Inspection on 16/11/05 for The Cedars Care Centre

This inspection was carried out on 16th November 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

The Cedars Care Centre 14/05/07

The Cedars Care Centre 11/01/07

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 Unannounced Inspection 16th November 2005 09:00 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 Nursing Home DS0000010419.V261268.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. Cedars Nursing Home DS0000010419.V261268.R01.S.doc Version 5.0 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 8449 9252 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.V261268.R01.S.doc Version 5.0 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. 27th July 2005 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. Cedars Nursing Home DS0000010419.V261268.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day. It was undertaken by Inspector Margaret Flaws, as part of the routine schedule of inspections for the home. The Registered Manager, David Adams assisted with the inspection throughout the day. The inspector spoke to ten nursing, care, activities, kitchen and domestic staff. The inspector also spoke to twelve service users and six relatives and friends during the inspection. A tour of the buildings and grounds, inspection of service user files, staff records, general home records and policies and procedures formed the basis of the inspection. Five new requirements were made on this inspection and two were restated from the last inspection. What the service does well: What has improved since the last inspection? What they could do better: Several minor requirements are made in relation to care planning documentation. Care plan fall records must to be kept up to date and any falls recorded in the accident books must be parallel recorded in the service users’ files. All risk assessments must be kept up to date and scores totalled. Consent for pressure sore photography must be clearly documented. Cedars Nursing Home DS0000010419.V261268.R01.S.doc Version 5.0 Page 6 All new staff must have CRB clearances before starting work. POVA checks must be done for staff who have started work and are waiting for CRB clearances. Finally, the home must source diabetes training for the nursing staff. 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. Cedars Nursing Home DS0000010419.V261268.R01.S.doc Version 5.0 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.V261268.R01.S.doc Version 5.0 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 the following standard(s): 3 Service users can be confident that their needs will assessed prior to admission and that they will be provided with the degree of information they require to decide on the suitability of the home. EVIDENCE: Service users have good information in advance about the care provided. Relatives spoken to described their process of selecting the home and the reasons why they chose it. Assessments on file give a good basis for care planning. Several service users at the home came there because of a fire at another care home. They do not have their original assessments on their current files. Likewise, their files are missing previous notes and other key information. However, Cedars had done re-assessments. Cedars Nursing Home DS0000010419.V261268.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9 and 10 Service users’ personal, health and social care needs are set out clearly in care plans and with minor exceptions, this documentation is complete. Staff are knowledgeable about service users’ needs. EVIDENCE: The health care plans of nine service users were inspected and seven service users spoken to. All of those admitted directly to Cedars had comprehensive plans of care, risk assessments, and documentation, such as falls records and nutrition assessments. Some falls were recorded in the accident and incident records but the information was not duplicated in service users’ falls records. This is required. Some night care plans needed updating and some scores on risk assessments were not totalled. This is also required. The files of the service users admitted in an emergency after a fire at another home were incomplete. Cedars has made good progress filling in information gaps and staff said that they had worked well with these service users and in several cases, seen the health status’ and wellbeing of these service users improve dramatically. There are still seven service users from the fire evacuated home at Cedars. Cedars Nursing Home DS0000010419.V261268.R01.S.doc Version 5.0 Page 10 Some photographs taken of service users’ pressure sores kept on their files noted that permission to take the photos been obtained, but it was unclear who had consented, the service user or the next of kin. The home should ensure that when pressure sore photos are taken, permission is clearly documented. All pressure sores had originated from service users’ hospital admissions. A tissue viability nurse is involved and staff have had recent training in pressure care. The home does provide a broad range of care. Some service users come to Cedars for terminal and palliative care and some return home after a period. Relatives and service users spoken to were universally positive about the standard of care provided. All said that they were treated with respect and that staff knew them and their needs very well. Cedars Nursing Home DS0000010419.V261268.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14 and 15 The home offers service users a good choice of activities and opportunities for family involvement. Service users and relatives were positive about the care at the home and about the quality of food provided. EVIDENCE: During the inspection, several activities took place - quizzes, monopoly and scrabble. The care staff participated very actively in the games with the service users. Several service users spoken to in their rooms and in the communal areas said that they had good choice of activities but also enjoyed being in their rooms, reading and watching television. Two activities coordinators are employed to cover the weekdays. There are no planned activities at the weekend. One activities coordinator said that there are problems getting group transport for service users to go out and also for wheelchair bound service users. She also said that Dial a Ride no longer provides group transport. Seven relatives were spoken to during the inspection. They all said that they were very pleased with the standard of care at the home and that they were involved fully in decisions about the care of the service users and that they Cedars Nursing Home DS0000010419.V261268.R01.S.doc Version 5.0 Page 12 could visit at any time. One said that her mother, who came in several months ago, had “not been this good for four years”. All the service users and their families said that their choices were well supported by the home, that they could get up and go to bed as they chose and participate in activities or not. The lunch prepared on the day was a homely dish (roast lamb) and the cook said that it was such a popular meal that they usually didn’t offer a choice. The menus were inspected and generally offered excellent choices, including a daily cooked breakfast, a large three course lunch, then soup, salad and sandwiches in the evenings. The cook said that there was a good budget for food and that she could introduce new options. The fridges were full of fresh vegetables and quality food supplies. Freezer temperatures were checked and were consistently lower than –18C. The Registered Manager described plans to move the kitchen closer to the dining room. Cedars Nursing Home DS0000010419.V261268.R01.S.doc Version 5.0 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 the following standard(s): 16 and 18 Service user can be assured that complaints will be appropriately investigated and followed up, that adult protection policies and procedures are in place and that staff are trained to put these into practice if required. EVIDENCE: There has been only one complaint since the last inspection, which is still in the process of being investigated. Documentation relating to this complaint was examined and it demonstrated that good process was being followed. The care plans of the service user involved in the complaint were examined and the care case tracked. The complaints book evidenced that all complaints are appropriately followed up and investigated. Staff records indicated that all staff have received adult protection training, most recently in April 2005. The Registered Manager delivers this training having completed a Train the Trainer course. Staff were able to describe how they would deal with allegations or incidents of abuse. Cedars Nursing Home DS0000010419.V261268.R01.S.doc Version 5.0 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 the following standard(s): 19 and 26 The environment for service users is comfortable, clean and pleasantly attractive. This includes both service users’ bedrooms and communal areas. EVIDENCE: The home was clean, hygienic and free from offensive odours on the day of the inspection. The kitchen was also inspected and was clean. Kitchen staff receive regular job specific training. Cleaning staff said that they were well resourced to do their jobs and that they had been taught regularly about infection control. The overall environment is very pleasant, with several large communal spaces. Some service users and relatives were interviewed in their bedrooms, which were comfortable and well furnished. Cedars Nursing Home DS0000010419.V261268.R01.S.doc Version 5.0 Page 15 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): 27, 28, 29 and 30 The home has the right numbers and skill mix of staff to meet the service users’ needs. The service users would be better protected by necessary improvements in the recruitment process, in particular regarding preemployment CRB checks. EVIDENCE: All staff spoken to said that the ratio of staff to service users was very good and adequate for the needs of the service users. The Registered Manager and staff said that staffing levels are regularly re-assessed according to service user’ dependency levels. Staff said that additional staff are always put on duty if they are needed and that staffing levels have been increased over time. The staff rota confirmed this. Four staff have been transferred from the fire affected home and have now been permanently appointed to the Cedars’ team. All of these staff have been fully inducted but the transfer of their staff records from the previous employer has not yet been achieved, partly due to the fire. Cedars has a relatively low staff turnover. Several staff records were examined and while good process has generally been followed and allowing for the difficulty of obtaining the records of transferred staff , there were some lapses. Three staff members from overseas did not have a British criminal records check, along with one other staff member. POVA First clearances are required for all of these staff Cedars Nursing Home DS0000010419.V261268.R01.S.doc Version 5.0 Page 16 members, pending CRB clearances being obtained. A previous requirement for an existing staff member to have a CRB clearance have been complied with. Staff training records were examined and showed evidence of foundation training regularly provided, including manual handling, fire training, food hygiene, safe handling of medications and areas of clinical care. Nursing staff have not yet received updated training in diabetes. The Registered Manager said that they have had some problems in sourcing this training for nurses, which is readily available for carers. The requirement is restated. Staff receive regular documented supervision and were very positive about the measure of support they receive. Cedars Nursing Home DS0000010419.V261268.R01.S.doc Version 5.0 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 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): 31, 33, 36 and 38 Service users’ health and safety is protected in the home and they benefit from a well run home. EVIDENCE: All staff and service users and relatives spoken to said that the home was well managed in their interest. Health and safety certificates were in order. Accident and incident records were examined and were complete. A previous requirement to amend the home’s evacuation procedure in consultation with the LFEPA has been met. Staff have had regular fire safety training. A requirement to review the written agreement with relatives regarding hospital admissions has been done and a protocol developed. Cedars Nursing Home DS0000010419.V261268.R01.S.doc Version 5.0 Page 18 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X 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 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 3 Cedars Nursing Home DS0000010419.V261268.R01.S.doc Version 5.0 Page 19 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 OP7 Regulation 13 (4) Requirement The Registered Person must ensure that falls are recorded in both in the home’s falls records and in the relevant service users’ files. The Registered Person must ensure that scores on all risk assessments are totalled. The Registered Person must ensure that all care plans, including night care plans are regularly reviewed. The Registered Person must ensure that where photographs are taken of service users’ pressure sores, permission is clearly documented, including the details of who has granted permission. The Registered Person must ensure that POVA First checks be obtained for existing staff member waiting for CRB clearances. The Registered Person must ensure that all new staff members have a CRB clearance before starting work. The Registered Person must DS0000010419.V261268.R01.S.doc Timescale for action 31/01/06 2 3 OP7 OP7 13 (4) 15 (2) 31/01/06 31/01/06 4 OP8 17 (1) 31/01/06 5 OP29 19 (5) 31/01/06 6 OP29 19 (5) 31/01/06 7 OP37 12 (1), 28/02/06 Page 20 Cedars Nursing Home Version 5.0 13(1) ensure that nursing staff update their training in the care of service users with diabetes. 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.V261268.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Cedars Nursing Home DS0000010419.V261268.R01.S.doc Version 5.0 Page 22 - 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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