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Inspection on 12/10/05 for Cherwood House Care Centre

Also see our care home review for Cherwood House Care Centre for more information

This inspection was carried out on 12th October 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The programme of activities and links with the community are excellent. One resident spoken to said that the staff member organising activities is "wonderful". The support to relatives and visitors is very positive. One relative commented to the inspectors "the care here is second to none". Meals and mealtimes are much appreciated by the residents and the inspectors received many favourable comments. Several residents said that the food was very good. The lunch observed was a very happy relaxed event. The training programme and management of the training and development of the staff is very comprehensive.

What has improved since the last inspection?

The level of care planning and documentation of events particularly in the nursing wing has improved significantly. The residents` psycho - social needs are being included in the care plans. There is more cooperation between the training co-ordinators.

What the care home could do better:

Review and reword the Complaints procedure. Review the care planning in the residential wing as to how to present a clear "picture" of the residents` care needs and how these will be met, without having to read through the very comprehensive documentation.

CARE HOMES FOR OLDER PEOPLE Cherwood House Care Centre Buckingham Road Caversfield Bicester Oxfordshire OX27 8RA Lead Inspector Philippa MacMahon 2nd Inspector Kate Harrison Unannounced Inspection 12th October 2005 09:30 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 Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 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. Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cherwood House Care Centre Address Buckingham Road Caversfield Bicester Oxfordshire OX27 8RA 01869 245005 018869 324844 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) Ellenbern Holdings Limited Yvonne Bazylkiewicz Care Home 103 Category(ies) of Past or present alcohol dependence (3), registration, with number Dementia (35), Dementia - over 65 years of age of places (35), Learning disability (4), Learning disability over 65 years of age (4), Mental disorder, excluding learning disability or dementia (10), Mental Disorder, excluding learning disability or dementia - over 65 years of age (10), Old age, not falling within any other category (103), Physical disability (12), Physical disability over 65 years of age (8), Sensory Impairment over 65 years of age (2), Terminally ill over 65 years of age (10) Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Categories of Residence: The following numbers must be observed when admitting service users: OP Nursing places limited to 58 DE and DE(E) Nursing places limited to 25 MD and MD(E) Nursing places limited to 4 PD Nursing places limited to 6 PD(E) No nursing places LD and LD(E) Nursing places limited to 2 A Nursing places limited to 1 TI(E) Nursing places limited to 8 SI(E) No nursing places Older people requiring nursing care may be admitted from age 60. The total number of service users must not exceed 103 The lower age limit for admission to the PD, A, LD, DE and MD categories is 40 years. 11th February 2005 2. 3. 4. Date of last inspection Brief Description of the Service: Cherwood House is part of Cherwood House Care Centre, situated close to Bicester in the Oxfordshire countryside. It is a family owned business, registered with CSCI to provide nursing and residential care in Cherwood House. The cottages within the grounds at Cherwood Close are not regulated by CSCI. This report only refers to the nursing and residential services provided at Cherwood House. Cherwood House is a substantial house that was originally a Royal Airforce Officers Mess, and carries with it a lot of history and the original timbers in the bar tell their own story. The house has been extensively extended over time and now provides nursing and residential care for up to 103 residents. The nursing and residential wings are separated by the spacious shared entrance hall, which also serves as a comfortable meeting area for residents, relatives and friends. The accommodation is provided over two floors in single or double rooms, Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 Page 5 some with en-suite facilities. There is a passenger lift in each wing, and ramps provided to allow wheelchair access throughout the home. The communal areas include spacious lounges, and dining rooms in each wing, and the bar is open to all residents at arranged times. The extensive grounds are accessible to all residents and include raised beds, a greenhouse, and a safe area suitable for vulnerable people. Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out by two inspectors. The inspectors examined care plans and records, and spent a large proportion of the time talking with the residents, visitors, and staff to obtain their views. The inspectors were afforded a very warm welcome by the staff and full cooperation throughout the inspection. The home have recently gone through a difficult period and it was evident to the inspectors that the whole team are pulling together to ensure that the best possible care is provided at Cherwood House, and the staff are well supported. What the service does well: What has improved since the last inspection? The level of care planning and documentation of events particularly in the nursing wing has improved significantly. The residents’ psycho - social needs are being included in the care plans. There is more cooperation between the training co-ordinators. Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 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 Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. All residents have an assessment of their care needs before entering the home. EVIDENCE: Each of the registered managers carries out their own pre-admission assessments. A number of pre-admission assessments of people recently admitted were observed by the inspectors on each unit, and found to contain all the information necessary to provide appropriate care. For residents admitted for respite care, a registered nurse is designated to be responsible for overseeing the care for the duration of their stay. This is good practice and is commendable. Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Every resident has a care plan in which their health, personal and social care needs are identified, and the action required to meet those needs. Every effort is made by the staff to ensure the residents’ needs are fully met. Overall the medication systems are good, but they would benefit from a review to ensure that safe practice is continued. All the residents are treated with dignity and respect. The registered managers make every effort to ensure that residents at the time of their death, and their relatives, are treated with every kindness and respect. EVIDENCE: The inspectors examined care plans in both wings of the home. As the residential and nursing wings provide different kinds of care the documentation is also different. The inspector examining the residential care wing found the care plans to be very detailed and reflected the residents’ assessed needs, and how these would be met. The daily record is held in a separate file and Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 Page 11 examination of these showed that changes in care needs were sometimes included in this record and not transferred into the care plan. It is recommended that the care planning system in the residential wing should be reviewed and discussed with the staff to ensure that all the care needs and any changes are always reflected in the care plans. A sample of care plans was examined in the nursing wing and in all cases the care plans were linked to the pre-admission assessment and covered all the health, personal and social care needs, including night time needs. Appropriate risk assessments were conducted and action recorded in the care plans. The care plans were detailed and regular reviews appropriately recorded. All residents are registered with a GP. Advice is sought from health professionals as necessary and on the day of the inspection a GP had been called to see a resident. The GP told the inspector “Its brilliant here and my colleagues think so too!” A visiting district nurse holds regular weekly clinics in the residential wing, and was present during the inspection. There was excellent communication between the staff, and the district nurse, who also provides teaching sessions for the staff periodically. One resident told the inspector that she had been waiting over a year for a cataract operation before admission to the home, and the staff had followed the issue up and now she has an appointment to attend the mobile unit in the coming weeks. Overall the medication systems within the home are well managed, and the inspectors found them to be in good order. On the residential wing the inspector noted a number of omissions recorded without any definition of why. There is a space to write the definition and it is recommended that whenever an omission code is used when giving medication that the reason be clearly recorded. It is further recommended that the staff should use the reverse of the medication administration record to record any medication given on when required basis. On the nursing wing staff were unsure where to record medication that new residents brought into the home with them. It is recommended that the medication policy should include advice on where to record medication brought into the home by residents and outside of the regular monthly ordering cycle. The inspectors observed residents being treated with dignity and respect by the staff, and several residents spoken to commented on how they felt valued and were respected by all the staff. The inspector noted in one care plan that a resident who lives in a shared room had an identified need regarding dignity during the carrying out of personal care. There is a policy regarding death and dying, and residents’ wishes are recorded on admission whenever possible. There is a beautiful book of remembrance in a glass case in the entrance hall, that is kept up to date, and once a year in July there is a remembrance service held in the home, that is led by local Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 Page 12 clergy. This is always well attended and much appreciated by the relatives and friends of the deceased. Whenever a resident dies the home is represented at the funeral, and at the time of this inspection the registered provider was attending the service of a resident who had recently died. Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Life at the home satisfies the social, cultural, religious and recreational needs of the residents. Residents can maintain contact with relatives and friends as they wish. Residents are helped to maintain choice and control over their lives as far as is possible. The residents receive a wholesome diet. EVIDENCE: The inspectors spoke with individual residents and with a group of residents in the day room about their experience of life at Cherwood House. Some people had a private phone in their room and others were able to go to the office to make or take personal calls. Information about activities is prominently displayed in the home and the staff follow this up so that those people not able to read the information are able to take part. Several residents spoke of how they enjoyed the outings and activities available, and especially the newspaper reading that takes place most mornings. The inspectors noted that a lot of the activities in the residential wing took place at 11am and some in the evening. The registered manager told the inspector that this was quite difficult to Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 Page 14 arrange but that it was a better time for the residents, rather than after lunch when they are ready for a nap! This is commendable. There is a notice posted on the notice board informing relatives and visitors that they are most welcome and what facilities are available to them and how they can access these. There is also a group known as the Friends of Cherwood House who arrange various fund raising activities and the proceeds go towards supplying extra facilities such as the new raised beds in the garden so that residents can take part in gardening. Relatives spoken to during the inspection said that they were always made very welcome, and were able to talk to the staff about their relative. There is a new newsletter that will be produced on a quarterly basis that sets out any relevant news for all to share. This is a positive initiative and much appreciated by both relatives and residents. Links with the local community are good and the local Salvation Army day centre is regularly attended by some of the residents. Christian religious services take place in the home on a regular basis and are well attended and appreciated by the residents. Food is prepared at the home and a record of menus is kept. On the day of inspection the main meal served was freshly prepared soup, roast beef and Yorkshire pudding followed by a choice of dessert, and was according to the menu. The meals are served in the various dining rooms with tables set in an attractive manner to enable social interaction. Staff are available to assist those people requiring help. The food was served to individual requirements from the heated trolleys. The inspector noted that in one dining room all the residents were wearing either plastic disposable aprons or fabric tabards supplied by the home. The nurse in charge told the inspector that all the residents were given a choice about what to wear and had made a personal choice. Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18. There is a complaints procedure in place that needs to be reviewed, and made more accessible to relatives, visitors and residents. Complaints are listened to and dealt with appropriately. All staff are aware of the protection of vulnerable adults issues. EVIDENCE: Residents spoken to say that they knew who to address complaints to. A framed copy of the complaints procedure was noted in the entrance hall to the home to be placed so high that it was difficult to read. Further examination showed that the wording did not make it clear that people could approach the Commission for Social Care Inspection at any stage. It is recommended that the complaints procedure should be re written to make it clear that people may raise concerns at any time with the Commission for Social Care Inspection. A file holding the complaints was made available to the inspectors. At election time residents are able to either attend the polling station or they are assisted to complete a postal vote if they wish to. All staff receive training in the protection of vulnerable adults as part of their induction, and the inspector noted a training session that was being held Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 Page 16 externally for trained nurses shortly, had a number of nurses signed up to take part. Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None The inspectors did not make a judgement on the outcomes in this section as none were inspected on this occasion. EVIDENCE: None of these standards were assessed on this occasion. Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 The registered managers are very committed to the training and development of all their staff. Staff are trained and competent to do their jobs. EVIDENCE: Dedicated staff are responsible for organising the training of staff in each wing. There is good collaboration between the units, and an excellent training matrix showing the training undertaken by all staff has been developed and is well maintained. A mixture of private, and public bodies provides training, and opportunities for specialist training from voluntary bodies such as The Osteoporosis Society are also taken up. All staff receive mandatory training in Health and Safety topics. The inspectors examined a sample of staff training files and were satisfied that there is appropriate training for the needs of the residents. Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None The inspectors did not make a judgement on the outcomes in this section as none were inspected on this occasion. EVIDENCE: None of these standards were assessed on this occasion. Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 Page 20 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 Page 21 No 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. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations It is recommended that the care planning system in the residential wing should be reviewed and discussed with the staff to ensure that all the care needs and any changes are always reflected in the care plans. It is recommended that whenever an omission code is used when giving medication that the reason be clearly recorded. It is further recommended that the staff should use the reverse of the medication administration record to record any medication given on a when required basis. It is recommended that the medication policy should include advice on where to record medication brought into the home by residents and outside of the regular monthly ordering cycle. Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 Page 22 2 OP9 3 OP16 It is recommended that the complaints procedure should be re written to make it clear that people may raise concerns at any time with the Commission for Social Care Inspection. Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cherwood House Care Centre DS0000027144.V257210.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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