needs to be further developed to demonstrate that the home is financially viable. There has been good progress made to ensure that all parts of the home are reasonably decorated, safe and maintained. A new carpet has been fitted on the stairs at the front of the building and the crack in the wall on the stairwell to the rear has been plastered and painted. The dining area and hallway have been redecorated. Redecoration of the lounge was in progress during the inspection. What they could do better: Although there has been good progress made to the internal décor of the home, attention needs to made to the cleanliness of the environment and the condition of fixtures and fittings, for example grab rails were seen to be rusty. Cedar lodge has recently had a visit by the Environmental Health Officer (EHO) their report indicates that standards were found to be generally good, but also refers to areas of poor hygiene and incorrect storage of food. Some of the carpets on the first and ground floor are lifting or are frayed which creates a tripping hazard to older people with poor mobility. Old carpet, paint pots and furniture had been discarded outside and were blocking the fire exit from the dining room. An immediate requirement was left for these items to be moved to provide a safe means of exit in the event of a fire. Staffing deployment and ratios still need to be addressed to ensure there are sufficient staff on duty at all times to meet the needs of the residents and must include sufficient domestic staff to keep the home clean and hygienic. A resident had broken both wrists as a result of falling down the stairs. A risk assessment must be undertaken to minimise the risk of further accidents occurring. The home did not notify the Commission for Social Care Inspection (CSCI) of the incident as required by Regulation 37. The quality assurance and quality monitoring systems need to be based on views of residents, family, friends and other professionals associated with Cedar Lodge such as the general practitioner (GP) to ascertain how the home is meeting the aims and objectives set out in the statement of purpose. The home does obtain the views of the residents, but currently the questionnaire has a yes no response. This could be developed for example with a grading system instead of providing a questionnaire that has ‘yes’ or Cedar Lodge Residential Home DS0000045594.V315444.R01.S.doc Version 5.2 Page 7 ‘no’ responses to provide a more accurate picture of how residents view the home. 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.V315444.R01.S.doc Version 5.2 Page 8 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.V315444.R01.S.doc Version 5.2 Page 9 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, Quality in this outcome area is good. Prospective service users can expect to have information about the home and have a contract that reflects the current amount and method of payment of fees. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose quotes a scale of charges from April 2005 between £300 and £375 per week. At the previous inspection in April the manager informed the inspector that all service users were charged a blanket fee of £331 per week. A requirement was made to amend the statement of purpose to reflect these charges. However information in the pre inspection questionnaire reiterated the range of fees as before. The fees charged by the home were clarified at this inspection with the deputy manager. Newly refurbished rooms will be charged at the higher rate. This needs to be made clear to residents when moving into the home. Three residents files were inspected, all had been issued with up to date contracts, these had been signed and dated and reflected their individual fee. Cedar Lodge Residential Home DS0000045594.V315444.R01.S.doc Version 5.2 Page 10 Three residents care plans were tracked and evidence was seen that a pre admission needs assessment had been completed covering all aspects of the resident’s health, personal and social care needs. The care plan of one newly admitted resident reflected that the manager had visited them twice before they moved into the home to ascertain that the home could meet their needs and what personal items they intended to bring into the home. Cedar Lodge Residential Home DS0000045594.V315444.R01.S.doc Version 5.2 Page 11 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, Quality in this outcome area is good. Residents can except to have sufficient information about their health and personal care needs recorded in their care plan and be protected by the home’s procedures for dealing with medicines. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans of three 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 details of the resident’s social, health and personal care needs. A requirement was made at the last inspection in April 2006 for care plans to be expanded to identify the level of support required by each resident. Evidence was seen at this inspection that there has been a significant improvement in the development of the care plans, which now provide detailed interventions for carers to help with the resident’s personal care and identified the short and long-term goals to encourage residents to maintain their independence. For example, one resident’s shortterm goal was to be supported to undertake as many activities independently, the long term goals was for the resident was to stay mobile. Cedar Lodge Residential Home DS0000045594.V315444.R01.S.doc Version 5.2 Page 12 However, entries in the daily records need to be expanded to give an accurate picture of the residents wellbeing throughout the day, for example, reference was made to one resident having a ‘good evening’ this does not give any indication of how the resident spent the evening. Evidence was seen that the health care needs of residents are being monitored. Risk assessments are being completed and reviewed on a regular basis, these include moving and handling, falls and self-medicating. An assessment had been completed for a resident with diabetes, which was supported by information on how to manage their condition. A record of all visits by healthcare professionals is held in the residents care plan. A code system reflects which health official has visited, the time and the date. Details of these visits are recorded separately on a progress form to monitor the provision of healthcare being provided to the individual resident. It was noted while checking the care plan of one resident that they had been admitted to hospital following a fall down the stairs, and had fractured both wrists. The resident was seen returning from a physiotherapist session. They had been told their wrists were mending and they been given some exercises to do and had to go back to the physiotherapist in two weeks time. The manager had not notified the Commission for Social Care Inspection (CSCI) of this incident, which is a requirement under the Care Homes Regulations. There was evidence 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. These were being signed and dated by the resident who were also being encouraged to write a statement about their review on each occasion. The progress was followed up on the requirements and recommendations made by the pharmacy inspector following the last inspection. The fridge was seen; all medicines being stored in the fridge were labelled and dated. This included eye drops which had been dated on opening to ensure they were being used before the expiry date. The temperature of the fridge was being monitored and recorded and was seen to be with in the recommended safe limits. Medication Administration Record (MAR) Charts were being properly completed and the correct codes were being used, for example to reflect if a resident refused the medication. A recommendation was made for regular monthly assessments for residents that self medicated to be undertaken. Evidence was seen that one resident had decided at their last review not to self medicate any more as they recognised that they occasionally missed out a dose. Cedar Lodge Residential Home DS0000045594.V315444.R01.S.doc Version 5.2 Page 13 The controlled drugs register was seen and records of temazepam were checked and found to be accurate. Evidence was seen where the GP had made changes to a resident’s medication the MAR chart had been amended and cross referenced to the progress notes in the residents care plan to give a full explanation of the change in medication and why. Cedar Lodge Residential Home DS0000045594.V315444.R01.S.doc Version 5.2 Page 14 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, Quality in this outcome area is good. Residents living in the home can expect to be consulted about activities to ensure they are given the opportunity to participate in social, recreational and religious interests of their choice. Residents can expect to have a good range of home cooked food. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A requirement was made at the inspections in November 2005 and April 2006 for the home to consult with residents about their interests and develop a programme of activities. This was to ensure that residents are provided with recreational activities to 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. The minutes of two residents meetings were shown to the inspectors. These took place in May and July and reflected discussions that had taken place with residents about the activities they wanted within in the home and in the community. Cedar Lodge Residential Home DS0000045594.V315444.R01.S.doc Version 5.2 Page 15 Residents made their suggestions, which included quiz games, games that could be played between residents, for example, skittles, cards and crosswords. They also requested to have outside entertainers coming into the home such as guest speakers and singers. Activities of interest outside of the home were discussed and residents identified that they would like to have escorted walks around the village, more trips out to seaside and places like Abbey Gardens. All residents agreed to an additional £5-10 fee to cover the cost of trips. One resident made a suggestion to have a section of the lounge made into a games area where they could store quiz games and puzzles. Suggestions were also made for the removal of the bar in the lounge to create the activities area. Evidence was seen during the inspection that this had happened and the room was being decorated. Pat dogs have been introduced into the home and evidence was seen that the ‘Yesteryears’ entertainers have been booked for a series of sessions throughout the year. An activity plan is in place, which involves quizzes on a Monday, Communion and a visit from the mobile library on a Tuesday. Wednesday is Arts and Crafts with Bingo on a Friday. The hairdresser visits on a Thursday. Manicures are available on request. The home’s policy on activities state that they “endeavour to create a programme of activities and entertainment that will best suit each individual” Evidence found at this inspection through observation and discussions with residents reflects that the home have made a concerted effort to improve the level of activities, however these need to remain flexible and varied to suit the needs of all residents. Residents all agreed to a two monthly residents meeting in the future. A further residents meeting has been arranged for the 25th October. One of the inspectors spent time talking with the cook, discussing the menus and food offered to the residents. They were preparing the midday meal, which consisted of fish and chips with beans and tomatoes or omelette followed by lemon meringue pie and ice cream. The cook explained that although they were using frozen fish, the majority of food was made from fresh ingredients and fresh vegetables. Residents were observed eating their meal and were very complimentary about the food. Cedar Lodge Residential Home DS0000045594.V315444.R01.S.doc Version 5.2 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): 16,18, Quality in this outcome area is good. People living in the home can expect to be protected by the home’s policies and procedures for dealing with complaints and reporting allegations of concern or abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints policy was seen displayed on the notice board in the entrance hallway. The policy has been updated to refer people to the Commission for Social Care Inspection (CSCI) The address for Social Services has been amended to show the correct address. The complaints log showed there have not been any complaints made to the home since the last inspection. However an anonymous complaint was made about the home to the Commission for Social Care Inspection (CSCI) in June 2006. An unannounced visit was made to the home on the 13th June 2006 to follow up these concerns. A random Inspection report was sent to the home identifying requirements that were of particular concern in a number of areas, which affected the safety of residents and consistency of the service. The home has obtained a copy of the Suffolk policy for reporting concerns and allegations of abuse, however a requirement was made at the last inspection for the homes policy to be amended to direct staff to the Customer First team, Social Care Services in line with the Suffolk Vulnerable Adults Protection Committee (VAPC) inter agency policy. The policy was submitted to the inspector following the last inspection, showing that this amendment had been made. Cedar Lodge Residential Home DS0000045594.V315444.R01.S.doc Version 5.2 Page 17 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): 19,20,21,25,26, Quality in this outcome area is poor. Some improvements have been made to the environment, however residents currently do not live in a home that is well maintained or kept clean and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An action plan with timescales for planed maintenance and decoration to the home was sent to the inspector following the last inspection, a tour of the home was made to check on progress. Evidence was seen that there has been some improvement made to the internal décor of the home and the surrounding grounds. The damp patch around ceiling skylight in shower room 1 has been repaired and painted. Bathroom number 1 on the ground floor has been decorated, however there were no taps fitted on the bath, the manager showed the inspector new taps that had been purchased but not yet fitted. The bath had limescale markings in the bottom of the bath these need to be removed and cleaned. Bathroom 2 had a tile smashed on the boxing covering the pipes and toilet number 1 washbasin is cracked, there are also old pipes which need to be capped or removed. Cedar Lodge Residential Home DS0000045594.V315444.R01.S.doc Version 5.2 Page 18 Toilets around the home were found to be unhygenic, the floors were sticky and particular attention needs to paid to cleaning around the edges of the floor, skirting boards and the box work covering pipes behind the toilets. The fixtures and fittings in toilet number 5 were rusting and pitted, and need replacing. In toilet number 6 plaster has cracked around the window and there are holes in the wall where screws have been removed. The home has two showers and two baths, only one of the baths is an assisted bath. However the three care plans seen stated that all three of the residents prefered to have a bath. This was discussed with the manager and the deputy who need to consider how the home meets the preferred needs of the residents and the National Minimum Standard (NMS) ratio of 1 assisted bath to 8 residents. The inspector had raised previous concerns about the stairwell at the rear of the building where large cracks had develped in the wall around the window and down the stairwell, these have been repaired and redecorated. The gate at the top of the stairs has been reapired and is now functioning properly. The dining room has been redecorated as has the hallway leading to the lounge. The lounge was in the process of being decorated, all the dark wood panelling has been painted with a lighter wood grain effect. The bar has been removed from the far end of the lounge to create an activities area and a new carpet has been ordered. The carpet on the stairs leading to first floor near the entrance has been replaced, however the carpet on the first floor outside toilet and shower number 1 is lifting away from the floor causing a potential tripping hazard. At the entrance of the extension to medication room and residents bedroom’s the carpet covering a manhole cover is frayed. A mat had been placed over this, again this is a potential tripping hazard An assessment of the home was carried out by an independent Occupational Therapist (OT), they produced a report in March 2005 making several recommendations to improve the safety of the residents. The home has complied with most of these, however there are still outstanding issues in relation to fire safety. The fire exit near the lift is not level and at the foot of the fire escape on the ground the surface is still rough and uneven. The inspectors raised concerns at the last inspection regarding the safe evacuation for residents and staff. Some improvement has been made; the fire exit signs have now been put up in the sunroom and on the back stairwell. The fire sign in the main lounge directing people back into the house has been removed, however the fire door to the outside was locked and bolted. The fire exit from the dining room is not level, this has a raised threshold creating a difficult means of escape for residents in wheelchairs or using walking aids. Additionally, where decorating has taken place old carpet, paint and furniture have been piled up outside the fire exit door preventing a safe exit in the event of a fire. These issues still need to be urgently addressed. Cedar Lodge Residential Home DS0000045594.V315444.R01.S.doc Version 5.2 Page 19 At the previous inspection a butane gas refill was found in the drawer in the sun lounge and a cupboard was full of redundant equipment, which have been removed. All radiator covers are now in place and the radiator in the back corridor has been removed. A convector heater was in use in one of the residents bedrooms. The heater had been checked in accordance with the portable electrical applianace (PAT) testing requirements, however, there was no risk assessment in place to assess the likely risk of the resident falling over the heater and burning or scolding themselves. A supply of liquid soap and paper towels and protective clothing such as aprons and gloves were available around the home. The laundry room is kept locked when no one is in it. The laundry has an industrial style washing machine with a sluice cycle for dealing with soiled linen and a tumble dryer. The liquid soap dispenser was seen dripping down the wall beside the boiler onto pipes and on the floor, making it difficult to clean up. Advice was given for this to be re-sited over the draining board. At the last inspection a safer system for taking soiled linen from the ground floor to the upstairs laundry was discussed and it was recommended that the home implement the use of red dissolvable alginate bags, which are placed directly into the washing machine. This was not inspected on this occasion and will be looked at the next inspection to see if these improvements have been made. Cedar Lodge Residential Home DS0000045594.V315444.R01.S.doc Version 5.2 Page 20 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, Quality in this outcome area is adequate. The staffing ratio or deployment of staff needs to be calculated to ensure that residents are supported by adequate numbers of staff at all times and to ensure the home is kept clean and hygienic. This judgement has been made using available evidence including a visit to this service. 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 inspector was shown the rota; this has been amended and is being used as a working document, reflecting staff hours, sickness, annual leave and who is covering the shift. The requirement made at the last inspection for staffing levels to be reviewed has not happened, there are still concerns about staffing levels and the disproportionate numbers of staff working in the morning, afternoon and weekends. During the weekdays, morning shifts consist of between 4-5 carers, supported by the deputy manager. Afternoon shifts consist of 2 carers supported by deputy until 5pm. The cook works between 9-6.30pm. At the weekends there are 2 carers morning and afternoon, supported by a cook between 9.30- 2.30pm. There are 2 night staff at all times. Cedar Lodge Residential Home DS0000045594.V315444.R01.S.doc Version 5.2 Page 21 This was discussed in more detail with the responsible individual, manager and deputy about how staffing levels are calculated in relation to dependency and need of residents. Care staff are also responsible for cleaning the home, evidence suggests from the unhygienic appearance of the toilets that not enough time is being allocated to cleaning. This was discussed with the manager and deputy and that the domestic arrangements should be taken into consideration when reviewing staffing levels. 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. Two of the staff have been employed at the home for a long time, the home had taken up the CRB checks in 2004. The third member of staff was a new employee; evidence was seen that a CRB and Protection of Vulnerable Adults (POVA) check had been undertaken prior to commencing employment, however it was noted that all three application forms did not have evidence of an employment history. Each member of staff has received an employee’s handbook, which contains details of sick pay, disciplinary, grievance and capability procedures and also set out revised terms and conditions of employment. These were seen signed and dated by each member of staff. The files showed that staff are receiving regular training covering a range of topics. Discussions with staff confirmed that they had undertaken training in first aid, basic food hygiene, fire safety, control of substances hazardous to health (COSHH), infection control, health and safety, protection of vulnerable adults (POVA), drug administration and moving and handling. There are a total of 15 care staff employed at the home, 9 have completed a National Vocational Qualification (NVQ) making a total of 60 of staff with an NVQ at level 2 or above, these figures include the deputy manager and a senior who have recently completed their National Vocational Qualification (NVQ) level 4. Cedar Lodge Residential Home DS0000045594.V315444.R01.S.doc Version 5.2 Page 22 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): 31,32,33,34,36,37,38, Quality in this outcome area is adequate. People living in the home cannot expect to have their health, safety and welfare protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has completed National Vocational Qualification (NVQ) level 4 and has 19 years experience working in the home. At the last inspection the manager informed the inspector that they continue to update their knowledge by attending all mandatory training but had been unable to find their certificates. These were later sent to the Commission for Social Care Inspection (CSCI), which confirmed they had attended training. Two staff spoken with both commented on how much they enjoyed working at the home and that they found the manager and deputy to be approachable and felt well supported in their role. Cedar Lodge Residential Home DS0000045594.V315444.R01.S.doc Version 5.2 Page 23 They talked of having opportunities to access training if they wanted to and felt that the residents were well cared for. They confirmed that staff meetings were being held on a regular basis where issues about the running of the home were being discussed, however these were not being recorded. There was evidence in the staff files of staff having regular supervision and bi annual staff appraisals. The supervision process has significantly improved. The format and terminology being used is appropriate and provides an opportunity for the manager and staff to raise concerns and issues about their work and further development. These were being recorded and where required identified further action. To further enhance the supervision process it was discussed with the manager and the deputy that an action plan be developed at the end of each supervision, which would form an agenda for the next session. It was noted that the manager and the deputy were both involved in the supervision session and that the member of staff may find this intimidating. The deputy explained that staff had been consulted and were happy to have both managers present although this needs to be agreed as part of the supervision agreement. 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 seen scored a 100 on all aspects of the service with the exception of activities. The quality assurance and quality monitoring systems need to based on views of residents, family, friends and other professionals associated with the Cedar Lodge such as the general practitioner (GP) to ascertain how the home is meeting the aims and objectives set out in the statement of purpose. It was discussed with the manager and the deputy that this information be used to form an annual development plan. The home does obtain the views of the residents, but currently the questionnaire has a yes no response. This could be developed for example with a grading system instead of providing a questionnaire that has ‘yes’ or ‘no’ responses to provide a more accurate picture of how residents view the home. 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 provided the inspector with a draft of a business plan they were writing for the future development of Cedar lodge, however this needs to be expanded to demonstrate that the home is financially viable to sustain staffing levels to meet the needs of the residents and to make environmental improvements required and the continued maintenance of the home. Cedar Lodge Residential Home DS0000045594.V315444.R01.S.doc Version 5.2 Page 24 The inspector looked at the documentation for the management of food hygiene. The home has a copy of the Better food, Safer Business pack provided by the Food Standards Agency, this was partially completed and was being held in the office. It was discussed with the deputy that this should be a working document and being completed by the kitchen staff. Evidence was seen that a new fridge had been purchased and that a spot check had been carried out on the storing of food and the cleaning schedule. The pack made reference to a recent visit form an Environmental Health Officer. The inspector requested to see the report, which confirmed that standards were found to be generally good, however there were several issues raised about improper storage of food, cleanliness and décor of the kitchen, including the replacement of kitchen cupboard doors and replacement floor covering in the utility area. Several of the home policies and procedures were seen; these included missing persons, activities and pressure care. Evidence was seen that policies and procedures were being reviewed and updated. The individual and home records are kept secure, these are well organised and up to date, however the manager had failed to notify the Commission for Social Care Inspection (CSCI) of an incident where one of the residents had fallen down the stairs fracturing both wrists. This is a requirement under the Care Homes Regulations that the home notifies the CSCI of any serious injury or any event in the care home which adversely affects the well being or safety of the resident. Further development of risk assessments needs to be undertaken to protect the safety and welfare of the residents. For example where a resident has fallen down the stairs and where residents have chosen to have a freestanding convector heater in their room. Cedar Lodge Residential Home DS0000045594.V315444.R01.S.doc Version 5.2 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 3 2 X X X 2 1 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 2 X 3 2 2 Cedar Lodge Residential Home DS0000045594.V315444.R01.S.doc Version 5.2 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 OP19 Regulation 23 (2)(b)(o) 12 (1)(a) Requirement A reviewed 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 24/04/06, 18/08/05 and 30/11/05 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 includes taking adequate precautions for safe escape in the event of a fire. This is a repeat requirement form inspection 24/04/06 and 30/11/05 A risk assessment must be undertaken to determine the use of convector heaters. Appropriate action must be taken to protect the safety of residents. DS0000045594.V315444.R01.S.doc Timescale for action 17/11/06 2. OP19 23(4)(iii) 17/11/06 3. OP25 13 (4) (a)(b)(c ) 17/11/06 Cedar Lodge Residential Home Version 5.2 Page 27 4. OP26 13 (3) 5. OP27 18 (1)(a) 6. 7. OP29 OP33 Sch 4 (6) (f) 24 8. OP34 25 9. OP37 37 10. OP38 13 (4)(c ) The registered person must make sure the premises are kept clean to prevent the spread of infection. The registered manager must ensure that at all times suitably qualified, competent and experienced persons are working in the care home in sufficient numbers appropriate to the needs health and welfare of the residents. Repeat requirement from random inspection 13/06/06 Any gaps in employment records must be explored prior to the appointment of staff. The home’s quality assurance (QA) system must be taken at least annually taking into account all persons connected with the home. A copy of the report made available to service users, staff and a copy sent to the CSCI, to reflect how information is used to improve the service. The responsible individual must prepare a business plan demonstrating the home’s financial viability and forward to the CSCI. Repeat requirement from 24/04/06 The registered person must notify the commission of any event in the care home that adversely affects the well being or safety of the residents. Risks that adversely affect the health and safety of residents are identified and managed within the risk management framework. 17/11/06 17/11/06 17/11/06 01/01/07 17/11/06 03/11/06 03/11/06 Cedar Lodge Residential Home DS0000045594.V315444.R01.S.doc Version 5.2 Page 28 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 OP21 Good Practice Recommendations The manager should consider how the home meets the preferred needs of the residents and the National Minimum Standard (NMS) ratio of 1 assisted bath to 8 residents. Cedar Lodge Residential Home DS0000045594.V315444.R01.S.doc Version 5.2 Page 29 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.V315444.R01.S.doc Version 5.2 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!