Inspection on 14/05/07 for The Cedars Care Centre

This inspection was carried out on 14th May 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Cedars Care Centre 11/01/07

The Cedars Care Centre 16/11/05

The Cedars Care Centre 27/06/05

The Cedars Care Centre 24/01/05

The Cedars Care Centre 12/06/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Cedars Nursing Home 12 Richmond Road New Barnet Hertfordshire EN5 1SB Lead Inspector Margaret Flaws Key Unannounced Inspection 14th May 2007 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 Cedars Nursing Home DS0000010419.V336465.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 Nursing Home DS0000010419.V336465.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedars Nursing Home Address 12 Richmond Road New Barnet Hertfordshire EN5 1SB 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) 020 8364 8839 020 8364 8583 h_asslanian@btconnect.com Cedar Gardens Care Limited David Adams Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places Cedars Nursing Home DS0000010419.V336465.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Specific service user: One specific service user who is under 65 years of age and has mental health needs may be accommodated in the home. This condition will need to be reviewed at such time as the service user attains the age of 65 years or vacates the home. 11th January 2007 Date of last inspection Brief Description of the Service: The Cedars Nursing Home is a care home registered for a maximum of 45 older people who require nursing care. It is one of a number of care homes owned by Cedar Gardens Care Limited. The present owners have owned the home since 1999. The aim of the service is to provide quality nursing care in a supportive environment. The home is a large detached two storey house. There are thirty five single bedrooms and five double bedrooms located across the ground and first floors. All the bedrooms have en-suite facilities. Air conditioning is provided in the home. There is a shaft lift serving the ground and first floor. The communal areas, including a dining room and two interconnected lounge areas, are on the ground floor. There is a well maintained garden with a patio area to the rear of the home. There is also a small parking area at the front of the home. The home is situated in New Barnet, a short distance from the Great North Road and in a quiet residential area. It is about a mile from shops and other community facilities located in High Barnet. Fees for the home are £610-£860. Cedars Nursing Home DS0000010419.V336465.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over one day on 14 May 2007. The Registered Manager and the Administrator assisted the inspector throughout the inspection. The inspector also spoke to eight staff members, six people living in the home, three relatives, one health care professional, the Registered Provider and observed the care, activities and support provided throughout the day. Care, home and staff records and a tour of the home formed the remainder of the inspection. The home has made excellent progress in meeting almost all of the requirements issued at the last inspection. What the service does well: What has improved since the last inspection? Medication improvements were made immediately after the last inspection and medication requirements are now met. Medication Administration Records (MAR) sheets now record when a person is hospital and tippex is not used to make changes on the records. Allergies and pain control issues are recorded and there is a sign on the room where oxygen is stored. Call bells are in a good state of repair and accessible to all residents and rooms requiring automatic door closures have been fitted where required. Individual activity options are available to people who spend most of the time in their rooms and the activity coordinators meet with them daily. The home has a system for reviewing resident’ dependency levels and matching this to staffing hours. The home now has a needlestick policy and procedure in place to protect staff wellbeing. Staff who administer medication have been bought up to date with annual medication training. Staff supervision has improved and the home should be Cedars Nursing Home DS0000010419.V336465.R01.S.doc Version 5.2 Page 6 able to meet the required number of six supervision sessions per staff member annually. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cedars Nursing Home DS0000010419.V336465.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Cedars Nursing Home DS0000010419.V336465.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective residents and relatives can be confident that they will be provided with the information they require to decide on the suitability of the home. They can also be confident that their needs will be fully assessed prior to admission. This includes ways of meeting the needs of people who may be dying. EVIDENCE: At the time of the inspection, there were thirty three people living in the home (including one person in hospital). The home has a balance of private, local authority and Primary Health Care Trust funded residents. Cedars takes people with complex needs and people who are terminally ill. Staff also work with the support of the North London Hospice and community based palliative care staff. A reasonable proportion of people living in the home have some form of cognitive impairment or dementia but this is not the primary reason for their referrals. Some people come to the home on a respite placement and then transfer to a permanent stay. Cedars Nursing Home DS0000010419.V336465.R01.S.doc Version 5.2 Page 9 The records of four newly admitted people were inspected. They had been comprehensively assessed and their assessments used as the basis for care planning. I spoke to two recently admitted people and two relatives. They all said that they have been able to visit the home before moving in and to have a trial visit if they wished. Cedars Nursing Home DS0000010419.V336465.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ personal, health and social care needs are clearly set out in newly revised care plans and in supporting documentation. Their choices are well supported in the home. They are protected by the home’s medication policies and procedures. Staff were knowledgeable about the needs of people living in the home. EVIDENCE: The health care plans and files of six people living in the home were inspected. New care plans have been designed and put in place. These care plans are regularly updated and discussed with the residents and their relatives. Descriptive life histories are also being obtained and placed on file. Risk assessments were regularly reviewed and updated. Staff said that they liked the new care plan format. The care plans also included good information on people’s social, cultural and religious needs. Cedars Nursing Home DS0000010419.V336465.R01.S.doc Version 5.2 Page 11 The home provides a broad range of care, including respite, palliative and terminal care. There are active mechanism for working with the specialist staff, such as palliative care and tissue viability nurse specialists. I spoke to six people living in the home, three relatives and observed the care of several people who were unable to communicate clearly. People were well dressed and presented; they said that personal care was given respectfully and that their needs were assessed and met. Staff were observed working respectfully with people, especially with those people with communication difficulties. Call bells are all in a good state of repair and easily accessible, meeting a requirement from the last inspection. The home’s accident records were inspected. These were well kept. Regulation 37 reports are sent regularly to the CSCI. One person has significant problems maintaining their and staff were observed providing close supervision to support them. The MAR charts and controlled drugs records were inspected. No errors were found and recording was accurate and in line with the home’s procedures. There are photographs of each person on the MAR sheets to assist with recognition during medication rounds. Controlled drugs are appropriately stored, handled and signed for by two staff in the controlled drug book. All medication requirements from the last inspection were met quickly after that inspection: hospitalisation is now noted appropriately on the records, and allergies and ways of determining pain levels recorded. A sign has been placed on the door of the room where oxygen is stored. Nursing staff have had additional medication training. The contracted and Primary Care Trust pharmacists undertake regular medication audits to supplement weekly audits done by nursing staff. Cedars Nursing Home DS0000010419.V336465.R01.S.doc Version 5.2 Page 12 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. The home offers people living in the home a good choice of activities, including an expanded range of options for people who are mainly bedbound; family support is encouraged and the food is good. EVIDENCE: Throughout the day, several activities took place. These included group and individual activities in the communal areas and individual activities in the rooms. One person celebrated his birthday and everyone sang happy birthday and shared a large cake with him. Two activities organisers worked the day together. Between them, they cover day shifts from Monday to Friday. I interviewed one activities organiser, who described their daily routines;hw they consult with and involve people in activities and how they tailor individual activities. These are all detailed on the activities records. Activities offered include quizzes, games, singalongs, embroidery, flower arranging, drawing and reminiscence sessions. People living in the home said that they enjoyed the activities and participated as they wished. Cedars Nursing Home DS0000010419.V336465.R01.S.doc Version 5.2 Page 13 The home has a significant number of people with cognitive impairment, dementia and communication issues. To assist the Activities Coordinators to meet the current needs of these people, a requirement is given that they are trained in communicating with people with dementia. The home has also recently employed an RMN staff member who has considerable dementia care experience and is able to make an active contribution in this area. Several relatives visited during the inspection and most said that they visit the home regularly. They are able to spend as much time with their relatives as they wish. Lunch was served in the lounge. The choice on the day was Shepherd’s Pie or Sausage and Mash. Menus include a daily cooked breakfast, a three course cooked lunch and soup, salad and sandwiches in the evening. Residents and relatives spoken to were unanimously positive about the food. The Cook showed me the recent survey of people living in the home and said that she is currently developing new menus based on their requests. The kitchen was clean and tidy. It is efficiently and safely run by the long term cook and her colleagues. One relative said that “the cook is fantastic and takes pride in her work”. The home always has a plentiful supply of fresh vegetables, fish and meat. Cedars Nursing Home DS0000010419.V336465.R01.S.doc Version 5.2 Page 14 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. People living in the home can be assured that complaints will be appropriately investigated and followed up. They are protected by the home’s adult protection policies and procedures and by staff training in these areas. EVIDENCE: The complaints records were inspected. There have been three complaints received since the last inspection. These have been appropriately investigated and followed up. Adult protection policies and procedures are sound and staff are regularly trained in this area. The Whistleblowing Policy and Procedure has been updated. Cedars Nursing Home DS0000010419.V336465.R01.S.doc Version 5.2 Page 15 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 and 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The environment is comfortable, clean and pleasantly attractive. Bedrooms and communal areas are well decorated and maintained. EVIDENCE: The home provides a pleasant and comfortable environment for people to live in. There are three main communal spaces – two adjacent lounges and a large dining room. All face out onto the garden. Several communal areas and some bedrooms have been redecorated and brightened up. The home was in the process of re-carpeting on the day of the inspection. The bedrooms are comfortable, well furnished, nicely decorated and of a very high standard. I visited several people in their rooms and also spoke to others in communal areas – they were all happy with the standard of accommodation. Cedars Nursing Home DS0000010419.V336465.R01.S.doc Version 5.2 Page 16 The home was clean, hygienic and free from offensive odours on the day of the inspection. The kitchen, bathroom and laundry areas are well maintained. Kitchen temperatures are taken daily and recorded and kitchen staff have received Food Hygiene training. Automatic door closures have been fitted to two bedroom doors, meeting a requirement. Cedars Nursing Home DS0000010419.V336465.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. People living in the home are protected by the home’s recruitment and training procedures. EVIDENCE: Four staffing records were examined. One new staff member, a Registered Mental Health Nurse, has been recruited since the last inspection. The home has a sound recruitment process and all pre-employment checks were completed correctly. There is also a good system for keeping staff files up to date with information on staff’ professional registrations and immigration and right to work status. The home had two full time nursing vacancies at the time of the inspection. The home has a clear process for reviewing the staffing levels against the dependency needs of the residents. This meets a previous requirement. There were sufficient staff on duty on the day of the inspection. The home has a good staff training system. Evidence of what training has been completed is kept on staff files and on a spreadsheet. Some staff have started a distance learning equality and diversity course. There is also a good clinical education programme for nurses and for nurse adaptees. Staff are making good progress towards NVQ qualifications. There are still some gaps in night Cedars Nursing Home DS0000010419.V336465.R01.S.doc Version 5.2 Page 18 staff training and all night staff must have the same level of training in all core care areas as the day staff. A requirement is restated but I am confident that the home will meet this requirement in the near future. The Registered Manager is undertaking his NVQ Assessors Award. One staff member is currently undertaking a project to review components and outcomes of the Skills for Care training. This will help the home to ensure that it meets all these outcomes in its training programme. The home now has a needlestick policy and procedure. Nursing staff have completed annual medication training, meeting a previous requirement. Cedars Nursing Home DS0000010419.V336465.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home has policies and procedures in place to gather the views of people living in the home. They are protected by the home’s robust systems. EVIDENCE: Residents and relatives are consulted for their views. Annual quality assurance surveys of relatives and residents were completed before the last inspection. Their financial affairs are safeguarded by the home’s policies and procedures. Staff supervision is improving and most staff had received supervision in May 2007. A supervision matrix has been produced. Staff spoken to said that they had recent supervision. The home should be able to meet the requirement of six individual supervision sessions per year. Cedars Nursing Home DS0000010419.V336465.R01.S.doc Version 5.2 Page 20 Health and safety checks are done regularly. Building and equipment safety certificates were checked – these were up to date and in order. The home has a current Fire Risk Assessment and all staff receive regular fire safety training. Cedars Nursing Home DS0000010419.V336465.R01.S.doc Version 5.2 Page 21 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Cedars Nursing Home DS0000010419.V336465.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP30 Regulation 12(1); 18(1) Requirement The Registered Persons must ensure that night staff receive the same level of training as that offered to day staff. Previous timescale of 30/0/7 not met. The Registered Persons must ensure that activities staff are provided with training in communicating with people with cognitive impairment and dementia Timescale for action 30/07/07 2. OP12 OP30 18(1) 30/07/07 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 Standard Good Practice Recommendations Cedars Nursing Home DS0000010419.V336465.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Cedars Nursing Home DS0000010419.V336465.R01.S.doc Version 5.2 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. 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