Inspection on 12/06/06 for The Cedars

This inspection was carried out on 12th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 25/10/07

The Cedars 31/01/07

The Cedars 17/03/06

The Cedars 02/11/05

The Cedars 25/02/05

The Cedars 17/08/04

The Cedars 24/02/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Cedars (The) Angel Lane Shaftesbury Dorset SP7 8DF Lead Inspector Gloria Ashwell Unannounced Inspection 12th June 2006 12:00 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 (The) DS0000020499.V299529.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 (The) DS0000020499.V299529.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedars (The) Address Angel Lane Shaftesbury Dorset SP7 8DF 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) 01747 852860 01747 852722 The Community Health Association of Shaftesbury Limited Care Home 26 Category(ies) of Dementia - over 65 years of age (26), Old age, registration, with number not falling within any other category (26) of places Cedars (The) DS0000020499.V299529.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th March 2006 Brief Description of the Service: The Cedars is a converted and extended detached premises close to the centre of Shaftesbury providing accommodation for 26 residents. The home is registered to provide nursing and social care to older people, including those with dementia type illnesses. The Cedars is owned by the Community Health Association of Shaftesbury; a charitable company limited by guarantee. Ownership of the home is represented by a Board of Trustees. The longstanding registered manager retired from the home’s employ on 31 May 2006; since that time the day to day running of the home has been overseen by Mrs Ballard, the registered manager of Castle Hill House, being a nearby care home registered to the same provider organisation. Laundering of clothing and household linen is carried out at the home and arrangements can be made for chiropodists, opticians and other health and social care professionals to visit individual residents. The home has a fully enclosed courtyard style garden, an open garden to one side and car parking at the front of the home. The home is located in the centre of Shaftesbury, close to shops and other amenities including bus services. Fees are charged weekly and at present range between £535 and £683 per person. Cedars (The) DS0000020499.V299529.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a statutory inspection required in accordance with the Care Standards Act 2000. Since the last inspection no formal complaints against the home have been received or investigated by the Commission. The inspection was unannounced and carried out by Regulation Manager Sue Barber and Lead Inspector Gloria Ashwell. The inspectors spoke to acting manager Mrs Ballard and members of nursing, care and household staff, in addition to 9 residents. The inspectors were assisted throughout their visit by the deputy manager. The inspection process included observing staff interaction with residents and the carrying out of routine tasks. The duration of the inspection was 5 hours. Additional information used to inform the inspection process included the monthly reports sent to the Commission by the provider organisation; the home is at present in the process of completing for the Commission a questionnaire providing details of various administrative and maintenance functions. During the 7 days following the inspection a number of completed Comment Cards were sent to the Commission: 25 from the relatives of residents, 2 from local doctors and 3 from health and social care professionals. All comments indicated general satisfaction with The Cedars; a number were very positive and one observed “The Cedars is exceptional…the staff here are wonderful people”. During this inspection compliance with the key standards of the National Minimum Standards was assessed; the major focus was on care standards and associated record keeping and compliance with the requirements and recommendations included in the report of the last inspection. Cedars (The) DS0000020499.V299529.R01.S.doc Version 5.2 Page 6 What the service does well: 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. Cedars (The) DS0000020499.V299529.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 (The) DS0000020499.V299529.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (The home does not provide intermediate care so Standard 6 does not apply) Quality in this outcome area is variable. This judgment has been made using available evidence including a visit to the service. Prior to admission, the needs of each proposed resident are usually assessed and the home then writes to prospective residents confirming the ability to properly care for them but there was no evidence of the pre-admission assessment of a recently admitted resident or of a letter sent by the home in advance of the admission confirming that the persons needs could be met by The Cedars. It is now becoming apparent that staff may not have enough information to properly meet and understand the needs of this person. EVIDENCE: The records of a recently admitted resident included details of the preadmission assessment carried out by the deputy manager when she visited the prospective resident in a nearby hospital, but for another resident there was no evidence of pre-admission assessment. The deputy manager explained that Cedars (The) DS0000020499.V299529.R01.S.doc Version 5.2 Page 9 this person had been admitted by a member of staff no longer in the home’s employ; the home had received insufficient information upon which to form a judgment regarding the capacity to meet the persons’ needs and is now trying to arrange for the person to be moved to another care environment. The resident indicated dissatisfaction with the home and said she had not been involved in the admission arrangements. To ensure that adequate information is considered when making the judgement to accept the resident into The Cedars, and that staff have enough information to properly meet the residents needs, it is required that comprehensive assessment details are recorded in advance of all new admissions and a letter confirming the homes’ ability to meet the assessed needs be sent to the prospective resident before the admission takes place. Cedars (The) DS0000020499.V299529.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good with regard to standards of care, but poor regarding associated recordkeeping. This judgment has been made using available evidence including a visit to the service. Care is delivered in accordance with a written plan of care but simplification of care documentation systems would improve provision of information necessary to guide/direct staff in their work. Resident’s health needs are mostly met, although periodic audit of accidents is not reliably recorded and thereby risks of recurrence may not always be minimised. Residents with complex health needs including wound management receive good nursing care. Medicine storage and handling is properly carried out to ensure that residents receive medicines as prescribed, to promote/maintain their health. Records of administered medicines must be improved to ensure the continued correct administration of all prescribed medicines. Cedars (The) DS0000020499.V299529.R01.S.doc Version 5.2 Page 11 In general, residents are treated with respect and their privacy and dignity is protected but one resident expressed concern about some aspects of staff conduct – the home will further investigate to determine if this is substantiated. EVIDENCE: Care plans and associated documentation are soon to be reviewed; the current system requires a great number of separate records being kept for each resident, including many which are repetitive and sometimes no longer relevant, and others which omit essential details because they have not been reliably updated in accord with changes in the person’s condition and needs. It is required that for each resident the care plan be comprehensive, up to date and accurate. It is again recommended that a system of internal care plan audit be implemented, to simplify, clarify and when necessary, archive the records. Records indicated that there have recently been a number of accidents involving the same resident. Since the last inspection the home has commenced use of an Incident Record, but upon examination this was found to duplicate details of the accidents recorded on separate forms. It is recommended that the home develop and implement a policy for the recognition and recording of incidents, and again recommended that accidents be periodically audited to identify any patterns or trends, in order that actions to minimise risk of recurrence may be promptly implemented as needs arise. Medicines prescribed by doctors are safely stored and carefully administered to residents by trained nurses, although some improvements to the recording systems should be made. The home uses a monitored dosage system for the administration of prescribed medicines; to ensure the continued correct administration of prescribed medicines the records are to be improved as follows: Handwritten amendments to the printed medicine administration records (MARs) must be signed, dated and countersigned by a person who has checked the entry for accuracy. When a variable dose is prescribed the records must state the amount administered on each occasion. Each medication administration record should state the allergy status of the resident, or “none known” when this is the circumstance. In general residents expressed satisfaction with all aspects of the home and in the presence of staff appeared relaxed, confident and at ease; staff interactions with residents were of a friendly and considerate manner. Cedars (The) DS0000020499.V299529.R01.S.doc Version 5.2 Page 12 However, one resident said that staff of a particular shift have been rude and unhelpful; the home will investigate this matter to determine if it is substantiated and must notify the Commission of the outcome. (If upon initial investigation it appears possible that the complaint may be substantiated, the home must act in accordance with the complaints and abuse policies and procedures.) Cedars (The) DS0000020499.V299529.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The quality of daily life in the home is good with residents assisted to maintain as much independence as possible. Social and leisure activities are suited to the preference and ability of each resident. Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home. Meals are appetising and of good quantity and quality. A combined lounge/dining room is available on each of the two floors but most residents take meals in their bedrooms. EVIDENCE: The inspectors visited a number of residents including many who were very frail and unable to reliably communicate; all those able to express an opinion indicated satisfaction with the range of activities, meal provision, and premises. Cedars (The) DS0000020499.V299529.R01.S.doc Version 5.2 Page 14 The home employs an Activity Organiser who attends for two sessions each week to arrange quizzes and ‘music and movement’; it is recommended that the number of hours be increased to enable a greater range of small group and one to one activities to take place. Visitors are welcome at any time and those present during the inspection said they are always made to feel welcome and placed at ease by the staff. Residents said they were satisfied with the quality, choice and quantity of food provided. Since the last inspection the home has introduced a choice of main courses available for the midday meal; one resident said that the range of choices was good; “I pick and choose – they come round and ask (for my selection from the menu)...they look after me and feed me well”. On each of the two floors there is a combined lounge/dining room but due to the severe frailties of most residents currently accommodated these rooms are rarely used at present. Cedars (The) DS0000020499.V299529.R01.S.doc Version 5.2 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 & 18 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The complaints procedure provides information on the procedure to follow to persons wishing to make complaint and service users know how to complain. The home adheres to a policy/procedure for the prevention of abuse and staff receive training in this subject to ensure they remain vigilant to protect vulnerable residents from risks of abuse. EVIDENCE: No complaints against the home have been received or investigated since the last inspection. The home has a policy/procedure for the prevention of abuse and staff have received training in this subject to ensure the proper protection of residents. Cedars (The) DS0000020499.V299529.R01.S.doc Version 5.2 Page 16 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 & 26 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The Cedars is a well-appointed and comfortable home, providing a safe and comfortable environment for residents and staff. On the day of inspection the home was clean, pleasant and hygienic and there was evidence indicating that this is the usual standard of provision, which protects service users from risks of infection. EVIDENCE: The Cedars is a partly traditionally built house, and partly purpose built extension. It offers compact bedrooms, bathrooms equipped for the use of persons requiring assistance and a communal room on each of the two floors. Cedars (The) DS0000020499.V299529.R01.S.doc Version 5.2 Page 17 Since the last inspection the separate dining room of the first floor has been changed into a bedroom, and the dining tables and chairs moved to the small lounge on this floor, a room not ideally suited to this combined purpose and currently accommodating two filing cabinets in addition to the armchairs and dining facilities. It is intended for the ground floor lounge/dining room to become the main communal room of the home, used by residents of both floors, and for the smaller first floor room to be returned to its’ original purpose as a ‘quiet room’ for the relaxation of residents preferring to remain apart from the main activities of the home. To enable ease of access to the garden from the ground floor lounge by persons with poor mobility and/or requiring the use of wheelchairs it is recommended that a ramp or similar device be provided. On the day of inspection the home was clean, tidy and comfortable throughout; there were no unpleasant odours. Cedars (The) DS0000020499.V299529.R01.S.doc Version 5.2 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): 27, 28, 29 & 30 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The home employs enough staff to meet the needs of residents and to ensure their safety and comfort and the good condition of the premises. Recruitment practices ensure the protection of residents from potentially unsuitable staff. Staff receive appropriate training and are competent to carry out their jobs. EVIDENCE: Registered nurses lead the care teams and staffing levels are provided in accordance with the assessed needs of residents to ensure that at all times sufficient staff are available to properly meet their needs. All staff spoken with during the inspection were enthusiastic about their work and felt that they provided a good standard of care to residents and are properly supported by the management and training provision. The records of two recently employed staff members were examined and found to contain all essential information including two written references, evidence of identity and induction training and Criminal Records Bureau (CRB) disclosures. Cedars (The) DS0000020499.V299529.R01.S.doc Version 5.2 Page 19 All staff receive training appropriate to their role and responsibilities; a recently employed nurse and a member of the household staff said relevant training had been properly provided. At present almost 50 of the care staff currently employed by the home hold a National Vocational Qualification in care and arrangements are underway for more to undertake training for this award; the home is thereby close to meeting the standard for at least 50 of the care staff to hold an NVQ. Cedars (The) DS0000020499.V299529.R01.S.doc Version 5.2 Page 20 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, 35 & 38 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The home is well managed and staff understand their work and receive training appropriate to their needs. Most residents are satisfied with the home and feel staff care for them well and put them at their ease. The home does not manage the finances of residents. The home is well maintained although particular aspects of premises safety must be improved to ensure the continued safety of all persons in the home. Cedars (The) DS0000020499.V299529.R01.S.doc Version 5.2 Page 21 EVIDENCE: The long-standing registered manager retired from the home’s employ on 31 May 2006; since that time the day to day running of the home has been overseen by Mrs Ballard, the registered manager of Castle Hill House, being a nearby care home registered to the same provider organisation. Mrs Ballard is supported in her role by a deputy manager who is an experienced nurse employed at The Cedars on a full time basis. Call system cables were observed to trail across the floors of many bedrooms and one recently occasioned a member of staff to fall sustaining injuries; it is required that tripping hazards are minimised and that call bell cables do not pose such risks. As noted in the reports of previous inspections, on occasion linen cupboard doors were left open contrary to fire regulations; the inspectors suggested the installation of a buzzer or magnetic closure to minimise this circumstance. The deputy manager stated that there are regularly recorded checks and tests of fire safety equipment; records sampled during the inspection confirmed that regular fire drills take place and alarm bells are tested at the required frequencies. The premises are currently undergoing improvement to ensure that they continue to provide a comfortable, attractive and safe environment. Cedars (The) DS0000020499.V299529.R01.S.doc Version 5.2 Page 22 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Cedars (The) DS0000020499.V299529.R01.S.doc Version 5.2 Page 23 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 OP3 Regulation 14 Requirement Comprehensive assessment details must be recorded in advance of all new admissions. For each resident the home must record a comprehensive and accurate care plan. When a variable dose is prescribed the amount actually administered on each occasion must be recorded. Previous timescale of 18/04/06 not met. Handwritten entries in medication instructions must be signed and dated by the writer and countersigned by a member of care staff who has checked the entry for accuracy. Previous timescale of 18/04/06 not met. Linen cupboard doors must be kept shut when not in use, in accordance with the written instructions on the label on the door. Previous timescales of 15/01/06 and 18/03/06 not met. DS0000020499.V299529.R01.S.doc Timescale for action 12/07/06 2. OP7 15 & 13 01/08/06 3. OP9 13 12/07/06 4. OP9 13 12/07/06 5. OP38 23(4) 12/07/06 Cedars (The) Version 5.2 Page 24 6. OP38 13 Tripping hazards must be 12/07/06 minimised; appropriate action must be taken to ensure that call bell cables do not pose such risks. 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 a system of internal care plan audit be implemented, to simplify, clarify and archive the records. This recommendation was also included in the report of the last inspection. It is recommended that accidents and incidents be periodically audited to identify any patterns or trends, in order that actions to minimise risk of recurrence may be promptly implemented as needs arise. This recommendation was also included in the report of the last inspection. It is recommended that the home develops and implements a policy for the recognition and recording of incidents. It is recommended that each medication administration record states the allergy status of the resident, or “none known” when this is the circumstance. It is recommended that the number of hours worked by an Activity Organiser be increased. It is recommended that to enable ease of access to the garden from the ground floor lounge by persons with poor mobility and/or requiring the use of wheelchairs a ramp or similar device be provided. 2. OP8 3. OP8 4. OP9 5. 6. OP12 OP19 Cedars (The) DS0000020499.V299529.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 (The) DS0000020499.V299529.R01.S.doc Version 5.2 Page 26 - 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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