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Please note that the information on this website is now out of date.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 08/06/05 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 8th June 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

Service users say that they staff treat them well and relatives have found the manager to be helpful and supportive. Privacy and dignity are respected. One GP described Cedar Lodge as a `homely sort of place` whilst a relative stated that `Cedar Lodge staff have been the most caring one could hope for`.

What has improved since the last inspection?

There have been some improvements to the environment with redecoration of a number of rooms. The home has developed a maintenance plan, so that they have a better idea of what needs doing. Service users have been offered and provided keys to their bedroom doors and lockable storage. Progress has been made in minimising risks to service users, for example around guarding radiators to ensure that no one gets burnt. A fire risk assessment had also been made.

What the care home could do better:

The home needs to make sure they have enough information when a new service user thinks of living at Cedar Lodge to decide whether it is the right home and they need to work with other professionals to ensure that carers are able to meet the needs of all service users, particularly those with particular health needs. Medication procedures need to be improved and the home needs to make sure that soiled laundry is managed effectively. The home could be more consistently managed to make sure that service users are protected through good recruitment practice and regular training.

CARE HOMES FOR OLDER PEOPLE Cedar Lodge Residential Home Hengrave Road Culford Bury St Edmunds Suffolk, IP28 6DX Lead Inspector Karen Howman Announced 8 June 2005 th 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 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 I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cedar Lodge Residential Home Address Hengrave Road, Culford, Bury St Edmunds, Suffolk, IP28 6DX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01284 728744 None None Mrs Sandra Spendley Mrs Sandra Spendley Care Home 25 Category(ies) of Older People (OP ) - 25 registration, with number of places Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The Home is regsitered to include one named person under the age of 65 with a mental disability. Date of last inspection 20 September 2004 Brief Description of the Service: Cedar Lodge is a residential care home that has provided care and accomodation 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 very rural setting within its own grounds and adjoining woodlands on the outskirts of Culford , which is aproximately 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 having 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 large lounge and a separate dining room and service users also have the use of a small sun lounge on the first floor. The homes office is very small and the owners are plannning to relocate the office in due course. Mr and Mrs Spendley became the Registered Providers of Cedar Lodge on the 1 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 7 July 2003. Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, undertaken by two inspectors, one of whom stayed for a full day. A specialist pharmacist inspector focused on standards 7 and 9, and a separate pharmacy inspection report has been sent to the home alongside this report detailing the findings of this inspection. This report is available on request. Service users, staff and management were spoken with and records, policies and procedures were examined as part of the inspection. Prior to inspection a comment card was sent to each service user with sixteen being returned. Comment cards were received from four relatives/visitors, three social care professionals and eight GP’s. The main focus of the day was to assess whether or not the home had addressed the large number of requirements and recommendations identified at the previous inspection. Service users were given access to the Inspectors on the day and relatives/visitors confirmed that they were advised about forthcoming inspections. The home states that they undertake quarterly audits of service user’s views however the issue of quality assurance was not covered during the day although a requirement was made at the previous inspection. A recommendation about the recording of service users wishes around their last wishes was also not fully discussed. Both issues will be looked again at the next inspection. What the service does well: What has improved since the last inspection? There have been some improvements to the environment with redecoration of a number of rooms. The home has developed a maintenance plan, so that they have a better idea of what needs doing. Service users have been offered and provided keys to their bedroom doors and lockable storage. Progress has been made in minimising risks to service users, for example around guarding Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 6 radiators to ensure that no one gets burnt. A fire risk assessment had also been made. 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 I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 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 standard(s) 1, 3 The home does not provide sufficient information to enable prospective service users to make an informed choice about living at Cedar Lodge whilst the home does not ensure that the fullest assessment of a prospective service user’s needs is obtained prior to providing care. EVIDENCE: The Home’s Statement of Purpose still requires further amendment to ensure that service users and their representatives have access to a comprehensive range of information as required by Regulation. The Statement of Purpose does not currently include details of fire procedures and needs to clarify room sizes. The Statement does not specify whether or not the home offers nursing care or the process of reviewing service user plans. The Home does however provide a Service User Guide, which includes key information about the service including a copy of the home’s terms and conditions. The Certificate of Registration is on display in the entrance hall. Files of three service users admitted since the start of 2005 were viewed. In each file there was evidence that an in-house assessment had been made however none of these assessments were dated so it was not possible to verify whether these had been completed pre-admission. In one instance a service Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 9 user had been placed by Social Care Services having lived previously in another care home. Their file showed that the home had obtained a copy of the moving and handling assessment from the previous home however there was no evidence that the home had obtained a copy of the service user’s community care assessment to ensure that they had a comprehensive picture of the service user’s needs and abilities. The Manager provided a copy of the home’s revised pre-admission form, which is based on the dependency level form already used by the home. The pre-admission form include personal care needs, as well as information on the history of falls and social interests and hobbies and includes space for signature, date and location of assessment. On each of the care records seen, staff had recorded details about the service user’s background including family details, key events and occupation. Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 9, 10 Service users’ privacy and dignity are respected. Service users with diagnosed chronic diseases are not protected by the provision of clear written and planned guidance on the management of illnesses within their individual care plans. The use of bedrails is not supported by documented risk assessments and service user involvement in care planning is not evidenced. Service users are not protected by the home’s policy and procedures for the safe management of medicines. EVIDENCE: Each service user had a ‘daily plan’ which briefly identified care required and the service user’s routines at different points of the day and night. Information about the nature of the support required is rather general, for example, in one instance a plan stated that they are ‘capable of dressing but needs some help’. Each care plan was supported by a dependency level chart, which had been completed on a monthly basis. One carer confirmed that they and other carers were responsible for completing the daily records; the Manager was Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 11 responsible for developing the care plan. There was no evidence of service user involvement in the process of reviewing the care plan with the staff. Staff identified one service user who required a higher level of support. This service user was prone to falls and their care records provided evidence of a moving and handling assessment with the decision to use a wheelchair for transfers. This service user had fallen out of bed and the accident was found to be recorded in both the care records and accident book. The home had gained consent from family to use bedrails although there was no evidence of a risk assessment to support this decision. On examining the contents of individual care plans for two service users with diagnosis of bipolar affective disorder and diabetes mellitus respectively, the inspector identified that the health needs of the respective service users are not addressed by the provision of clear written guidance on the management of aspects of the illnesses. The homes medicine policy document is inadequate, as it does not provide procedural guidance on many aspects of the management of medicines relevant to the home. The inspector found evidence to suggest that unsafe record-keeping procedures are sometimes followed when medicines are administered. Records for the receipt and disposal of medicines are incomplete and therefore medicines cannot be fully accounted for. The inspector, however, found no evidence of secondary medicine administration procedures at the home. In addition, the home has developed some areas of good recordkeeping practice. The home currently does not conduct and record risk assessments for service users self-administering medicines. In addition, provision for the secure storage of such medicines stored in rooms is currently not made. The inspector became particularly concerned that members of care staff are currently administering insulin by injection to a service user without having received specialist training in this field. The home is planning to create a secure area in which medicines will be properly stored and managed. This will be a welcome development when compared to current arrangements. Service user comment cards confirmed the fact that service users felt that their privacy and dignity is respected. Service users spoken with confirmed that staff knocked on their bedroom doors before entering and staff were observed to be discreet when asking a service user if they needed assistance to get to the toilet. Service user assessments identified preferred names. The home provides one shared room and it was positive to note that the privacy curtain in place previously had been replaced with one that could be pulled all the way round the bed to provide a much greater level of privacy. The home Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 12 was also able to evidence in the service users care records that the occupants of this room had been asked whether they minded sharing. The home has a large lounge and separate dining room on the ground floor and a smaller sun room on the first floor. Comment cards from relatives/visitors stated that they were always able to see their relative (or friend) in private. This view was supported by comments in professional comment cards although one professional stated that there has been ‘on occasion an expectation that the review can take place in the common room – but privacy is respected..’ Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 Overall, service users are able to spend their time as they choose and their hobbies and interests are encouraged although service user preferences had not been taken fully taken into account when deciding the timing of breakfast. Visitors are welcomed at Cedar Lodge. EVIDENCE: It was evident from observation and discussion that some service users were more able to independently maintain activities outside of Cedar Lodge. One service user organised a taxi and went out during the course of the inspection whilst another confirmed that they still enjoyed attending various clubs and activities in the local community and were supported by external volunteers. There was a notice board in the hall, which displayed any planned activities including bingo, hairdressing and a boat trip. With the exception of one service user comment card, all service users who responded stated that the home provided suitable activities. Service users were observed to have their own routines, sitting where they wanted and with whom they wanted. Staff maintained records of activities undertaken on each service user’s file. The pre-inspection questionnaire identified that breakfast time was from 7am8am with the cook coming on duty at 9am. Service users confirmed that breakfast was brought to them in their rooms before night staff went off duty. Two service users spoken with felt that this was rather early however they accepted this on the basis that they felt that staff were busy. Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 14 Comment cards received from relatives and visitors stated that they are welcome at the home at any time and one service user spoken with confirmed that their family were able to visit when they wanted. Visitors are asked to sign the visitor’s book for safety purposes. Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 15 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 standard(s) 16,18 The home has a clear complaints policy and service users know who to raise concerns with. Staff understand what is meant by abuse and know that any concerns must be raised to ensure the protection of service users however the homes’ policy does not fully protect their interests as it does not clearly identify the requirement for working together with Social Care Services nor does the Manager fully understand what action to take if an allegation is made. EVIDENCE: Three of the four comment cards from relatives and visitor’s cards confirmed that they were aware of the complaints procedures. Comment cards from and discussion with service users evidenced that they knew who to raise concerns with. Service users confirmed that they would speak with the Manager. The complaints procedure was displayed in the entrance hall and a copy contained in the Service User Guide and Statement of Purpose. Since the last inspection the home has developed a policy and procedure on abuse. The policy briefly identifies a range of types of abuse and includes the procedure to be followed when abuse is suspected. The procedure states that the person reporting alleged abuse should alert the emergency agencies, Social Care and help groups amongst others. The procedure does not clearly identify show that all allegations of abuse must be notified to Social Care Services who take the lead role with respect to allegations of abuse, in line with local adult protection procedures. The policy/procedure guides staff to contact CSCI if they have concerns about possible abuse by the manager or other provider. One member of staff spoken with was unaware that the home had a policy whilst another was aware of the policy and knew that it was held on the policy Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 16 file in the office. Both these carers and a third carer spoken with were able to describe what was meant by abuse. Three staff files were examined and two of these showed that they had attended a two hour Vulnerable Adults at Risk of Abuse training session in October 2004. The third carer had been unable to attend that day and training was still required. One of the owners advised that there were two staff that required training, one of which was the cook. Discussion on the day identified that there were in fact three staff including the cook who required training. The Manager had attended the awareness session however discussion demonstrated that she was still unclear as to what actions she would take as a Manager if someone disclosed an allegation of abuse. Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 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 standard(s) 19,21 The home provides a comfortable and homely environment with appropriate aids and adaptations in place. Environmental risk assessments are not comprehensively undertaken and recorded and infection control practices are not ensured. EVIDENCE: The garden to the front of the property was tidy and accessible to all service users. Some of the service users were observed to sit out and enjoy the garden taking advantage of the nice weather on the day. The owners had introduced a schedule of maintenance work required identifying the planned date for action together with completion dates as the work is undertaken. A maintenance log was also maintained. One relative’s comment card had referred to the fact that there had been some problems with the lift. The owners advised that the lift had been affected by lightening damage and provided evidence of a test certificate following the damage. The home provides a bathroom on each floor, one of which was an assisted bath. At the previous inspection the assisted bath had been out of action however it was found to be working on the day of inspection. There are also Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 18 two shower rooms however one of the owners advised one of these was not used. Eight of the twenty-three single bedrooms have en suite toilet and shower facilities, and the shared room has en-suite toilet facilities. All other bedrooms have a washbasin. There are a number of toilet facilities around the home, with the commode disinfection machine being located separately from bathroom facilities. One of the service user assessments identified that due to a risk of falls; the service user should be transferred with the use of a wheelchair. Staff were observed to ensure that wheelchair footplates were used when taking one of the service user’s from the lounge to the toilet before lunch. Service users are able to access all parts of the building by stairs or passenger lift and there is a small metal ramp to the home’s front door. Staff confirmed that they had access to a hoist if needed and records evidenced that this hoist had been serviced in April 2005 although there was no evidence that the assisted bath had been serviced. Previous inspections had identified that when the call bell had been activated in the assisted bathroom, the call bell panel did not correspond to identify that it is was this room where assistance was needed. This and one other call bell were activated and were found to correspond with the panel. It was noted however that call bell points in bedrooms did not have pull cords attached making them inaccessible unless the service user was positioned right next to the call point. Grab rails and raised toilet seats were also available. The Manager advised that they had arranged for an Occupational Therapist to undertake an inspection of the Home and that whilst this had been undertaken in April 2005, a report of the Occupational Therapist’s findings had not yet been made available to the Manager and a copy of a letter requesting this report be forwarded was shown to the Inspector. Cedar Lodge provides twenty-three single bedrooms and one shared room. Several of the bedrooms had been redecorated and some had had new furniture, ensuring a greater degree of privacy than was previously offered. One service user who used to share this bedroom was very pleased with having been provided a single bedroom, which was more suited to their needs and provided en-suite facilities. Bedroom doors were lockable and one service user spoken with confirmed that they had been given a key. Service users had been offered bedroom keys and care records evidenced service users had been asked whether they wished to have a door key and a key to lockable storage within their bedroom. One of the owners stated that lockable storage was now available in all but three bedrooms. The owners have started to have radiators covered and intended to have this completed by 30 June 2005. Covers had been fitted to some of the communal areas of the home however the owners had also identified that in one room, the bed was situated right next to the radiator and posed a greater risk. The Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 19 home’s risk assessment had not however taken account of unguarded radiators in the bathrooms and toilets. Whilst it was summer and most radiators were turned off, one of the bathroom radiators was found to be warm. Staff recorded water temperatures in the main bathroom almost on a daily basis and these were found to be satisfactory to minimise the risk of scalding. The temperature of the bath water was checked by the Inspector and the owner advised that it was low, at 37.1 degrees Celsius due to the fact that a number of service users had recently had baths. Staff have the use of two washing machines, one on each floor. One is located next to the staff toilet whilst the second is located in the same room as the commode-cleaning machine. In discussion staff identified that, if handling soiled linen, they would soak or rinse off the soiled items before putting them in the washing machine however PHMEG (Department of Health) recommends that items are not hand sluiced as this gives rise to the potential for cross infection. Staff stated that they washed soiled laundry at the highest temperature although it was noted that neither machine identified what temperature this was and neither machine had sluice facilities. Carers were clear about the home’s procedures for the emptying and cleansing of commodes. Carers were observed to wear white plastic aprons and disposable gloves when assisting a service user with personal care. The same type of plastic aprons were used when serving lunch to service users although care staff advised that they always put on fresh aprons. Whilst carers had access to appropriate handwashing facilities in some areas of the home, it was noted that they did not have access to liquid soap or disposable towels in the main bathroom where they provided personal care. Nail brushes and soap bars were also found in bathrooms and therefore available for general use rather than returned to service user’s rooms. Overall the home was clean and tidy at this time, and carers cleaned one of the toilets and the door to the COSHH (Care of Substances Hazardous to Health) cupboard when requested to do so by the Inspector. Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 Staffing levels were found to be adequate at this time. Recruitment procedures are not sufficiently robust to ensure the safety of service users and key training, such as moving and handling and abuse training is not routinely planned for all staff. Staff have not received training to meet specific health care needs. The home has recognised the need to have suitably qualified staff through NVQ, although there is a long way to go in achieving the good practice requirement of having 50 of staff trained to NVQ level 2 or equivalent. EVIDENCE: Four comment cards received from relatives/ visitors stated that in their opinion there were always enough staff on duty and nine of the ten comment cards from professionals also stated that there was always a senior member of staff to confer with. Staffing levels were found to be satisfactory at the time of inspection with call bells responded to promptly and positive feedback given by service users. Both owners (one of whom is the Manager) were present and a cook was on duty throughout the day in addition to the carers. One relative wrote that ‘ the staff are efficient, friendly and show love and respect to their resident, whilst another stated that ‘the staff are very kind and caring’. Service users also spoke positively about the care they received although one service user identified that carers did not have enough knowledge or understanding of their specific health needs when they were unwell. Care staff also have responsibility for what all those spoken with described as ‘light cleaning’ duties. Night carers are given the dual role of carer/domestic. Whilst the rota included the hours staff were due to work it did not specify in Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 21 which capacity the staff were working. From discussion it was evident that day care staff undertook cleaning in the mornings once service users were out of bed however the rota did not identify whether any care staff were left solely to meet the needs of service users during this period. The Manager also provided a job description for a domestic /carer/activities person and again the rota did not reflect how their hours were managed to the benefit of the service user. The pre-inspection questionnaire identified that there were 4 staff with NVQ level 2 or above, and that this represented 21 of their care staff. The manager advised that there were eight carers due to undertake their induction to NVQ level 2 in June 2005, with the senior carer and the domestic/carer/activities person due to start their NVQ level 4. Recruitment records of a recently appointed carer were inspected. The file was found to contain an application form, evidence of ID and a photograph, an interview assessment form and health declaration. There were two written references on file however both were received after the member of staff started work. A satisfactory CRB disclosure had been obtained however again this had not been received until after they had started work at the home. There was no evidence of a POVA first check having been made as is required if starting a staff member before a full CRB disclosure has been received. Files of three other staff were examined. All three were found to hold CRB disclosures together with correspondence from the Criminal Records Bureau with respect of one disclosure. The training file of a recently appointed carer included a copy of the home’s own induction programme, signed off as complete a month after commencing work. The file also evidenced that the member of staff had read and signed a number of policies and procedures including the dress code, grievance and disciplinary and harassment procedures, Hepatitis B, personal hygiene and infection control. TOPPS induction was not discussed with the Manager at this time. When the home was last inspected it was noted that care staff had not received training in abuse awareness nor had care staff received refresher training in moving and handling. Two carers had received a two-hour moving and handling update session following the inspection whilst one carer’s training records evidenced that they had not received training since September 2003. The manager advised that another session was planned for the 30 September 2005 and one of the owners advised that there were five carers requiring refresher training. A carer appointed in April 2005 had not however received any training in moving and handling since starting work. The manager had arranged a training session on the protection of vulnerable adults. Three staff including the recently appointed carer and cook needed training in this area. Carers spoken with stated that they had received other training including infection control (by correspondence course), fire and first aid. The manager Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 22 had identified which staff required refresher training. The senior carer advised the Inspector that they were undertaking their medication training. Cedar Lodge is registered to provide care to one service user with mental health needs. Feedback from professionals and from viewing training files identified that care staff had not received any training in caring for someone with these needs. Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 38 Whilst a qualified and experienced manager manages the home, there is insufficient recognition of the need to work jointly with other organisations such as health and social care to ensure the welfare and safety of service users. Health and safety requirements have been partially addressed. EVIDENCE: The Manager, Mrs Spendley has worked at Cedar Lodge for a number of years and has been the Registered Manager since July 2003. She has undertaken NVQ level 4 in management. Mr Spendley, co-owner of Cedar Lodge, takes responsibility for issues such as health and safety and maintenance. Since the last inspection the manager has completed a correspondence course dealing with medication. The Manager has overall responsibility for the administration of medication in the home and staff were found to be providing assistance with injections without supporting training and guidance to staff from health care professionals in place. She has also joined staff in a session on the protection of vulnerable adults however discussion evidenced that the Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 24 manager was uncertain about how to deal with an allegation of abuse and not fully aware of local adult protection procedures. Mrs Spendley was unsure of the location of several documents during the inspection and relied heavily on the person in the domestic/ carer/activities role. The job description for this post referred to reading and writing reports however it did not specify that they had administrative responsibilities or that as a consequence they had access to confidential information such as recruitment files or CRB disclosures. The home does employ a senior carer who confirmed that they were being given more responsibility with the role being further developed. Evidence of an appropriate job description was provided. One of the owners completed a fire risk assessment of Cedar Lodge in March 2005, required by CSCI at the previous inspection and again required by the Fire Service following their inspection in November 2004. Fire records showed that the home’s fire fighting equipment had been inspected in September 2004. Fire alarms were being tested on a weekly basis with extinguishers visually checked each month. The record showed regular fire drills however the names of the staff attending these drills were not recorded. Hot water temperatures to the bath on the first floor were checked and recorded each day however there was no evidence that the assisted bath had been serviced. Radiator covers were installed to minimise the risk of scalding to service users however the risk assessments undertaken by one of the owners had not included the risks posed from radiators in the bathrooms and toilets. It was noted that since the last inspection the owners have installed window restrictors to toilets and bathrooms on the first floor. A number of bedrooms on the first floor already had window restrictors installed however whilst the owners advised that they believed that there was no risk posed by windows which are on the first floor and which have a large windowsill, this was not identified within a formal risk assessment. Care staff confirmed that none of the service users required assistance with transfer by hoist however the hoist had been serviced in April 2005 in readiness. Training records showed that a recently recruited carer had not received moving and handling training and another carer had not had training since September 2003. Accident records were maintained and some staff had already received first aid training. Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x COMPLAINTS AND PROTECTION 2 x 3 3 x 3 2 1 STAFFING Standard No Score 27 3 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 2 x x x x x x 2 Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 26 Yes Are there any outstanding requirements from the last inspection? 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 1 Regulation 4 Requirement The Registered Persons must ensure that the Statement of Purpose complies with Schedule 1 of the Care Homes Regulations. (Timescale of 6.10.04 not met) The Registered Persons must ensure that a full pre-admission assessment is undertaken and that records of assessment by other professionals is held on file. (Timescale of 30.10.04 not met) The use of bedsides must be supported by a written risk assessment identifying the reason for their use together with any risks involved. The registered person must take steps to ensure the health and welfare of service users is protected by providing clear written and planned guidance on the management of identified chronic diseases in their individual care plans (requirement outstanding and unresolved since the previous inspection of 10th September 2004) The registered person must Timescale for action 8 July 2005 2. 3 14(1) 30 June 2005 3. 7 14(2) 15(2) 8 July 2005 4. 7.1 13.4 15 30 June 2005 5. 9.1 13.2 31 July Page 27 Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 6. 9.1 13.2 7. 9.2 13.2 8. 9.3 13.2 provide clear and comprehensive written procedural guidance on the handling and administration of medicines in order to safeguard the health and welfare of service users at the home. The registered person must undertake and record risk assessments for service users self-administering medicines which must be reviewed on a pre-determined basis in order to assist in ensuring the safety of self-administration. The registered person must make arrangements for the secure storage of medicines selfadministered and held in service users rooms by providing robust lockable storage and ensuring such medicines are stored securely at all times. The registered person must take steps to ensure records for the administration of medicines are completed immediately following their administration at all times. The registered person must take steps to ensure full and accurate records for the receipt and disposal of all medicines are maintained at all times. The registered person must take urgent steps to ensure specialist training is provided for members of staff administering insulin by sub-cutaneous injection. Training must be provided and competence re-assessed on a regular and pre-determined basis The homes abuse policy and procedures must be reviewed in the light of local adult protection procedures to ensure that all allegations of abuse are appropriately referred to Social 2005 30 June 2005 30 June 2005 With iimmediate and ongoing effect With immediate and ongoing effect 30 June 2005 9. 9.3 13.2 10. 9.7 18.1(c) 11. 18 12(1)(a) 13(6) 8 July 2005 Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 28 Care Services. 12. 18 Three staff have been identified as not having received training in the protection of vulnerable adults. These staff must receive appropriate training. 23(2)(n) Call bells must be fully accesible to service users. 13(4)(a)(c The assessment of risks to ) service users posed by unguarded radiators must be comprehensive including those in bathrooms and toilets, with remedial action taken as required. 13(4)(a)(c The home must evidence that ) risk assessments have been undertaken with respect of risks posed to service users from windows above ground floor level, with appropriate remedial action taken as required. 13(3) Nail brushes must be for personal use only and returned to the service users room to ensure good infection control practice. 13(3) Care staff must have access to appropriate handwashing facilities i.e. disposabel towels and liwuid soap in all areas where they provide personal care to ensure the risk of cross infection is minimised. 13(3) The practice of soaking and rinsing or hand sluicing soiled laundry must be stopped to ensure good infection control. 13(3) The home must ensure itself and confirm to CSCI that washing machine facilties are adequate to meet disinfection standards and control the risk of infection. 17, 18, 19 The Registered persons must Schedule operate thorough recruitment 2 processes to ensure the protection of service users.(this I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc 13(6) 8 September 2005 Immediate 30 June 2005 13. 14. 22 25 15. 25 30 June 2005 16. 26 Immediate 17. 26 Immediate 18. 26 Immediate 19. 26 Immediate 20. 29 Immediate Cedar Lodge Residential Home Version 1.30 Page 29 21. 29 17,19 Schedule 2 22. 23. 30 30 38 30 38 12(1)(b) 18(1)(c ) 18(1)(c ) 24. 13(4) 25. 31 9(1)(i) 12(1)(a) 26. 38 13(4) 23(2)(C ) was made an immediate requirement at the last inspection in September 2004) The Registered Persons must ensure that criminal records diclosures are obtained in line with current CRB guidance.(This was an immediate requirement at the last inspection in September 2004) All staff must undertake suitable mental health awareness training. The home must ensure that all new staff receive moving and handling training as part of their induction The Registered Person must ensure that care staff receive refesher training in moving and handling at regular intervals.(Timescale of 30.10.04 not met) The manager must ensure that they have a sound understanding of local adult protection procedures and what action to be taken if they receive an allegation of abuse. The home must be able to evidence that the assisted bath facilities are serviced and maintained. Immediate 30 october 2005 Immediate 30 September 2005 Immediate 30 July 2005 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 1 Good Practice Recommendations The Statement of Purpose should identify aids and adptations provided within the home to assist prospective service users and their representatives when choosing a home. The home should demonstrate that service users are I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 30 2. 3,14 Cedar Lodge Residential Home 3. 9.1 4. 9.3 5. 9.3 6. 7. 8. 9. 10. 11. 9.4 .9.5 9.7 9.7 9.8 9.10 12. 12 13. 14. 27 26 involved in the development and review of service user plans. Signatures of service users (or their representatives) be sought to demonstrate their involvement. It is recommended that records of medicines supplied to service users self-administering medicines are completed and used to both monitor compliance with treatments and ensure that medicines can be fully accounted for. It is recommended that issues relating to the safety of printed MAR (medication adminstration record) charts are discussed with the supplying pharmacy to achieve a safe and satisfactory resolution. It is recommended that MAR chart medicine entries for oral medicines not included in the MDS(monitored dosage system) containers are highlighted clearly indicating stating that the medicines are stored separately in the medicine trolley or storage facility. It is recommended that the home gives consideration to providing relevant information alongside MAR charts in order to enhance the safety of medicine administration. It is recommended that a cabinet compliant with the Misuse of Drugs (Safe Custody) Regulations 1973 is obtained for the storage of Controlled Drugs. It is recommended that the competence of all staff administering medication is assessed on a regular basis and records of such assessments maintained. It is recommended that the home considers the provision of medication related training for additional members of care staff. It is recommended that the home makes provision for the register recording of controlled drugs. It is recommended that records of all healthcare professional visits and interventions are recorded separately within individual service user files in order to monitor the provision of healthcare for individual service users. Service users should be consulted to ensure that their wishes and preferences about the timing of breakfast can be taken into account, in as far as as is reasonably possible. The staff rota should differentiate the care hours worked by staff and time spent on cleaning tasks. That prtoective clothing for cleaning and care tasks should be different to avoid confusion or error. Cedar Lodge Residential Home I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 31 Commission for Social Care Inspection 5th Floor, St Vincent House 1 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 I54-I04 S45594 Cedar Lodge V219561 050608 Stage 4.doc Version 1.30 Page 32 - 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!