Inspection on 02/07/08 for Cedardale Residential Home

This inspection was carried out on 2nd July 2008.

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

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

Other inspections for this house

Cedardale Residential Home 06/12/06

Cedardale Residential Home 15/11/05

Cedardale Residential Home 19/07/05

Cedardale Residential Home 30/11/04

Cedardale Residential Home 18/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/11/2008.

CARE HOMES FOR OLDER PEOPLE Cedardale Residential Home Queens Road Maidstone Kent ME16 0HX Lead Inspector Wendy Mills Unannounced Inspection 6 am 2nd July 2008 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 Cedardale Residential Home DS0000059264.V367377.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. Cedardale Residential Home DS0000059264.V367377.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedardale Residential Home Address Queens Road Maidstone Kent ME16 0HX 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) 01622 755338 michaellisis@blueyonder.co.uk MGL Healthcare Ltd Mr Michael Joseph Gaetan Lisis Care Home 21 Category(ies) of Dementia - over 65 years of age (21) registration, with number of places Cedardale Residential Home DS0000059264.V367377.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users between 55 and 65 years of age experiencing difficulties with memory loss or a diagnosis of dementia may be admitted. It has been agreed that rooms 2, 6, 10 and 11 can be shared by married couples, siblings or individuals whose needs can be evidenced as best met in a shared facility. 6th December 2006 Date of last inspection Brief Description of the Service: Cedardale Residential Care Home was first registered to care for older people in 1989. MGL Healthcare Ltd. took over ownership in April 2004 and since June 2005 has been registered to accommodate up to twenty-one people aged fiftyfive and above who have a diagnosis of dementia. MGL Healthcare Ltd has two other care homes in Kent. At present the home is being extended to provide additional bedrooms and another lounge. Cedardale is located in a quiet residential area of Maidstone, close to shops, pubs, churches, public transport and other usual town amenities. The home is a two-storey building with a newer single storey extension. There are thirteen single and four shared bedrooms. Eight of the single rooms and all of the shared rooms have en suite toilet and washbasin. The first floor is accessed by a stair lift. At present the building works mean there is no access to the garden at the rear. A small patio area to the side of the property is still accessible. There is some off road parking to the front of the home. This is limited at present due to the extensive building works taking place. The home employs care staff, working a roster, which gives twenty-four hour cover. The home also employs other staff for catering, domestic and maintenance duties. The home’s current fees range from £421 to £468.00 per week. Additional charges are made for hairdressing, chiropody, and newspapers. Further information, including a copy of the last inspection report can be obtained from the registered manager of the home. Cedardale Residential Home DS0000059264.V367377.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Wendy Mills and Gary Bartlett, Regulatory Inspectors for the Commission for Social Care Inspection (CSCI) undertook this Key Inspection Site Visit, which was made in accordance with the Regulations of the Care Standards Act 2000. The visit was unannounced. This means that we did not tell anybody that we were coming. It took eight hours and began at 6am on 2nd July 2008. The start time was early because we had received information that night staff were getting the residents up unacceptably early each morning. This report takes into account the findings of this key unannounced visit and other information that we have received about the home. This includes information that the home has given us, such as their annual quality assessment (AQAA) and notifications about the welfare of the residents; and information we have received from other sources such as the views of relatives and supporters of the residents, complaints and information we have received from visiting health and social care professionals. Consideration of all the evidence will result in the home receiving a star rating. Throughout this report, the people who use this service will be referred to as “the residents”, as this is their preferred term. The visit confirmed the allegation that residents rights, privacy and dignity were not being respected by night staff and that there we no safeguarding protocols in place to ensure that this did not happen. The extensive building works had increased the fire risks in the home. Fire precautions at the time of this visit were inadequate, as they did not account for the additional risks presented by the building work, the reduction of fire exits and the inaccessibility of the fire assembly point. Residents’ movements have been restricted throughout the summer due to the building work. There is no access to the garden of the home although some efforts have been made to arrange outings for residents to visit the other homes in the MGL group. Relatives expressed satisfaction with the care and daytime care was given in a kindly manner. However, some procedures in the home did not take into account the need to respect the privacy of the individual. For example, the ironing was being carried out in a resident’s room. Two immediate requirements in respect of safeguarding and fire were placed as a result of this visit. Other requirements with a longer timescales were also placed. The quality rating for this home is no stars Cedardale Residential Home DS0000059264.V367377.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? A new head of Care has been appointed. She has worked hard to improve communication and documentation in the home. Staff meetings and staff supervision are now better established and more regular. The head of care has produced a monthly newsletter for the past six months. The newsletters are informative and interesting. Relatives said how much they value them. An activities co-ordinator has been appointed for the home. Activities for residents are now more creative, fun and appropriate. The MGL group have appointed a Head of Training got its three homes. This appointment has meant that training is much better monitored and that more training is now provided for staff. New carpets have been laid in communual areas and a new hoist has been provided. Cedardale Residential Home DS0000059264.V367377.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Cedardale Residential Home DS0000059264.V367377.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 Cedardale Residential Home DS0000059264.V367377.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 The home provides the service users, their relatives and supporters with information to help them make a decision about their choice of home. The outcomes in this area for people who use this service are adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a Statement of Purpose and Service User Guide. The Service User Guide is placed in a special holder in each bedroom. This complaints procedure contained in this guide requires updating. The information given in the document is not available in any other form, such as large print, or on audiotape. However, the new head of care for the home has introduced a monthly newsletter. This is both interesting and informative. Relatives said that the home keeps them well informed and praised the newsletter. Cedardale Residential Home DS0000059264.V367377.R01.S.doc Version 5.2 Page 10 There are written pre-admissions policies and procedures and there is evidence that pre-admission assessments are made and that the home liaises well with care managers when making decisions about offering someone a place in the home. However, the recording of these assessments and the needs and wishes of the residents could be improved by adding more detail. In particular, there should be clear written evidence about what decision making process is used when residents are no longer able to make informed choices for themselves. The home does not provide intermediate care. Cedardale Residential Home DS0000059264.V367377.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The outcomes in this area for people who use this service are adequate. This judgement has been made using available evidence including a visit to this service. The home adequately meets most aspects of the heath care needs of the residents but there are some areas that require immediate attention to ensure the residents are protected from harm, that their privacy is respected and that their dignity is maintained. EVIDENCE: A recommendation was made at the last inspection over a year ago that work on further developing the care plans should be carried out. This is to ensure consistent specific detail of care and support is available to staff. Care plans are important documents. This is because they form one of the means by which the residents and their families can tell that they will be supported in the manner of their choice. Also, the plans are a source of reference information for the care workers who need to ensure that they assist people in a consistent and appropriate manner. Cedardale Residential Home DS0000059264.V367377.R01.S.doc Version 5.2 Page 12 Work has recently begun on the task of reviewing and improving the care plans, following the appointment of a new Head of Care and a new Head of Training. Both these staff members are now working together to review the care plans. However, so far only a few have been reviewed and those inspected still do not contain sufficient specific detail. This was discussed with the head of care and the head of training. They said that they would go back over the revised care plans and ensure that more detail is included. As previously mentioned, this visit was made in the early morning because we had received information that the night staff were getting many of the residents up at unacceptably early times. When we arrived at 6 am there were already twelve residents in the lounge. Eleven were washed and dressed and one was still in her nightclothes. A thirteenth resident was brought into the lounge at 6.15am. This resident was transferred from a wheelchair into a chair using unacceptably poor moving and handling techniques. We were told that three of the residents had “been up all night ”and that it was the choice of the others to get up at that time. One of the two night staff said that they had begun getting the residents up at 5.30am. However, it later became evident that the staff had got some residents up as early as 5am. The residents who were up were those who were more heavily dependent and were unable to tell us whether this was their choice. The care plans of the residents who were in the lounge so early were examined. There was no evidence in any of these to show that this was the choice of the residents. Staff spoken with were not able to say how they had used the care plans to base their decision to get residents up, washed and dressed at such an early hour. We found that, between 6am and 8am, some residents were not being given due respect. A night carer was heard to command a resident to, “eat your biscuit”, in a loud and threatening way. Other residents were left in their chairs with cups of tea, but, because they were so tired, began falling asleep holding half full teacups in their laps. By 7.35am, nine residents were asleep in their chairs and two more were dozing. Several looked very uncomfortable. At this time a medicines round was being carried out, some residents were woken to take their medicines. One resident became distressed and called out for help. The member of staff administering the medicines was unable to attend to her and the other member of staff was not in the lounge whilst medicines were being administered. It is good practice to have two members of staff available whilst medicines are being administered in case any resident requires attention at this time. The staff member administering medicines should not be distracted from this task as this is when errors are likely to be made. Cedardale Residential Home DS0000059264.V367377.R01.S.doc Version 5.2 Page 13 When asked to tell us which residents had been up all night the more senior night carer stood in a doorway and pointed directly at individual residents, “That one, has been up, and that one”. At this point we challenged her, as we believe it was not appropriate to allow such disrespectful practice to continue. We found that night staff had left the laundry, the cupboard that contains substances hazardous to health (COSHH), a boiler cupboard and the dry store, unlocked. Any of these areas could present a danger to a confused resident who might wander into them whilst staff are otherwise occupied. We also found that the night care staff did not fully understand the fire procedures. This was a serious concern as there are major building works taking place at present and one rear fire exit is not available. Poor fire safety puts the welfare of the residents at considerable risk and is a serious breach of Regulation 23 of the Care Standards Act 2000. This will dealt with more fully under the outcome area for Management and Administration. The home was required to take immediate action in respect of fire safety. Relatives spoken to during the course of this visit said that they are happy with the care their relatives receive and that the home keeps them informed if there are any changes. The home has established good working relationships with local General Practitioners (GPs) and other health and social care professionals. All the residents are registered with GPs and we found good evidence that healthcare advice is sought in a timely way on behalf of the residents. Prescriptions for medicines are faxed through to the pharmacy and medicines are stored, administered and recorded correctly. Staff administering medicines have received training in the management and administration of medicines. Nutritional monitoring takes place and residents ware weighed regularly. Fluids are positively encouraged and all the residents were either in good health or making good progress in recovery from illness on the day of inspection. Cedardale Residential Home DS0000059264.V367377.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home promotes good communication with families and supporters. Residents are involved in appropriate activities and are offered nutritious and appetising meals. More work is required to ensure that residents are able to maintain as much independence and choice as possible in all aspects of their lives. EVIDENCE: As previously noted, care plans do not fully describe the needs of the residents and show how these needs are to be met. This means that the service does not fully take account of the previous lifestyles and cultural backgrounds of the residents when developing the care plans. Therefore it is not possible to determine the choices a resident might have made. For those residents who are no longer able to make informed choices, this means that care staff are making these choices for them but have little on which to base their decisions about those choices. Cedardale Residential Home DS0000059264.V367377.R01.S.doc Version 5.2 Page 15 Observation of care practice during the day showed that the day staff had some knowledge of the residents’ backgrounds. They made attempts to include this in their interactions. For example, two residents are from other European countries and staff made attempts to speak a few words of the residents’ first languages to them. Since the last inspection the home has employed an activities co-ordinator. Staff said that this has made a positive difference to the way the residents spend their day. Many are now getting involved in art and craftwork, music and movement and such other activities. The garden of the home is not currently available to residents due to the building work. There is a small patio area with some seating just outside the lounge where residents can sit if they wish. This is also the designated smoking area for residents. In order to compensate for the lack of access to the garden the home has organised some trips out to visit its sister home in Maidstone. Residents have been able to use the garden at this home. The two homes share a minibus and this has been made available to the residents of Cedardale. The residents have enjoyed these trips out very much. Some residents go out on a regular basis with their families and others take walks out with staff to a nearby shopping area where there is a coffee shop. During the day we noted that residents are free to move anywhere in the home and that the day staff engage them in meaningful conversation and activity. The head of care, who took up her post last October, has introduced a monthly newsletter. This is both informative and interesting. Relatives said that they very much enjoy reading the newsletter. They said that the home keeps them well informed and that they are pleased with the way their relatives are looked after. Residents said that they enjoy their meals and their relatives supported this view. Menus are varied and nutritious but there is only one option for the main meal. The cook said that she would prepare specialist diets if required and that she will cook something different, “such as an omelette”, for anyone who does not like the meal offered. Cedardale Residential Home DS0000059264.V367377.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has complaints and protection policies and procedures in place. These require updating and staff must be informed of current complaints and protection protocols. EVIDENCE: The home has a complaints policy that is included in the service guide. This policy requires updating. The registered manager said that the MGL group is currently developing a new complaints, concerns and compliments policy and procedure and this is soon to be introduced at Cedardale. The complaints procedure should tell residents and their supporters exactly how to make a complaint and to whom to speak if they have concerns. It should also include information about what to do if their complaint is not resolved satisfactorily in the first instance. The head of training has made good progress in improving staff training at the home. She said that staff have received Protection of Vulnerable Adults (POVA) training. The staff on duty during the day were clear about their responsibility to report any concerns about the way the residents are being treated. They were able to describe the types of abuse that vulnerable people might experience. Cedardale Residential Home DS0000059264.V367377.R01.S.doc Version 5.2 Page 17 However, it was clear, as previously mentioned, that there was poor care practice at nighttime. An immediate requirement was made. The registered manager has subsequently informed us that action has been taken to ensure the residents are now safe and protected from all forms of abuse. Cedardale Residential Home DS0000059264.V367377.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean and pleasant but the ongoing building work has had an adverse effect on the environment. Fire safety and infection control measures must be improved. EVIDENCE: The home has a relaxed and friendly atmosphere during the daytime. The ongoing building work has meant that there is no access to the garden and only a small patio area where the residents can get outside for some fresh air. As mentioned previously, the home has tried to compensate for this by introducing outings to the sister home where the residents can use their garden. Cedardale Residential Home DS0000059264.V367377.R01.S.doc Version 5.2 Page 19 Since the last inspection new carpets have been fitted to the communual areas. A number of minor maintenance issues were noted during a tour of the home. Some bedrooms would now benefit from refurbishment, as the décor is looking tired. The registered manager explained that there is a plan to refurbish the bedrooms once the extension is completed. It is accepted that it would not be practical to begin work on the bedrooms in the older part of the home until the new rooms are available. There are, however, some maintenance issues that require immediate attention. For example, there is one toilet that has no waste bin, the wooden toilet seat in this toilet is split, the support frame around the toilet is not fixed to the floor and incontinence pads are stored loose next to the toilet. These defects and infection risks must be dealt with as a matter of urgency. The home was clean and free from offensive odours on the day of inspection but a number of infection control hazards were noted. In particular, the laundry systems are unclear, early in the morning it was noted that a container of dirty laundry was placed under the tumble drier where clean laundry would be unloaded. Personal clothing was found airing in one bathroom that was also used as a toilet for residents. Due to the building work, the laundry room is also being used as a store for cleaning materials and equipment. A dirty mop was found lying across the sink instead of being correctly stored. The lid of the bin used for clinical waste was very dirty. This lid has to be lifted by hand and is not operated by a foot pedal. This is a significant infection risk, particularly if staff are not fastidious about hand washing. A foot pedal bin must replace this waste bin. This will reduce the risk of cross infection. There was not sufficient vigilance in respect of locking cupboards and rooms that could present a health and safety hazard to residents. Early in the visit we found the laundry door unlocked as well as the COSHH cupboard and a boiler cupboard. All these areas could present a serious hazard to a confused resident who might wander into these areas when only two night staff are on duty. When these deficiencies were pointed out the manager he took immediate remedial action to prevent further risk. The building work has increased the fire risks within the home. This is because the number of fire exits has been reduced and one point of exit from the home is now through the building site itself. In addition, hot work, such as soldering, is being carried out in the shell of the new extension. The building site manager has instigated good fire precautions for the site but night staff were unclear about which fire exits are to be used in the event of fire. The fire risk assessment was inadequate and not up to date. There was no updated fire plan to take into account the current situation in the home. It was unclear where the fire assembly point would be as the building works take up all of the rear garden and most of the front garden areas. Some bedroom doors were seen to be propped open with rubber wedges. The home must immediately update its fire risk assessment and fire plan. Since this visit the registered Cedardale Residential Home DS0000059264.V367377.R01.S.doc Version 5.2 Page 20 manager has told us that he has sought the advice of the fire safety office and revised the fire risk assessment and fire plan. Most of the bedrooms in the home are comfortable and homely. Residents have been able to personalise their own rooms. However, some concerns in respect of residents’ rooms were noted: There is one double room that does not afford enough privacy and autonomy for each resident. The way this room is laid out means that one resident has to go into the other resident’s part of the room to access a wardrobe. Due to the size of this room, only one resident is able to have an armchair and, as the door to the en suite toilet and washbasin opens outwards, one resident will have great difficult negotiating past the end of the other resident’s bed to access the toilet. The ensuite toilet does not have a lock on the door and the curtain used as a privacy screen between the beds is semi transparent and is too short. In addition, one of the fire exits is through this room. The ends of both beds reach so close to the wall that it would be very difficult for staff to assist residents past in the event of fire. It is strongly recommended that this room is not used as a double room once the new rooms are ready for occupancy. Another double room was seen to be used fro a member of staff to do the ironing. This seemed to be because there is little space in the laundry room and the residents’ room was deemed to be a safe and convenient place to carry out this task. However, this does not respect the rights of the residents to the privacy of their own room. It also means that their room is not available to them whilst the ironing is being done. When we explained this to the staff member, she was receptive to the reasoning and understood why a more suitable place must be found for the ironing. In some rooms we looked at the way the beds had been made. They were poorly made; the bottom sheets were not pulled tight and were creased. If the bottom sheet is not pulled tight it can be very uncomfortable for the resident. In addition, creased sheets increase the risk of pressure sores developing. It appeared that duvets had just been thrown over the beds without proper checks. One bed was found to have a very old mattress in which the interior springs had collapsed. This mattress must be replaced as a matter of urgency. Cedardale Residential Home DS0000059264.V367377.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 &30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are sufficient, staff training has improved and there are sound staff recruitment policies. More supervision and training is required for night staff. EVIDENCE: There are two care staff on duty at nights and three care staff on duty during the day. In addition there is a part-time activities co-ordinator, a cook, a cleaner and a laundry assistant. This means that care staff are able to concentrate on care duties. Three members of the day staff were spoken to in private. They said that they enjoy working in the home and have been offered an increase in training since the last inspection. Direct and indirect observation of the interaction of the care staff with the residents during the day showed that they are treated in a kindly manner. Cedardale Residential Home DS0000059264.V367377.R01.S.doc Version 5.2 Page 22 Since the last inspection the MGL group has appointed a Head of Training for its three homes. This has improved staff training and created more consistency throughout the group. . All mandatory training is undertaken, for example, infection control, fire safety and manual handling. However, there needs to be more supervision following training to ensure staff are able to put techniques learned into practice. As previously noted, despite receiving moving and handling training, staff were still using poor techniques. Staff were unclear about fire safety precautions despite having received fire safety training and one member of the ancillary staff was seen to ignore basic infection control procedures when dealing with commodes. Individual staff supervision has been introduced but so far has not been frequent enough. One to one supervision needs to be established on a more regular basis. Training needs are identified and performance issues are addressed at supervision sessions and these should be accurately recorded. There are policies and procedures in place for the recruitment of staff but care needs to be taken to ensure job descriptions are more specific. For example, one staff member was first employed as a cleaner and is now a carer. The job description did not make present duties clear enough. The application form requires revision to take into account recent legislation about age discrimination. The home employs staff from diverse backgrounds and their gender mix reflects that of the residents. Cedardale Residential Home DS0000059264.V367377.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home is adequate but must be more proactive particularly in all matters of health and safety. EVIDENCE: Cedardale is one of three-care home owned by MGL Health Care Ltd. Mr Michael Lisis (director/owner) is currently registered as manager of Cedardale. Mr Lisis is registered nurse and has many years experience in care of the elderly and dementia care In October 2007 an appointment of Head of Care was made. She acts as deputy to the registered manager. This has made lines of responsibility clearer and many of the recommendations made at the last inspection in December 2006 are now being worked on. However, several recommendations have still to be put into practice. Cedardale Residential Home DS0000059264.V367377.R01.S.doc Version 5.2 Page 24 The home holds small amounts of residents’ money for safekeeping. This is so they have enough money available to pay for items such as hairdressing and toiletries. The home has no other involvement in residents’ monies. Money for safekeeping is held securely with an associated record for each resident. We were told that receipts are kept for incoming monies and outgoing expenditure. There is much room for improvement in the quality assurance systems at the home. During a tour of the home we found a number of general maintenance issues that should have been picked up either on the registered manager’s regular tours of the home or during monthly visits by the roistered provider. Examples of these omissions have been mentioned earlier in this report but this is not an exhaustive list. One-to-one supervision takes place but this is not regular enough and the records made are not comprehensive enough. For example, some comments made by staff are recorded but there has been a failure to record actions taken or advice given. Some serious health and safety concerns were noted during the visit. Several of these, such as fire safety, infection control and failure to supervise night staff appropriately have been dealt with under other outcome areas in this report. Although it is disappointing to identify such shortfalls, it was encouraging that the registered manager, head of training and head of care were all keen to deal with the issues once they were pointed out. However, on the day of inspection the fire risk assessment was not up-to-date and there was no fire plan in place for the home whilst the building work was being carried out. We have been assured that the two main concerns, the fire safety and protection of vulnerable adults, will be addressed as a matter of urgency. In addition, we were given an undertaking that the home will immediately work to improve the care plans and staff supervision as well as addressing the other concerns that we identified. However, some of these concerns had been raised at previous inspections. It is now imperative that the registered manager and the registered provider work to address all the concerns highlighted in this report. Cedardale Residential Home DS0000059264.V367377.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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 2 2 2 2 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 1 X 3 1 X 1 Cedardale Residential Home DS0000059264.V367377.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 OP37 Regulation 17(2) (b) Requirement Records as listed under Schedule 4, in particular Schedule 4. 14 & 15 in respect of fire safety, must be available in the home at all times for inspection by any person authorised by the commission to enter and inspect the care home This requirement was made at the last inspection. Timescale for action 10/07/08 2 OP7 13 (2)(a)(b) 15 12 (4) (a) The home must improve the care 30/10/08 plans and the care planning process as a matter of urgency The arrangements for health and personal care must ensure that the resident’ privacy and dignity are respected at all times. In particular, the use of resident’s bedrooms for whilst they are elsewhere in the home must cease. All staff must address residents by their preferred form of address, privacy screening in double rooms must afford adequate privacy and all staff must be instructed to treat residents with respect all times. DS0000059264.V367377.R01.S.doc 3 OP10 10/07/08 Cedardale Residential Home Version 5.2 Page 27 4 5 OP16 OP18 Schedule 1. 14 12,13 6 OP18 13. (5) 7 OP26 23 8 OP33 24, 26 9 OP38 23 The complaints procedure must be updated Staff who may be unsuitable to work with vulnerable adults are referred, in accordance with the Care standards Act, for consideration for inclusion on the Protection of Vulnerable Adults register The home must make arrangement to ensure safe moving and handling techniques are used at all times to protect the residents from harm caused by poor techniques Infection control measures must be improved. In particular, the laundry systems must be reviewed and risks in the toilet and bathing facilities minimised. Additional training for staff in infection control measure is required. Quality assurance systems in the home must be improved. In particular there must be regular monthly monitoring in accordance with Regulation 26. The home is required to send these monthly reports to the Commission for the months of July, August and September 2008 Health and Safety on the premised must be improved. In particular in respect of fire and infection control. This was placed as an immediate requirement. 31/07/08 30/08/08 31/07/08 31/07/08 30/09/08 02/07/08 Cedardale Residential Home DS0000059264.V367377.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 2 3 4 Refer to Standard OP29 OP36 OP36 OP1 Good Practice Recommendations The home’s job application form should be updated to take into account recent legislation in respect of age discrimination Job descriptions should be reviewed as part of the supervision process, to ensure they reflect the job the staff member is carrying out One-to-one supervision should be more frequent and regular. Accurate written records should be made of each session and agreed with the staff member. The service users guide should be reviewed and made more accessible to the residents. For example, the use of Plain English, pictures and photographs should be considered. Cedardale Residential Home DS0000059264.V367377.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Cedardale Residential Home DS0000059264.V367377.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. 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