Inspection on 24/01/06 for Silverleigh Cedars

This inspection was carried out on 24th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Silverleigh Cedars 30/06/09

Silverleigh Cedars 10/05/07

Silverleigh Cedars 03/08/05

Silverleigh Cedars 25/01/05

Silverleigh Cedars 03/08/04

Silverleigh Cedars 17/02/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Silverleigh Cedars Silver Street Axminster Devon EX13 5AF Lead Inspector Vivien Stephens Unannounced Inspection 24th January 2006 2:30 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 Silverleigh Cedars DS0000022030.V266879.R01.S.doc Version 5.1 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. Silverleigh Cedars DS0000022030.V266879.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Silverleigh Cedars Address Silver Street Axminster Devon EX13 5AF 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) 01297 32611 01297 32559 Silverleigh Limited Christine Susan Brooke Care Home 54 Category(ies) of Dementia - over 65 years of age (54), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (54), Old age, not falling within any other category (54), Physical disability over 65 years of age (54) Silverleigh Cedars DS0000022030.V266879.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd August 2005 Brief Description of the Service: Silverleigh Cedars is a detached, converted and extended property set in its own grounds in the centre of the town of Axminster. The home is laid out in two distinct parts - one side is known as Silverleigh and the other side is known as Cedars. Accommodation and personal care is provided for up to 54 older people who may also have a physical disability, mental disorder or dementia type illness. There are five lounges and two dining rooms plus other smaller sitting areas around the home. There are 36 single bedrooms, 5 double rooms and 4 apartments each consisting of an entrance hall, living room, kitchenette, bedroom and bathroom. 30 of the bedrooms have an en suite W.C. There are bedrooms on the ground, first and second floors. Passenger lifts provide access to all levels. There is also a stair lift. Outside, there are pleasant and interesting gardens with plenty of seating, and a private parking area. Silverleigh Cedars DS0000022030.V266879.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection started at approximately 2.30pm and finished at 7pm. During the afternoon discussions took place with 10 residents and 8 staff. The manager, Sue Brooke was present for the last 1½ hours of the inspection. The home submitted a pre-inspection questionnaire in advance of the visit. During the inspection care plans, financial records, staff recruitment files and medication administration records were seen. What the service does well: Good information is given to prospective new residents before they move in. Residents interviewed during the inspection said they were very happy living at Silverleigh/Cedars and thought they had made the right choice. Assessments are carried out to ensure the home can meet their needs. A few days after admission a care plan is drawn up covering all aspects of individual care needs. The storage and administration of medicines were checked and found to be entirely satisfactory. Staff have received good training and safe systems have been implemented. The home provides an exceptional range of outings and activities to suit every resident. A team of staff are employed to provide assistance with group and individual activities. Detailed care plans show the interests of each resident and how these will be met. Visitors are always made welcome. Residents expressed confidence in the home’s concerns and complaints procedures. Staff have received good training and support to enable them to recognise and speak out against any areas of poor practice or possible abuse. The home has been maintained and decorated to a very high standard throughout. Four maintenance staff are employed to ensure constant improvements are carried out. Staffing levels are high. The home takes good care when recruiting new staff to ensure residents are safeguarded, and to ensure the staff have the right abilities and approach. Residents were full of praise for the caring manner of the staff. Discussions with residents and staff confirmed that the staff respect and uphold residents’ rights of privacy, dignity, choice and independence at all Silverleigh Cedars DS0000022030.V266879.R01.S.doc Version 5.1 Page 6 times. A very good level of training has been provided covering all relevant subjects. 81 of the staff have achieved NVQ level 2 or above. The staff demonstrated a confident, caring and professional manner. The home has good procedures in place to safeguard residents’ cash and valuables. Good care is taken to ensure the health and safety of staff and residents at all times. 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. Silverleigh Cedars DS0000022030.V266879.R01.S.doc Version 5.1 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 Silverleigh Cedars DS0000022030.V266879.R01.S.doc Version 5.1 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 Good admission and assessment procedures are in place. EVIDENCE: Some of the residents who had recently moved into the home talked about the process of choosing the home and moving in. Wherever possible a representative (usually the Manager) from Silverleigh/Cedars carries out a home visit to meet the prospective new resident and carry out an assessment of their needs. The assessment form covers all relevant aspects of their personal, health and social care needs. The prospective resident is invited to visit the home, stay for a meal, or to have day care or respite care for a period before making a decision to move in permanently. They are given verbal information that is backed up by a comprehensive ‘welcome pack’ containing a range of useful information about the home. A copy of this, plus the most recent inspection report, is kept in the entrance hallway. It is unusual for residents to be admitted in an emergency, but where this has happened the home has carried out an assessment on admission. Silverleigh Cedars DS0000022030.V266879.R01.S.doc Version 5.1 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, 9, 10 Thorough care plans have been drawn up covering all aspects of individual care needs. The systems of storage and administration of medicines are safe and secure. The privacy and dignity of residents are upheld by staff at all times. EVIDENCE: Five care plans were case tracked during the inspection. The care planning system has not changed since the last inspection. There are two distinct parts – one part covers the health and personal care needs and the other part covers the daily life and social needs. The care staff have responsibility for the health and personal care plans, and daily reports showed how the plans have been met. The Activities Organisers have responsibility for the social activities care plans, and these are also detailed. A range of systems are in place to ensure staff carry out the care tasks at times to suit the residents. There are two separate storage areas for medications, one in Silverleigh and one in Cedars. The medicines are kept in modern, well-equipped and secure Silverleigh Cedars DS0000022030.V266879.R01.S.doc Version 5.1 Page 10 rooms. Each part of the home has a medicines trolley and locked medicines cupboards. Tablets are supplied where possible in a monitored dosage system. Good records have been kept to show medicines ordered, administered, and where unwanted medicines have been returned to the pharmacist. Controlled drugs are stored and recorded correctly. Policies on the safe administration of medicines are in place and these have been recently updated. All staff have recently undertaken training on the safe administration of medicines. No residents held or administered their own medicines at the time of this inspection but this would be possible if they wished (depending upon a satisfactory risk assessment). Residents said they were happy with the way the home administers their medicines. Staff talked about how they maintain privacy and dignity. They said this subject was covered in their induction and in on-going training. They also talked about specific instructions in the care plans, such as the name the resident wishes to be known by. Staff were seen knocking on doors and treating residents in a respectful manner. Residents praised the staff and confirmed that their privacy and dignity are always respected. The home has a range of policies and procedures in place that ensure the cultural background of both residents and staff are respected at all times. Silverleigh Cedars DS0000022030.V266879.R01.S.doc Version 5.1 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 The home provides an exceptionally high level of assistance with individual and group activities to meet all interests. Relatives and friends are always made welcome. EVIDENCE: At the time of this inspection a number of activities were taking place. A group of residents had gone out for the afternoon in the home’s minibus. An activities organiser was working in one of the main lounges playing games and sitting and talking to residents. An occupational therapist was holding an art class in a small room off another main lounge. Residents talked about some of the things they enjoy doing including knitting, crosswords and reading. A large screen television has recently been provided for one of the lounges and residents talked about some of the programmes they enjoy watching. Exercise classes, swimming sessions and computer lessons are just some of the various activities that are provided. Separate care plans have been drawn up covering the social needs of each resident, and the home employs an activities organiser and large team of activities staff to ensure all individual needs are met. Residents talked about how staff take them out and about in the town, shopping or to community events. Silverleigh Cedars DS0000022030.V266879.R01.S.doc Version 5.1 Page 12 During the afternoon a number of visitors were welcomed by staff. The home encourages visitors at all times. Silverleigh Cedars DS0000022030.V266879.R01.S.doc Version 5.1 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, 18 The home has good systems in place to deal with any concerns or complaints. Staff have received good training and support to enable them to recognise and speak out against any areas of poor practice or possible abuse. EVIDENCE: The home has a clearly worded complaints procedure. A copy of the procedure is provided in the ‘welcome pack’ and a copy is kept in the entrance hallway. Residents said they felt confident that if they had any concerns or complaints they could speak to one of the staff or to the manager and the matter would be sorted out quickly and satisfactorily. One complaint has been received since the last inspection. The matter has been investigated and the complaint was not upheld. The staff confirmed that they have all received training on the protection of vulnerable adults. They were aware of the home’s policies and procedures, and also knew about the Devon Social Services Alerters’ Guidance. They were confident that they could speak out if they had any concerns and these would be dealt with appropriately. Silverleigh Cedars DS0000022030.V266879.R01.S.doc Version 5.1 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 Constant improvements are being made to ensure the standards of decoration and safety are always maintained to the highest standards. EVIDENCE: During the inspection the communal areas of the home were seen plus a sample of some of the bedrooms. All areas of the home have been maintained to a very high standard. Four maintenance people are employed thus ensuring that all areas are regularly decorated, repairs carried out promptly, and improvements are being made constantly. When bedrooms become vacant they are completely redecorated and thoroughly cleaned. The gardens and exterior of the home were neat and tidy and in good order. Silverleigh Cedars DS0000022030.V266879.R01.S.doc Version 5.1 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, 30 Staffing levels are high. Residents are safeguarded by careful recruitment procedures. Staff have received a very good level of training. Staff demonstrated a confident, caring and professional manner. EVIDENCE: Copies of recent staff rotas were supplied prior to this inspection. Staff interviewed during the inspection confirmed that there have been no changes in the staffing levels since the last inspection. Residents said they were completely satisfied with the number of staff provided, their caring manner, and their competence. In the mornings there are usually 19 care staff, 6 activities staff, 1 housekeeper, 7 domestics, 2 cooks, 4 maintenance, 3 administrators and 1 manager. A physiotherapist is employed for 3 hours per day. In the afternoons there are usually 12 care staff, 6 activities staff, 1 housekeeper, 2 domestics, 1 cook, 4 maintenance, 3 administrators and 1 manager. In the evenings there are usually 11 care staff and 3 domestic staff. Silverleigh Cedars DS0000022030.V266879.R01.S.doc Version 5.1 Page 16 At night there are normally 4 waking care staff and 2 sleeping-in staff on the premises. The recruitment files were seen of three staff employed by the home since the last inspection. These showed that application forms had been completed, interviews carried out, at least two satisfactory references plus CRB and POVA checks carried out. Job descriptions, contracts of employment, staff evaluation and induction records were in place. Staff talked about the training they have received and said they felt the level of training was very good. NVQs have been encouraged and this is reflected in the very high percentage of staff who hold this qualification – information provided for this inspection showed that 81 of the staff have achieved NVQ level 2 or above. Information provided for this inspection show that staff have received a wide range of training both in-house and through external training providers. All mandatory health and safety topics have been covered plus specific care related topics such as ‘old age’, stroke awareness, pain relief, aggression safe administration of medicines and the protection of vulnerable adults. Plans are in place to meet future training needs. Silverleigh Cedars DS0000022030.V266879.R01.S.doc Version 5.1 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): 35, 38 The home has good procedures in place to safeguard residents’ cash and valuables. Good care is taken to ensure the health and safety of staff and residents at all times. EVIDENCE: Some residents have asked the home to hold cash on their behalf to pay for personal items such as hairdressing, toiletries and small daily shopping requirements. The cash is held securely in individual wallets, and each transaction is individually recorded and balances checked. A sample of the records and balances were checked, and these were found to be satisfactory. The home will provide secure storage for valuable items if required, but wherever possible these are passed to families or legal representatives to take Silverleigh Cedars DS0000022030.V266879.R01.S.doc Version 5.1 Page 18 responsibility. Policies and procedures are in place to safeguard individual financial interests. Risk assessments have been carried out on the premises. Two members of staff have responsibility for health and safety in the home. Both staff keep themselves up-to-date with new legislation and good practice. They ensure that this information is passed on to the rest of the staff group. They also ensure that staff are working in a safe manner and that equipment is provided where necessary. In addition the cooks have responsibility for health and safety in the kitchens and one of the maintenance staff has responsibility for ensuring safe use of any chemicals in the home. Training records seen during the inspection showed that all staff have received health and safety topics including moving and handling. The senior staff recently attended infection control training at the Royal Devon and Exeter hospital. Staff were aware of the home’s policies and procedures on health and safety. Silverleigh Cedars DS0000022030.V266879.R01.S.doc Version 5.1 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 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 4 8 X 9 4 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X X STAFFING Standard No Score 27 4 28 3 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 4 Silverleigh Cedars DS0000022030.V266879.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? No 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. Refer to Standard Good Practice Recommendations Silverleigh Cedars DS0000022030.V266879.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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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