Inspection on 10/04/07 for Cedars Resource Centre

This inspection was carried out on 10th April 2007.

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

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Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cedars Resource Centre Morwick Road Lynne Estate North Shields Tyne & Wear NE29 8JB Lead Inspector Janet Thompson Key Unannounced Inspection 10th & 20th April 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cedars Resource Centre DS0000064693.V333895.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. Cedars Resource Centre DS0000064693.V333895.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedars Resource Centre Address Morwick Road Lynne Estate North Shields Tyne & Wear NE29 8JB 0191 2006177 0191 200 8905 karen.robinson@northtyneside.gov.uk 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) North Tyneside Council Mrs Karen Robinson Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Cedars Resource Centre DS0000064693.V333895.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 5 service users category PD, Physical Disability, can be accommodated at any time. Not Applicable Date of last inspection Brief Description of the Service: The Cedars is an intermediate care facility situated in a residential area of North Shields. The facility is divided in to two units, Highgrove and Roseborough. The Roseborough unit accommodates older people who have orthopaedic problems and the Highgrove unit admits older people who have other health care needs. Most people come to The Cedars from hospital and stay for short periods only. Bedrooms are all single accommodation. There are three lounge/dining rooms and a gym/rehabilitation area. A passenger lift is available to take patients to the first floor. The intermediate care team are based in the home. They consist of care staff, nurses, physiotherapists, occupational therapists and social workers. Doctors and other professionals regularly visit. There is no charge for the facility other than for some aids and adaptations. The service is jointly managed between Northumbria Healthcare Trust, North Tyneside Primary Care Trust and North Tyneside Council Social Services. The aim of the facility is to return people to their own homes and avoid unnecessary hospital stays. Cedars Resource Centre DS0000064693.V333895.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first inspection of the The Cedars since it was registered with CSCI. The inspection was unannounced and took place over two days. The manager of the home was not present during the first inspection day but was at the second visit. The inspector sent out satisfaction surveys to ten residents and relatives before the inspection. Four relatives’ and five residents’ questionnaires were returned. Comments from these have been included in this report. During the visits the inspector walked around the building, talked to residents and some staff and looked at the food being served. Records relating to residents health and personal care were examined. The management of health and safety and staff recruitment was also assessed. For the purpose of this report people who use the service will be called ‘residents’. Within the Cedars they are referred to as ‘patients’. What the service does well: The home was clean; there were no unpleasant smells. Bathrooms were bright and clean. The food looked very good. Residents said it was usually good. The cook does a lot of home baking and there were homemade scones on offer that day. The dining rooms were attractive. Residents did not look hurried over the meal and some groups sat chatting at the tables afterwards. Three residents told the inspector that they could have a choice of meal. One resident said the food was “absolutely lovely”. The health care of residents appeared to be very good. Good health assessments were in place and there is a lot of input from the on-site health professionals. Records relating to the maintenance of the building were well organised. Health and safety checks were up to date. Records about accidents occurring in the home were clear. Cedars Resource Centre DS0000064693.V333895.R01.S.doc Version 5.2 Page 6 Good efforts are made to seek the views of residents who have used the service. A representative of the residents is also invited to attend clinical governance meetings. Records showed that good checks are made when staff are recruited and that staff are properly trained. This is essential to protect and ensure the welfare of residents. Management of residents’ medication was good. Generally the home seemed to be well managed. Relatives said the service was “excellent, they could not have looked after my mother better”. “Staff are very friendly, they make everyone feel really comfortable, it could not have been better”. “Everyone seems very happy there, it was excellent”. In their questionnaires residents indicated that they were happy with the level of the service. They said that the food was “usually very good” and the building was “clean and smells fresh” What has improved since the last inspection? What they could do better: The building is an older type that is beginning to look worn in places. Some of the furniture is old and scraped. The toilets look institutional. The paint is peeling from the walls. One of the bedrooms has an old carpet that is stained and faded. Several carpets looked old and faded. The laundry rooms are very small and, although they were clean, it is very difficult to keep clean and dirty linen separated. This is to prevent cross infection. There was not a lot of evidence of social activities taking place. Care plans did not fully reflect residents’ social and personal needs. In questionnaires returned three out of five residents said that there was “never” a good level of social activities. Relatives said that residents could benefit from the provision of some large print books. Cedars Resource Centre DS0000064693.V333895.R01.S.doc Version 5.2 Page 7 There were no fresh vegetables used in the cooking. The cook stated that this was because she had been told that frozen vegetables were healthier. The manager is going to review this. The windows in the home were not fitted with restrictors. Residents could fall from the first floor. 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. Cedars Resource Centre DS0000064693.V333895.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 Cedars Resource Centre DS0000064693.V333895.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): 3 and 6. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. All residents receive a comprehensive needs assessment before admission, so that staff know they can meet their needs. Staff are fully committed to supporting residents to achieve independence. EVIDENCE: A qualified nurse assesses all residents before they are admitted to the home. The assessment is very comprehensive. Account is taken of reports from all associated health professionals such as occupational therapists, dieticians, speech therapists and physiotherapists. The assessment is used to inform the staff of the initial care needs of the resident and form the basis of the care plan. On the day of inspection an admission was refused because the care needs of the person were “end of life” rather than “rehabilitation”. This shows staff understand and are committed to the principles of the home. The aim at The Cedars is to enable people to return home as soon as they are fit to do so. The development of living skills and independence is a high Cedars Resource Centre DS0000064693.V333895.R01.S.doc Version 5.2 Page 10 priority. The intermediate care team work as one to ensure that each resident has one package of care that meets both health and social needs. Residents have access to small kitchens were they are assisted to carry out ordinary living skills. Assessments of these are done before the resident returns home. The inspector talked to one resident who was going home in that week. She said that the team had all helped her to “get back on her feet”. She had been home with an occupational therapist to see if she needed any adaptations in her kitchen. These had been provided. An analysis is kept of all residents admitted and discharged. This showed that the vast majority of residents went home after their stay at The Cedars. This was usually after a period of two to four weeks. Cedars Resource Centre DS0000064693.V333895.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 and 10.Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Care plans set out residents’ health needs but do not completely reflect their social care needs. Residents’ health needs are fully met. The home has efficient medication policies, procedures and practices. Residents’ are treated respectfully. EVIDENCE: Five care plans/case records were examined. Two were case tracked to individuals that the inspector had seen or met. The case files are divided into two separate files. One contains all of the assessments from the nurses, doctors, physiotherapists and occupational therapists. The other file stays in the residents’ room and contains records of the day-to-day care delivered. This includes night and day checks, records of baths and showers etc. The health care needs of residents were well documented. In depth assessments from the appropriate health professionals were in place. The care is ‘prescribed’ by a nurse or other health expert. The plans are based on residents’ health problems and in this area provide some excellent information. The social needs of residents were not so well identified. There was no real Cedars Resource Centre DS0000064693.V333895.R01.S.doc Version 5.2 Page 12 plan of care for the individual as a whole. Personal care needs were not clearly recorded, though in practice they did appear to be met. The inspector suggested that the file kept in residents’ rooms could contain this information, which should be written for, accessed and used by the care staff. Residents’ health needs were very well planned for and met. Two residents spoken to said they had been helped back to full health very quickly. Residents looked clean and well cared for. The contribution of health experts in the day-to-day care of people is excellent and the benefits obvious. Staff are trained and competent in health matters. Training is arranged on topics that relate to resident care. Relatives said the service was “excellent, they could not have looked after my mother better”. “Staff are very friendly, they make everyone feel really comfortable, it could not have been better”. “Everyone seems very happy there, it was excellent”. In their questionnaires residents indicated that they were happy with the level of the service. They said that the food was “usually very good” and the building was “clean and smells fresh” Medication storage, receipt, administration and disposal were examined and found to be satisfactory. Residents wear hospital style identity bracelets. These are checked during the administration of medication. Staff have received training to administer medication. Staff were observed to talk to residents respectfully. Residents spoken to were full of praise for staff. They described them as “approachable” “kind” and “caring”. Cedars Resource Centre DS0000064693.V333895.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are not provided with a range of social activity. Contact with family and friends are maintained. Residents are helped to exercise choice and control in their lives. The food is of good quality and meets the needs of residents. EVIDENCE: Care plans, as previously stated, did not set out residents’ social and emotional needs and expectations. This service is different to the average care home in that residents are only there a short time. During that time they receive physio and occupational therapy aimed at maximising independence and returning home. Otherwise divertional therapy is minimal. Residents did say that once their treatments had finished for the day it was “a bit boring”. In questionnaires returned three out of five residents said that there was “never” a good level of social activities. Relatives said that residents could benefit from the provision of some large print books. Cedars Resource Centre DS0000064693.V333895.R01.S.doc Version 5.2 Page 14 Visitors are welcome in the home between 13.30 and 20.00hrs. This is to enable therapies and treatments to be carried out in privacy in the morning. The restrictions to visiting are flexible however. Different arrangements can be made on request. This is all stated in the service users guides, which are in each bedroom. Residents are given choice within the constraints of timetables for health treatments and the routines of the home. One resident described how she had a very structured morning with exercises to do and physiotherapy to attend. In the afternoon she was free to do as she pleased. She confirmed that staff helped her when she needed. The food looked very good. Residents said it was usually good. The cook does a lot of home baking and there were homemade scones on offer that day. The dining rooms were attractive. Residents did not look hurried over the meal and some groups sat chatting at the tables afterwards. Three residents told the inspector that they could have a choice of meal. One resident said the food was “absolutely lovely”. In the kitchen the cook had information about residents’ special dietary requirements. There were no fresh vegetables used in the cooking. The cook stated that this was because she had been told that frozen vegetables were healthier. The manager is going to review this. The kitchen was very clean and tidy. Cedars Resource Centre DS0000064693.V333895.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is supplied to everyone in the home and residents know how to use it. The policies and procedures for safeguarding adults were available and clear. EVIDENCE: The complaints procedure is in the service user guide. These are available in all rooms. Leaflets produced by the three managing authorities also set out procedures for complaints. Residents spoken to knew how to complain. The manager records all complaints. There was one complaint recorded for 2006. This was from a relative who felt they had not been given information quickly enough. The reply to the complainant was very detailed. The complaint was resolved to the satisfaction of the complainant. Adult protection procedures are available in the home. All staff have received training in adult protection. There have been no incidents requiring the intervention of the adult protection team. Cedars Resource Centre DS0000064693.V333895.R01.S.doc Version 5.2 Page 16 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, 21 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The maintenance of the home is not always up to date. There are sufficient toilets but they require decoration. The home is clean and tidy but some minor hygiene issues have been identified. EVIDENCE: The physical environment meets the needs of the people who use the service. It is comfortable and clean. Maintenance tends to be reactive rather than proactive. Several areas need redecoration. These include the toilets, some bedrooms and living areas. Some of the carpets are old and faded, particularly bedroom 2 and the corridors. The bedroom furniture in some rooms is old and worn. Armchairs look old and worn. One accident record showed a visitor had sat on an armchair, which collapsed in the middle. This could have had serious consequences. Cedars Resource Centre DS0000064693.V333895.R01.S.doc Version 5.2 Page 17 None of the windows are fitted with restrictors. They open outwards like doors. Residents could easily fall from these. One resident described the home as “shabby”. The nature of the building does not reflect the good work that goes on inside. Although bed linen was clean and functional some of it was quite creased. This is because the home is not provided with a press. Bed linen is ironed by hand in the hair salon because the laundry areas are too small. Both laundry rooms are very small. It is impossible to separate clean and dirty linen in this space. Consideration needs to be given to the provision of a separate laundry room. Residents clothing is generally done by their families due to the short space of time that they are in the home. Cedars Resource Centre DS0000064693.V333895.R01.S.doc Version 5.2 Page 18 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 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Resident’s needs are met by adequate numbers of staff. Residents are in safe hands. Good recruitment procedures in the home help to protect residents. Staff are trained to do their jobs. EVIDENCE: There were adequate numbers of staff on duty. The current staffing for the home is: One nurse throughout twenty four hours. Five care staff during the day and one team leader. Three care staff at night. Staff training records were checked. Training is targeted and focussed on improving outcomes for residents. There were individual training plans for staff, which showed that all staff were up to date with statutory training. The manager reported that a good amount of vocational training also takes place. Records showed that this included things such as infection control, capacity, swallowing, medication, risk management, oxygen therapy and hip fractures. The staff team support each other and share skills and knowledge. There are a lot of medical and professional staff on hand in the building to provide individual ad hoc training when needed. The result of this is a diverse staff team that has the knowledge and skills to meet residents’ needs. Cedars Resource Centre DS0000064693.V333895.R01.S.doc Version 5.2 Page 19 Five staff recruitment files were checked. Good recruitment procedures were followed. All files contained evidence of reference checks, background, and identity and criminal records checks. An interview form was used to ensure accountable and consistent interviewing. There was evidence of a good understanding of equality and diversity throughout the recruitment process. Cedars Resource Centre DS0000064693.V333895.R01.S.doc Version 5.2 Page 20 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): 31,33,35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is experienced and competent to run the home. The manager tries to run the home in the best interests of residents. Resident’s monies are well managed. The health and safety of residents and staff was not fully protected. EVIDENCE: The manager has three years experience in management. She has been assessed by CSCI as “fit” to run a care home. The manager is keen to run the home well for the residents. She has consulted them through surveys, meetings and an open door approach. The results of resident surveys were posted on the walls throughout the home. Residents confirmed that they felt listened to by staff. Cedars Resource Centre DS0000064693.V333895.R01.S.doc Version 5.2 Page 21 Resident’s money is well managed. Accounts are individually held and receipts kept. Money was not counted at this inspection. Health and safety checks were up to date. Certificates were in place for the testing of gas, portable electrical appliances, water chlorination, lifts and hoists. All internal safety checks were up to date. These included fire fighting equipment, door closures, ventaxia and hot water. There were no obvious trip hazards in the home. Fire exits were clear of obstructions. All rooms containing hazardous fluids were locked. Comments have been made in various sections of this report regarding the safety of residents, staff and visitors. This can be improved by making improvements to the building and taking a proactive approach to maintenance. One staff member had identified a problem in that staff working together yet employed by different organisations were receiving different levels of fire training. The manager felt that this was now under control as all staff are working to one procedure. This will be kept under review. Cedars Resource Centre DS0000064693.V333895.R01.S.doc Version 5.2 Page 22 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 X X 4 X X 4 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Cedars Resource Centre DS0000064693.V333895.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N/A 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. 2. Standard OP7 OP19 OP38 Regulation 15 13(4)(b) 23(2) Requirement Care plans must identify the personal, social and psychological needs of residents. Provide a programme of renewal and redecoration. This must include armchairs, bedroom furniture and carpets. Provide window restrictors that comply with the HSE recommendations. Provide a programme of redecoration for toilets areas. Reconsider the laundry area to ensure that clean and dirty linen can be separated. Provide an ironing press. Timescale for action 01/06/07 01/06/07 3. 4. OP21 OP26 23(2) 13(3) 01/06/07 01/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000064693.V333895.R01.S.doc Version 5.2 Page 24 Cedars Resource Centre 1. Standard OP12 Provide a programme of social activities. Cedars Resource Centre DS0000064693.V333895.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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. 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