Inspection on 11/05/05 for Cedarwood Nursing Home

This inspection was carried out on 11th May 2005.

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

Other inspections for this house

Cedarwood Nursing Home 02/05/07

Cedarwood Nursing Home 26/05/06

Cedarwood Nursing Home 09/01/06

Cedarwood Nursing Home 31/01/05

Cedarwood Nursing Home 15/06/04

Cedarwood Nursing Home 01/03/04

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

CARE HOMES FOR OLDER PEOPLE Cedarwood Nursing Home 492 Kettering Road Spinney Hill Northants NN3 6QP Lead Inspector Sarah Smart Unannounced 11 May 2005 10.00 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cedarwood Nursing Home C51 S12605 Cedarwood V226519 110505 Stage 2.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cedarwood Nursing Home Address 492 Kettering Road Spinney Hill Northampton Northants NN3 6QP 01604 643114 01604 719606 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Cedarwood Nursing Homes Limited Care Home with Nursing 32 Category(ies) of TI Terminal Illness (32) registration, with number OP Old Age (32) of places PD Physical Disability (32) Cedarwood Nursing Home C51 S12605 Cedarwood V226519 110505 Stage 2.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Of 32 service users, a maximum of 3 will be in the category of Personal Care PC. 2. One named service user exemption allowed who is 58 years old. 3. To provide care to 1 named Service User who is 54 years of age. 4. Provide care for a named service user who has a diagnosis of dementia. Date of last inspection 31st January 2005 Brief Description of the Service: Cedarwood Nursing Home provides nursing and personal care for up to 32 Service Users within the categories of old age, physical disability and terminal illness. The home is situated in a residential area within the suburbs of Northampton and has good access to local facilities and amenities. The accommodation offers 12 single rooms and 10 shared rooms with three lounge areas and a dining room. The business is a family run venture and the service users and their families are encouraged to be involved within the home. Cedarwood Nursing Home C51 S12605 Cedarwood V226519 110505 Stage 2.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was undertaken between the hours of 8.55am and 13.00pm. The pre-inspection questionnaire had not been sent out and returned to the inspector prior to the inspection. This will be distributed, and used in the following inspection report. The primary method of inspection used was ‘case tracking’. This involves selecting a number of service users and tracking their care and experiences through review of their records, discussion with them, the care staff and observation of care practices. The following areas were covered during the inspection: case tracking, medication, sample of policy review, staff rota, staff files, quality assurance, staff supervision, accident records, complaints records, previous requirements made, and staff and service user interviews. Two service users were case tracked. Three staff members, plus the manager, were interviewed at length, and several others briefly, whilst three service users and one relative were spoken to in detail. Unannounced inspections have been made to the home during the past months due to immediate requirements made in relation to the management of medication. (see “what has improved”). What the service does well: Service user contracts informed the reader adequately of the terms and conditions of residency. The home demonstrated that they meet the needs of the service users in their care. The privacy, dignity, and rights of the service users is respected at all times. Staff communicated effectively and pleasantly with the service users. There are a variety, and regular activities within the home both in groups and on a one to one basis. Service users are protected by staff knowledge of the complaints and Protection of Vulnerable Adults procedure. With the exception of one bedroom carpet the environment of the home is satisfactory. Staffing levels were adequate to meet the current needs of the service users. Carers are offered, and attend a wide variety of training on relevant subjects. Cedarwood Nursing Home C51 S12605 Cedarwood V226519 110505 Stage 2.doc Version 1.30 Page 6 Quality monitoring was carried out to a very high standard, the results being published within the home. What has improved since the last inspection? 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. Cedarwood Nursing Home C51 S12605 Cedarwood V226519 110505 Stage 2.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Cedarwood Nursing Home C51 S12605 Cedarwood V226519 110505 Stage 2.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3,4 Documentation is not satisfactorily completed to ensure that service users needs and wishes are met at all times. EVIDENCE: The contracts for the two service users were signed, and contained all of the required information to protect the service users and the home. The assessments carried out on the two service users case tracked, had not been fully completed upon, or since, their admission. The information held as a baseline about these service users was limited. Despite the needs assessment being incomplete, the home was meeting the needs of the service users case tracked. Staff spoken to demonstrated a good knowledge of the service users in their care, and stated they read the care plans. Service users spoken to stated that their needs are met. A relative in the home also stated that he was pleased that his wife’s particularly needs were being met in relation to her dietary requirements. Cedarwood Nursing Home C51 S12605 Cedarwood V226519 110505 Stage 2.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11,(partially) Service users health and personal care needs were being met, although not all of the documentation was in place to ensure this. The provision of care in the event of a service users death was not acceptable. EVIDENCE: Care plans were written to an acceptable level, although additional information was identified in many instances. One of the care plans was signed by the relative of the service user, however the second was not. The manager and the nurse in charge stated that the service users relative has an active role in his wife’s care, and planned to consult him about his wife’s care plans later that day. For this reason, a requirement has not been made. Care plans were regularly reviewed, and accurately reflected the needs of the service users. One service user, whose condition has recently deteriorated, did not have a care plan for pressure area care, although some aspects of this were covered in the hygiene plan. At least two healthcare assessments had not been completed. This service user was identified as having a poor nutritional intake, however, her nutritional Cedarwood Nursing Home C51 S12605 Cedarwood V226519 110505 Stage 2.doc Version 1.30 Page 10 assessment had not been completed. This service user was also not weighed for the first two months of her stay in the home. A further healthcare assessment score indicated that dietetic advice was required, however this had not been sought. All of the previous requirements made in relation to medication were checked, and had been met. Medication was recorded appropriately, the storage was more suitable, and was being monitored. Service users spoken to stated that their privacy and dignity is respected by the staff. Observation in one of the service users lounges demonstrated wholly appropriate and pleasant communication between staff and service users at all times. Staff demonstrated knowledge of the service users needs. Service users wishes in the event of their death were not recorded. The manager and the nurse in charge stated that they found this a difficult subject to discuss with service users and their relatives. The nurse and manager explored all of the alternatives, and concluded that such information should be gathered upon admission to the home. Cedarwood Nursing Home C51 S12605 Cedarwood V226519 110505 Stage 2.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 (partially) The activity and psychological care needs of the service users is met. EVIDENCE: The home employs an activities organiser, who works with groups of service users, and on a one to one basis. A notice board advises service users and visitors to the home of the planned activities. This demonstrated that external entertainers visit the home regularly. Service users spoken to stated that they enjoy this a lot. Service users stated that they watch church services on the television, and a local church visits the home often. Other recent activities in the home include a clothes sale, flower arranging, gentleman’s afternoon – including dominoes, and bingo, as well as manicures etc. Service users advised that their visitors are welcomed into the home. Service users stated that they can make choices about when to have a bath etc, and the care plans reflected this. Service users are not offered a choice of food, however an alternative is always available for those who do not want the main meal. The cook demonstrated Cedarwood Nursing Home C51 S12605 Cedarwood V226519 110505 Stage 2.doc Version 1.30 Page 12 knowledge of the service users likes and dislikes. One service user has a special diet corresponding to her religion. The manager stated that her food is purchased specially, and handled completely separately from other service users food. Lunch looked and smelt appetising. Cedarwood Nursing Home C51 S12605 Cedarwood V226519 110505 Stage 2.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 (partially), 17 Service users rights and protection is maintained. EVIDENCE: Staff spoken to demonstrated a good knowledge of the complaints and Protection of Vulnerable Adults procedures. Service users stated that they had not voted in the recent general elections. One service user said, “I didn’t vote because I couldn’t get there, but I’m not bothered”. The manager stated that the service user had been given her postal voting form, which had been arranged for her, but she instructed staff to throw it away. Cedarwood Nursing Home C51 S12605 Cedarwood V226519 110505 Stage 2.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26 The environment of the home was satisfactory. EVIDENCE: All areas of the home are accessible to the service users residing there. Some service user rooms have doors onto the patio area. The home has recently purchased new carpeting to several communal areas of the home. The only bathroom in the home is not currently used, as all of the service users prefer showers. Communal areas of the home include two lounges and a conservatory, which is used as a dining room, however many of the service users eat in their chairs in the lounge. The manager stated that all of the service users have safety rails available on their beds. The home has a certain number of pressure relieving mattresses. The two service users case tracked were identified as being at high risk of developing pressure sores, and were cared for on overlay type mattresses. The manager stated that if considered necessary, air mattresses would be supplied. Cedarwood Nursing Home C51 S12605 Cedarwood V226519 110505 Stage 2.doc Version 1.30 Page 15 One service users bedroom carpet had been repaired several times, and may require replacement soon. A stair gate was being used to prevent a service user from falling down the stairs. The other dangers this may cause were discussed, and the manager stated that the use of the gate if no longer required, and decided to remove its use. Action will need to be taken if this is to be used in the future. Service users were noted to be personalised by the service users being encouraged to bring in their own belongings. The home was clean and tidy. Cedarwood Nursing Home C51 S12605 Cedarwood V226519 110505 Stage 2.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,30 (partially) The skill mix, knowledge and experience of the staff in the home is satisfactory. Ancillary staff had not received statutory training. EVIDENCE: The staff rota indicated that there is one trained nurse on duty 24 hours per day. In addition to this there are 5 carers on a morning shift, 4 carers on an afternoon shift, and two carers over night. The staffing levels were adequate to meet the current needs of the service users. Staff spoken to stated that they had received induction training. Care staff had also undergone statutory training, including moving and handling. The training board demonstrated a large amount of training available to staff, both in house, and held externally, for example, Parkinson’s disease, care of the dying, diabetes, stroke. Staff are asked what training they feel would be helpful, and their needs are also discussed during staff appraisal. Staff demonstrated a good knowledge of the service users in their care. A member of ancillary staff spoken to stated that this staff team do not receive moving and handling training. This was discussed with the manager who stated that this is to be discussed at the domestic staff meeting later this week. Cedarwood Nursing Home C51 S12605 Cedarwood V226519 110505 Stage 2.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,38 Quality monitoring is maintained to a very high standard. Some aspects of health and safety management could benefit from a small amount of improvement. EVIDENCE: Accident records demonstrated at least one trend in the accidents occurring in the home. The manager recognised the need to take action to further protect one service users safety. Cleaning chemicals were left unattended by the domestic on duty. These were removed by the manager at the time, and the staff member was spoken to by her senior. Therefore a requirement has not been made. The results of the homes quality monitoring process were viewed. The manager was able to demonstrate that any action identified had been carried out. The results were very clearly tabulated, and displayed in the home for staff, service users and visitors to see. The monitoring is undertaken on a 6 monthly basis. Cedarwood Nursing Home C51 S12605 Cedarwood V226519 110505 Stage 2.doc Version 1.30 Page 18 Cedarwood Nursing Home C51 S12605 Cedarwood V226519 110505 Stage 2.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 2 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x x 3 x x x x 3 Cedarwood Nursing Home C51 S12605 Cedarwood V226519 110505 Stage 2.doc Version 1.30 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 8 Regulation 12(1) Requirement Healthcare assessments must be available, accurate, and reviewed timely. (This requirement was made at the previous inspection and has not been met) General assessments must cover all aspects of standrad 3. Ancillary staff must undergo moving and handling training. Timescale for action 20.6.05 2. 3. 3 30 14 18(1)(i) 20.6.05 30.6.05 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. 5. 6. Refer to Standard 7 8 11 24 38 38 Good Practice Recommendations The care plans should contain more instruction to staff. Service users should be weighed on admission, and reviewed regularly. Service users wishes in the event of their death should be ascertained. The carpet in one service users bedroom should be replaced. The fire offciers advice should be sought if the stair gate is to be used at any time. Accidents should be monitored to ensure that any preventative action is taken. C51 S12605 Cedarwood V226519 110505 Stage 2.doc Version 1.30 Page 21 Cedarwood Nursing Home Cedarwood Nursing Home C51 S12605 Cedarwood V226519 110505 Stage 2.doc Version 1.30 Page 22 Commission for Social Care Inspection 1st Floor, Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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