Inspection on 20/06/07 for The Cedars

This inspection was carried out on 20th June 2007.

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

The Cedars 06/10/05

The Cedars 27/06/05

The Cedars 23/02/05

The Cedars 01/09/04

The Cedars 01/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE The Cedars 78 Morton Terrace Gainsborough Lincs DN21 2RJ Lead Inspector Mr David Bacon Key Unannounced Inspection 20th June 2007 08:00 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 The Cedars DS0000041858.V324007.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. The Cedars DS0000041858.V324007.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cedars Address 78 Morton Terrace Gainsborough Lincs DN21 2RJ 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) 01427 612129 angelakirman@lincolnshire.gov.uk www.lincolnshire.gov.uk Lincolnshire County Council Angela Kirman Care Home 35 Category(ies) of Dementia - over 65 years of age (11), Old age, registration, with number not falling within any other category (23), of places Physical disability over 65 years of age (1) The Cedars DS0000041858.V324007.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home is registered to provide personal care for service users of both sexes whose primary needs fall within the following categories:Old Age, not falling within any other category (OP) (23) Dementia - over 65 years of age (DE(E)) (11) Physical Disability - over 65 years of age (PD(E)) 1 The maximum number of service users to be accommodated is 35. 2. Date of last inspection 6th October 2005 Brief Description of the Service: The Cedars is a care home run by Lincolnshire County Council. It is a purpose built two-storey home that offers care and accommodation for older persons on a permanent and respite basis. The home is also registered for the short term care of people who have dementia. The home is situated to the north of the town, in a residential area off the main road. There are local facilities available and the town of Gainsborough is approximately a mile away. It is set in large, well maintained grounds, with gardens to the front and rear. There is also a safe garden for the use of residents who have dementia, which is also private. There is ample parking to the front and side of the property. The home operates on policies and procedures established by Lincolnshire County Council Social Services Department. The home has a day centre (which did not form part of this inspection) situated on the ground floor. The homes service users guide gives information to prospective residents as well as the care that they can expect when admitted to this home. Copies of inspection reports are maintained in the main foyer for service users and members of the public. The care fees range up to £431 per week. Hairdressing and private chiropody are not included in the fees. The Cedars DS0000041858.V324007.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection took place during June 2007 and the visit to the home was undertaken over approximately four hours. The methodology for the inspection visit used is called ‘case tracking’. This means that the care received by three service users was looked at in detail, including service users care, staff and general home records, which pertain to their care and support. We also spoke with four service users, the registered manager and three staff members about the support offered to people living at the home. Five completed quality satisfaction surveys were also seen during the visit, which have been used to further inform the judgements made within this report. A partial tour of the premises was conducted including areas relating to the service users who were case tracked. Observations were also made of day-today care practice. Notifications received along with a pre-inspection questionnaire, completed by the manager were also viewed as part of the overall information gathering regarding the service. What the service does well: A detailed assessment of service users care needs is undertaken of which they are fully involved. Service users rights are fully promoted during their stay and they are supported to spend their time as they like. The standard of meals provided is excellent, with service users dietary needs and preferences being met. Much of the food is home prepared and there is a good choice. Comprehensive recruitment procedures are in place to protect service users and staff receive a good standard of induction and they are well trained to meet individuals care needs. The physical environment is of a good standard and provides a safe, clean and comfortable place for service users. There are good quality satisfaction systems in place to establish service users views regarding the service provided and these have recently been developed to more fully act upon the information received. The home is well managed and service users feel safe here. Service users comments included: “Its as close as you could get to perfection for me, they The Cedars DS0000041858.V324007.R01.S.doc Version 5.2 Page 6 take you in and give you the best care possible”. “No complaints here, I’m very satisfied and will tell them so”. “You can relax, do as you like and Its just easy, the really look after you well”. “From the moment I arrived they have all been wonderful”. 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. The summary of this inspection report can be made available in other formats on request. The Cedars DS0000041858.V324007.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 The Cedars DS0000041858.V324007.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): 1, 3, 6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are satisfied with the admission process, which is comprehensive. They are involved in planning the care they receive and can be assured that their care needs will be appropriately met. EVIDENCE: A statement of purpose and service user guide have been produced and these are displayed in the main entrance and regularly updated. A new leaflet has also been produced giving a brief insight as to the services provided, which is also displayed in the entrance. The Cedars provides care for individuals being part of the intermediate care service and for short stays. Due to the nature of the services provided home visits are not generally undertaken by home staff prior to admission although service users receive comprehensive information about the service during the admission process. The Cedars DS0000041858.V324007.R01.S.doc Version 5.2 Page 9 The manager confirmed that no admissions would be made without a comprehensive assessment being received prior to admission. The care records viewed evidenced that a comprehensive assessment of service users care needs had been undertaken, which clearly identified potential risks and individuals likes and general preferences. The records seen clearly documented service users involvement in the assessment process and the one record not signed was regarding a service user unable to give written consent. Records clearly identified how service users were made aware of their rights, which included data protection and confidentiality and again was signed, where possible by service users. Discussions held with service users confirmed that they were satisfied with the homes admission arrangements. Comments included: “Well, of course I was satisfied else I wouldn’t have stayed”. “They have all been smashing, wonderful, they all tell you what you need to know”. “I can’t remember arriving here but they are on hand to help you with anything and if you have any questions you just ask”. “There was some information given but now I’m here I would just ask the staff”. The Cedars DS0000041858.V324007.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures for the administration of medication are appropriate. Service users benefit from a supportive and well-informed staff team who treat them with respect and they can be assured that their care needs are met. EVIDENCE: A detailed care plan is completed for each service user from the initial assessment and the care records seen documented each service users care needs and instructs staff how these are to be met. Care records document needs such as pressure area care, mobility, personal care, falls, nutrition, catheter care, night care, and medication. Individual preferences are also recorded. The manager said that improvements were currently being made to ensure that the care provided to service users was more fully documented. Any assessed health care needs are recorded, which include input from supporting agencies and records are updated and reviewed as necessary. The Cedars DS0000041858.V324007.R01.S.doc Version 5.2 Page 11 The service users spoken with said: “Well you can see what the care is like here and I’m not complaining”. “You couldn’t wish for better treatment, they can’t do enough for you”. “I didn’t know what to expect really and I would prefer to be at home but they have been better than you could ever hope for, really marvellous”. “They treat you respectfully, you do just as you would at home, whatever you like”. Information seen in the satisfaction questionnaires completed by service users further confirmed these views. The two care staff members spoken with were fully aware of service users care needs and how these were met and confirmed that they received a rolling programme of awareness training and support specific to service users assessed care needs. Policies and procedures promoting service users privacy, dignity, choice, rights and independence are in place. Staff also confirmed that the culture in the home enabled them to express their views regarding the care provided and that these were respected and acted upon where appropriate. Systems are in place to support service users to administer their own medicines where this is risk assessed as appropriate. Staff whom administer medication receive accredited awareness training regarding this. Medicines were properly stored and records clearly documented medicines as receipted into the building, as administered and where disposed. Pre inspection information received stated that a new medication policy has recently been introduced, of which the staff member spoken with was aware. The Cedars DS0000041858.V324007.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 excellent. This judgement has been made using available evidence including a visit to this service. Service users choose how they spend their time, they are supported to maintain community links as they prefer and to express their views regarding life within the home. Service users are provided with good quality meals, which they enjoy and their dietary needs are met. EVIDENCE: Information promoting service users rights, independence and choices is clearly displayed in the home. Service users are initially consulted with about their likes and dislikes and any preferred routines as part of the admission process, which then forms part of the overall care plan. Service users said they were encouraged to make informed choices during each day, that there were no restrictions as to how they could spend their time and that their visitors were made welcome. Activity plans are displayed in the entrance hall, and records show that there are regular activities such as: movie nights, bingo, quizzes as well as visits to the local pub and park. A “booze and nibbles” evening has recently been The Cedars DS0000041858.V324007.R01.S.doc Version 5.2 Page 13 introduced each Friday, of which the service users spoken with were looking forward to. Pre inspection information received stated that service users views regarding recreational activities are further sought during service users meetings held each month. Service users comments included: “Apart from being here, you can do as you would at home”. “Well, you do as you like, like at home, there are mealtimes but really you do as you please”. “There are all sorts of activities, if you want but I’m happy doing my own thing”. “There seems to be a good variety of things going on, it’s quite friendly”. Information in the homes completed satisfaction questionnaires further confirmed these although some of the records seen regarding the activities undertaken by individual service users did not give a full picture of the activities undertaken. Service users confirmed that they enjoyed the meals provided of which a choice of food is available at each mealtime. For example, a selection of hot and cold foods are available at breakfast. The service has been awarded five stars following the most recent environmental health inspection and meals are very well balanced and cater for specific individual dietary needs and preferences. Service users comments regarding meals included: “It is smashing, you get to taste it if you get the chance, very good”. “You get top quality, good choice and it if you want something specific then you just have to ask”. “They spoil you really but it’s nice and friendly and informal”. “It’s relaxed eating, you are not hurried so you can enjoy the food properly”. The Cedars DS0000041858.V324007.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, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to express any views about the home and staff are made aware of the systems in place to protect service users from abuse. EVIDENCE: Policies and procedures are in place to safeguard service users of which are also displayed in the home. Pre inspection information received indicated that all staff are trained as alerters within the safeguarding adults policy. The staff members spoken with were aware of these and explained the correct action to be taken in the event of an issue of abuse being identified. The service users spoken with said that they felt able to express any views regarding the care provided and that these would be appropriately acted upon, which was further confirmed in the quality satisfaction surveys seen. Comments included: “I have no reason to complain but they like to see that you are alright during your stay and you are invited to speak up”. “I would be surprised if anyone had a complaint but I’m sure they would listen”. “There is some information somewhere about complaining but I’d just speak with someone here”. Records show that there have been no complaints since the last inspection although one safeguarding adult referral has recently been made, which was not formally closed at the time of writing this report. The Cedars DS0000041858.V324007.R01.S.doc Version 5.2 Page 15 The Cedars DS0000041858.V324007.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users benefit from a hygienic, comfortable and well-maintained environment with the organisation ensuring the safety of each area of the home. EVIDENCE: On the day of the visit the home was clean, tidy and well maintained throughout all the areas seen. Pre inspection information received indicated that ten bedrooms have new sinks fitted and have received some refurbishment recently. The service users spoken with were satisfied with the cleanliness and of the home. Comments included: “I don’t think you could ask for more, just look”. “It is a lovely environment and the girls keep it spotless looking”. “It is not home of course but you could forget that here”. “Yes, it’s all kept very well”. The Cedars DS0000041858.V324007.R01.S.doc Version 5.2 Page 17 Substances identified as being potentially hazardous to health are stored appropriately, and there are information sheets and risk assessments in place providing guidance for staff. The Cedars DS0000041858.V324007.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are safeguarded through comprehensive recruitment procedures being in place and the staff receive induction when commencing work at the home. There are sufficient numbers of staff, appropriately deployed and well trained to allow them to meet service users individual care needs. EVIDENCE: The pre inspection information received identified that there are sufficient levels of staff to meet the needs of service users, which was further evidenced during the visit and through the service users spoken with who confirmed that they were satisfied with the standards of care provided. Comments included: “They have been wonderful to me, anything I have needed, you often don’t need to ask”. “I would like to thank them all for the wonderful care, they are all very good at what they do”. “Well, anytime I have needed them they have been right there”. The staff records seen evidenced that appropriate recruitment checks and procedures had been undertaken of which clear guidelines are in place. Recruitment records contain application forms, references, criminal record bureau checks, and identification. Newly appointed staff attend induction training upon commencing work at the home of which records are maintained. The Cedars DS0000041858.V324007.R01.S.doc Version 5.2 Page 19 A training plan is in place and any outstanding training needs are identified and provided for and pre inspection information received stated that more than 50 of care staff have achieved a national vocation qualification relevant to their work, which was further confirmed during the visit. The staff members spoken with confirmed that they received regular training appropriate for their roles and to reflect the needs of service users, which was further evidenced in the training records seen. Staff confirmed that they felt supported and valued by managers and that any routines were flexible where possible to meet service users individual choices and lifestyles. Staff also said they felt able to voice their opinions regarding the care provided including during supervision, appraisals and staff meetings, of which records are maintained. The Cedars DS0000041858.V324007.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are supported to express their views regarding the care they receive. The home is well managed and systems are in place to ensure that care is provided in a safe and appropriate manner. EVIDENCE: The service users spoken with confirmed that they were satisfied with the management of the home, the care provided and that they felt able to voice their views and that these would be acted upon. Quality satisfaction questionnaires are given to service users or their representatives where appropriate following each stay and the manager said that a new system was being introduced to formally assess and act upon the comments received. The The Cedars DS0000041858.V324007.R01.S.doc Version 5.2 Page 21 manager demonstrated how short and long term goals were being made following audits of previous comments received. It is also positive to note that service users meetings are held to further enable service users to express their views about the service provided. Service users comments included: “Well, it’s not home but apart from that the place is faultless, they really try their best to help you and make your stay comfortable”. “If I had any reservations before then I certainly don’t now”. “You don’t know what to expect from these places but the care has been second to none”. “They work very hard to make you at home and to get you back on your feet again”. “You can talk with any of them any they will help you, not just the top chiefs” The staff members spoken with said they received very good management support including regular supervision of which records are maintained and that they were satisfied with the management of the home, which was further confirmed by the district nurse spoken with. The manager described a clear vision for the service and how this was being monitored, reviewed and implemented. All areas of the home seen were well maintained of which records are kept and a risk assessment of the premises has been undertaken, which is updated as necessary. Pre inspection information received stated that all necessary health and safety checks are undertaken as necessary. The records seen evidenced that fire safety tests were appropriately maintained and the home staff receive regular awareness training. Policies and procedures are in place to protect service users where the home has any involvement in their finances. Monies are kept separate and receipts and records of transactions and totals are maintained. Service users sign for any transactions where possible. The Cedars DS0000041858.V324007.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 3 X 4 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 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 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 3 X 3 The Cedars DS0000041858.V324007.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations It is recommended that records of activities are more fully documented. The Cedars DS0000041858.V324007.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 The Cedars DS0000041858.V324007.R01.S.doc Version 5.2 Page 25 - 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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