Inspection on 06/12/06 for Cedardale Residential Home

This inspection was carried out on 6th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cedardale Residential Home 02/07/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cedardale Residential Home Queens Road Maidstone Kent ME16 0HX Lead Inspector Lynnette Gajjar Key Unannounced Inspection 6th December 2006 09:20 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.V319715.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.V319715.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 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.V319715.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. 11th November 2005 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 21 people aged 55 and above who have a diagnosis of dementia. MGL Healthcare Ltd have also purchased two other care home on Kent. At present the home is in the transition period with proposals for a new ground floor single bedroom and dining area and lounge to be build in part of the large garden. Cedardale is located in a quiet tree lined residential area of Maidstone, close to shops, pubs, churches, public transport and other usual town amenities. Cedardale consists of 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. The home has large landscaped gardens with car parking to the front of the house. At present the home is in the transition period with proposals for a new ground floor single bedroom and dining area and lounge to be build in part of the large garden. The home employs care staff, working a roster, which gives 24-hour cover. The home also employs other staff for catering, domestic and maintenance duties. The home’s current fee ranges from £401.26p per week, to £480.00 per week. Additional charges are made for hairdressing, chiropody, and newspapers. The last inspection report is available on request from the home staff office and Owner Mr Michael Lisis. Cedardale Residential Home DS0000059264.V319715.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection, for the year running from April 1st 2006 to March 31st 2007. The visit lasted from 09.20am until 17:00pm. At the time of this visit Cedardale had no vacancies. The visit was spent talking directly with residents users privately and collectively, care and ancillary staff, visiting relatives, the manager and registered Manager/ Owner Mr Michael Lisis. Some residents experience levels of confusion, which prevent direct questions and answer. The inspector spent the majority of the inspection sitting with residents in the lounge, which gave opportunities to observe interactions during the day. This report includes evidence and judgements made through conversation, observation, records and previous inspection reports. Additional information was obtained through receipt of the manager’s pre-inspection questionnaire, a tour of the premises and conducting a case tracking exercise, by reading the files and care plans of the three clients and two care staff and new manager, as well as some policies and records maintained by the home. Questionnaires feedback was also received from a further 6 relatives/carers, 1 health and social care professional and 2 GP’s. Overall the ladies and gentleman living here, relatives and professionals are very satisfied with the service received. Comments included: “The home and staff endeavour to keep a good standard.” “An excellent care home. My mother is very well looked after.” As part of this unannounced inspection the quality of information given to people about the care home was looked at. People who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service users guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk. Throughout the inspection, there was a relaxed atmosphere with residents going about their business supported discreetly and courteously by staff. Cedardale Residential Home DS0000059264.V319715.R01.S.doc Version 5.2 Page 6 Whilst there are some areas needing further action in respect of good practice, these are to be set against a service, which demonstrated good personalised care and consideration for older people and a willingness to explore any opportunities to improve service provision. What the service does well: What has improved since the last inspection? To protect resident rights, residents’ statement of terms and conditions has been revised to give more detailed and resident focussed. Individual needs are now easily monitored by more detailed care plans, including reliably responsive risk assessments. Fire Risk Assessment have been completed and submitted to the fire officer and found satisfactory. Staff rosters have been revised and a record of employment dates has been introduced. New staff induction programmes have been implemented. Recruitment procedure, induction and suitable training for all staff, a full staff supervision system based on aims of the service and job descriptions, and Cedardale Residential Home DS0000059264.V319715.R01.S.doc Version 5.2 Page 7 forward planning of staff shifts has been introduced but not fully implemented to all staff files. Residents are better protected from the risk of accidents following a system for accident monitoring has been put into place. Work is about to commence of refurbishing the laundry room. New dining room and lounge furniture has been ordered but awaiting delivery. Records and finances held for service users required by regulation are not being made available for inspection at all times by a person authorised to do so. Planning permission has been granted to develop a further 8 single bedrooms and communal areas on the ground floor. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Cedardale Residential Home DS0000059264.V319715.R01.S.doc Version 5.2 Page 8 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.V319715.R01.S.doc Version 5.2 Page 9 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.V319715.R01.S.doc Version 5.2 Page 10 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): 1,2,3,4,5,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The ladies and gentlemen living at Cedardale and their representatives have access to the information needed in making a decision as to whether the home can best meet their needs. Further development of a photographic service user guide would assist those with memory loss and familiarity to their new home. EVIDENCE: Cedardale has a detailed ‘statement of purpose’ and ‘service user guide’ for prospective residents. These are currently under review due to management and staffing changes. These documents would be altered to an alternative format on request, such as larger fonts, Braille, languages. After discussion consideration to include photographs of key personnel and staff, especially as most residents are admitted from hospital and family members or care managers have visited or made the choice of home. Having photographic guide would assist a person with cognitive impairment to know where they are Cedardale Residential Home DS0000059264.V319715.R01.S.doc Version 5.2 Page 11 going and who is going to be there. It was also discussed that the key person who visited them in hospital should be on duty on their day of arrival to offer more security possibly some familiarity. Cedardale senior staff and manager undertake full pre-admission assessments before offering a visit to the home. This enables staff and residents / representatives to get a clearer understanding of the services offered and if the home is able to meet their care needs and expectations. To offer more information and recording of the assessment, the acting manager is reviewing current formats. Due to the differing cognitive abilities of those living here, families and care management have taken the lead role in the selection, final choice and arrangement for fees and contract on behalf of the relatives. Contracts are in place outlining what the home does and doesn’t provide within its fees. Three residents and their families spoken with were very happy with the support given when looking to move into Cedardale and were very complimentary of the kindness shown by staff and management. Terms and conditions of residency were observed in each resident file. The home is a preferred local authority contractor; with predominantly local funded residents and so reflected in the current fees range of £401.26 per week. Files tracked contained service delivery orders from the local authority. The top scale of fees charged is £480 per week. The home does not provide intermediate care. Cedardale Residential Home DS0000059264.V319715.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Residents continue to receive a high standard of personal and health care. Daily records could be improved to offer more accurate information of the individual and personal support observed. EVIDENCE: Three individual care plans were tracked, giving detailed and personal information about the support required by the individuals. Those spoken with described very personal, consistent, safe care and support given by the care staff. How their choices and personal preferences are respected and followed through. Direct observation demonstrated staff on duty showing excellent consideration and respect for each resident on a personal level. More detail in daily records would evidence the good care observed today. Records are stored securely. Cedardale Residential Home DS0000059264.V319715.R01.S.doc Version 5.2 Page 13 The health and personal care needs of the ladies and gentleman are well supported with regular contact with specialists and external professionals. Interaction between residents / relatives and staff is good showing genuine respect, friendship and appropriate familiarity with each other. Relative meetings are planned and well attended. Safe medication practice is encouraged with regular monitoring and auditing by the senior care staff. Residents and staff would benefit from more detailed guidelines of what PRN medication is given for and specific triggers or indicators for administration, particularly for those who may be more confused. Good medication storage and administration was observed during this visit. Cedardale Residential Home DS0000059264.V319715.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 good. This judgement has been made using available evidence including a visit to this service Residents continue to live in a home where they can be active and have social contacts. EVIDENCE: Cedardale has just employed a new activities organiser to arrange activities and outings but will work between this and a sister home near by from Jan 2007. Currently staff and the acting manager have undertaken this role. A programme of events planned was displayed in the home, which is joined in by residents as they wish. As the lead up to Christmas, the Christmas party with live entertainment is booked for the following week, local children coming to sing carols and being involved in making Christmas cards and decorations. Residents have assisted in going shopping and choosing new tablecloths. Residents were sitting in the lounge and dining room listening to music and reading magazines and chatting to each other etc. A passive exercise session was also taking place using stress balls with staff. Attendance at any activity is purely voluntary, staff recognise the short attention span for some residents and are quite happy that they ‘drop in and out’ of activities. Cedardale Residential Home DS0000059264.V319715.R01.S.doc Version 5.2 Page 15 Residents spoken with said that they enjoyed sitting in the lounges and bedrooms and when the weather is better making use of the extensive and attractive gardens. Others were walking freely around the home and engaging in conversation with peers and staff. Religious services are arranged in the home and where possible supported to attend church if they wish. Many residents’ families take their relative out for dinner and trips on a regular basis. New activities are being introduced such as Tai Chi, this was not received as popularly as hoped but “we did have a good laugh at some of the things they did” was one comments shared by a resident. Relatives also joined in. Staff aim to ensure that just because the older person is in a residential home, their right to choice and decision making isn’t taken away. Whilst there are some normal restrictions as part of any group living situation, residents have choice in such areas as times of getting up and going to bed, when to have their bath, where they would like to eat and what they would like to do with their day. Residents are encouraged to bring personal possessions with them and every effort is made so that they are in an environment where they feel content. Menus are prepared in advance and residents choose what they want from the menu each morning. The menu choices are not on displayed or alternatives on offer, this would a useful trigger to assist with reminding tem what is available and prompt remembering their choice. Most clients prefer to take their meals in the dining room and can sit at attractively laid out tables. All those spoken with felt there is always a good choice and the food is well cooked and there is “always a lot of it”. Drinks are now being served from a trolley offering more visual choices and accessibility through out the day. Resident’s families and friends are in regular contact, with an open door visiting policy. A steady flow of visitors was observed through out the day and in discussion spoke with fondness and familiarity about care and management staff. The ladies and gentlemen were observed to be stimulated and comfortable in their home. Cedardale Residential Home DS0000059264.V319715.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 good. This judgement has been made using available evidence including a visit to this service. Those living here and their relatives feel confidant to raise concerns or complain to the manager and staff, as they feel they are listened too, and that every action will taken to resolve them. Protection from abuse will be better promoted through all staff receiving training and understanding of the support and actions they may need to take in incidences of abuse. EVIDENCE: The home has a clear written complaint procedure. They have not received any complaints. Neither has the Commission. Most residents and all families of the home reiterated quite clearly that if they had a concern they would openly discuss it with the owner and staff. They all felt that it would be listened to and acted upon quickly. Two service users as detailed earlier were unhappy about the restriction of going out un-supported by staff as ridiculous but the manager, relatives and staff were managing with difficult situation offering alternative choices trying to maintain the residents dignity and respect. However they all wished it to be known they had no complaints at all. Cedardale Residential Home DS0000059264.V319715.R01.S.doc Version 5.2 Page 17 A training matrix has been developed indicates only 5 of the 20 staff have undertaken training in Adult Protection. The owner stated a senior carer has now under taken the trained trainer course for this and they are looking to ensure all staff has done this training within the next few months. Staff who have been spoken with evidenced a good understanding of how to protect and prevent abuse, including reporting to their senior carer or owner to discuss further and report to Social Services and the Commission. The home does not have any current adult protection investigations nor has had any since the last inspection. Cedardale Residential Home DS0000059264.V319715.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 ladies and gentlemen live in a safe, clean, comfortable and well maintained home which will be further enhanced through the planned refurbishment of laundry, kitchen, decoration and dining / lounge furniture on order. EVIDENCE: Cedardale started life as a large family home and was later extended to provide more specialist accommodation. The house retains its origins as a homely environment and fits well into the local area. Furnishings are domestic, suitable for the residents accommodated and new items are currently on order for the dining room and lounge. There is no shaft lift; access to the upper floors is by stair lift. MGL, the owners, recognise the changing and increased needs of people moving into care and are have obtained planning permission to further extend and rearrange the home which Cedardale Residential Home DS0000059264.V319715.R01.S.doc Version 5.2 Page 19 they hope to start next year. This would reduce the number of shared rooms; provide a new kitchen and laundry, shaft lift and more en suite rooms. Replacement of laundry equipment with new sluicing facilities is due to start in the coming weeks Residents using the upper floors are risk assessed as safe independently or needing staff assistance. Railings are fitted by the front door and to the rear ramped access. There is wheelchair access to the side of the house. The large rear garden is a secure area where residents can wander freely. The lounge leads onto a patio area with seating. Indoors there is a good-sized L shaped lounge, the smaller quiet lounge converted to an office on KCC contract requirement and a dining room. Reducing the resident’s communal space and quiet room to meet with relatives. The majority of bedrooms have a good outlook and have good natural light. There is a domestic style kitchen, which at the time of inspection was clean and well ordered, and a laundry with domestic washer and drier. Both have facilities to reduce the risks of cross infection. Washing needs are reduced as the majority of sheets and pillowcases are sent to a local laundry. There is a clinical waste contract for the safe disposal of contaminated waste. A cleaner is employed. A number of rooms are en suite; in addition there are separate toilets for general use and a staff toilet. There are two bathrooms, a standard bath on the upper floor and a Parker bath on the ground floor. One room has an en suite shower. Residents have use of a staff call system. A mobile hoist has been purchased which is under a maintenance contract. The manager will access specialist advice regarding suitability of the environment before starting the refurbishment, with particular attention to environment and design to meet the needs of those with cognitive impairment, texture, flooring and colour/ reduced patterns to aide orientation and independence. Residents can chose what items they would like in their rooms. Residents can choose whether to hold key to their room. The home felt warm, bright and comfortable. Radiators are fitted with covers to prevent risk of burns. The temperature of hot water accessible to residents is regulated by pre set valves. The fire safety risk assessment has been updated and agreed satisfactory by the fire officer. A fire test took place during this visit. The fire officer has been in regular contact and visiting due to the proposed extension and plans. Cedardale Residential Home DS0000059264.V319715.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. 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. Resident’s benefit from the support of a confident and motivated staff team, resulting in good morale and enthusiasm to improve the ladies and gentlemen’s whole quality of life. Further development of the recruitment documentation and induction of staff will ensure a more a robust system. EVIDENCE: Staffing levels continue to offer with three staff on duty between 8 am and 8 pm, and two waking night staff. In addition a domestic and cook are employed. The staff roster indicates that at all times one member of staff will be designated senior and hold responsibility for running the shift. The manager sets up the staff roster. Rosters are prepared 2 weeks in advanced. Residents spoken to like all the staff but clearly have their ‘special’ staff and look forward to them being on duty. Throughout the inspection there was evidence of very good staff/resident interactions. It was clear that staff listened, got to know individuals and was approachable. Staff balance personal care needs with time for one to one chats, activities and recording daily events. Staff spoken with detailed training courses they had been on since they started at Cedardale. Staff felt that the courses had helped them work more effectively with older people. The new Cedardale Residential Home DS0000059264.V319715.R01.S.doc Version 5.2 Page 21 training matrix does evidence progress being made in core training but gaps are still evident but the owner stated training has been booked to cover these. There is a pro-active approach to NVQ training with an assessor in the home during the afternoon. Ten of the eighteen-care staff hold NVQ 2 in care training or above. Senior staff is being supported to commence their RMA award in the coming year. Whilst there are no concerns as to the skills and integrity of the current staff team, at the last inspections it was found that recruitment did not support good practice to protect residents. Records are now being held at the home and new staff records are better recorded but there are still gaps from longerterm staff that required completion. The deputy manager is addressing this. A member of staff who started work few weeks ago confirmed she had filled out an application form, attended for interview and had worked alongside a more experienced member of staff until she got to know residents. She said she had only started work after a satisfactory criminal records bureau certificate had been obtained. She spoke of being asked to read the policy file but had been given the new recorded induction to follow. This was her first job in care and was aware that she was still learning from more experienced staff. She said that until she had been watched and was doing tasks correctly, she would not be allowed to do the work by herself. Staff spoken with continue to say they enjoy the work and considered the home gave a good quality of life to residents. Since the last inspection a new induction course are being implemented with staff working through Pathways to care’ and a formally recorded induction package. Even those who work in care must undertake a formally recorded induction to ensure that they understand the expectations of Cedardale and their policies and procedures. Cedardale Residential Home DS0000059264.V319715.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32, 33,35,36, 37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents continue to benefit from living in a home that is well managed, safeguards their best interests and promotes and protects their health, safety and welfare. Better record keeping would validate the good care and practices observed and better protect resident’s and staff. 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 with the support of two senior carers, who are to undertake their RMA Awards. Mr Lisis is a registered Nurse and has 21years experience in care of the elderly and specialising in dementia care. Cedardale Residential Home DS0000059264.V319715.R01.S.doc Version 5.2 Page 23 A deputy manager has been in post 3 months but is due to transfer to one of the other homes next month. She will however be looking at generic system and practices that will be implemented in all three care homes. Already her experience and influence in record keeping and developing easy to track records is evident. Residents, relatives and staff expressed a high regard for their management approach to the home. Residents continue to feel the registered manager and deputy manager are approachable and staff said they felt well supported. Regular quality assurance questionnaires are circulated to residents and relatives with prompt responses to issues raised. Staff supervision has been increased with new-recorded formats being introduced by the deputy manager. This is still very much in its infancy and requires more time to embed and evidence its suitability and evidence at least 6 take place in a year. Job descriptions for all levels of staff should be used as part of the supervisory process. A senior continues to make good progress in bringing resident records up to a good standard. The deputy manager now holds responsibility for maintaining personnel and service records and good progress have been made but with gaps still to be tracked. Recognising that residents need access to cash for items such as hairdressing and shopping, the home will hold money for safekeeping. There is no other involvement in residents’ monies. Money for safekeeping is held individually with an associated record, which supports accountability. Expenditure and income was stated to linked to receipts. Only one staff member has accessed to the finances and not on duty today so these could not be assessed. In her absence the owner stated if a resident required money he would loan this to them until the staff returned on duty to pay him back. A fire log file is held with section for fire safety checks, staff training and fire risk assessment. The file recorded regular fire safety checks having been carried out, a fire test took place during this visit. Cedardale Residential Home DS0000059264.V319715.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 2 Cedardale Residential Home DS0000059264.V319715.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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 OP29 Regulation 19 (1) Requirement No member of staff shall be employed to work at the home unless a minimum of two satisfactory written references have been obtained, their employment history, including the reason for leaving any employ with vulnerable people, has been obtained and validated. Part of this requirement is carried forward from a previous inspection. There is clear evidence that this has been implemented since for new employees. Old records are being updated with information by the owner but are not complete as yet. To be completed by timescale date. There must be evidence that all staff have the training necessary to carry out the work they are to perform, this will include evidence that all staff have: A recorded induction procedure Cedardale Residential Home DS0000059264.V319715.R01.S.doc Version 5.2 Page 26 Timescale for action 31/05/07 2. OP30 18 (1) (c) 31/03/07 Training in Basic Food hygiene/food hygiene awareness where the member of staff prepares, handles or stores food. Training which includes caring for older people with dementia Updated moving and handling training Training in the safe handling of medication if they administer medication With refresher training and assessment of competency within good practice guidelines. Part of this requirement has been carried forward from four previous inspections. There is good evidence that this is being addressed through the current training matrix but there are still gaps for core training. To be completed by timescale date. 3. OP37 19 (1) There must be a record of the dates staff employment commences and finishes. There is good evidence that this is being addressed through the records assessed but gaps is evident. To be completed by timescale date. 4. OP37 17(2) (b) Records as listed under 31/07/07 Schedules 3 & 4 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 31/03/07 Cedardale Residential Home DS0000059264.V319715.R01.S.doc Version 5.2 Page 27 There is good evidence that this is being addressed through the current training matrix but there are still gaps for core training. To be completed by timescale date. 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 OP1 Good Practice Recommendations It is recommended that the service user guide is reviewed to be more accessible and a visual memory tool using more pictorial referencing for those with cognitive difficulties and who do not get the opportunity to visit the home before moving in. Work on further developing the care plans should be carried out to ensure consistent specific detail of care and support is available to staff. It is strongly recommended daily records accurately reflect the care and support given. Showing personal choices and preferences of care are maintained. It is strongly recommended that full PRN protocols be written to ensure consistent administration, recognised triggers and symptoms of ‘when required’. It is strongly recommended the remaining 15 staff have completed adult protection training by March 31st 2007. It is recommended that professional advice re environment design, decoration and visual triggers is undertaken prior to the refurbishment and alterations planned in the coming years to meet the needs of those DS0000059264.V319715.R01.S.doc Version 5.2 Page 28 2. OP7 3. OP8 4. OP9 5. 6. OP18 OP19 Cedardale Residential Home with cognitive disabilities and encourage orientation and independence. It is strongly recommended that there is continued commitment to develop the environment as submitted in the homes previous action plan. 7. OP27 It is recommended that new template for staffing rosters are put into place to include, full name, position and hours rostered and actual hours worked. All employees including management should be included in the roster to accurately reflect who is in the building at what times. The reference should ensure full detail of the referee, including the name of the company/organisation providing the reference, is recorded. This is carried forward from the previous visit as new monitoring tools have just been introduced and details being backtracked and input to these records. Care staff should receive formal recorded supervision not less than 6 times a year. This is carried forward from the previous visit as new supervision format and responsibility has been set but too new to assess suitability and achieving at least 6 per year. Job descriptions for all grades of staff should be drafted to use as part of the supervisory process. Systems of evaluation put in place to track patterns of accidents must be recorded. 8. OP29 9. OP36 10. 11. OP36 OP38 Cedardale Residential Home DS0000059264.V319715.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local 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.V319715.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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