Inspection on 21/10/05 for The Cedars

This inspection was carried out on 21st October 2005.

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 15/01/07

The Cedars 28/02/06

The Cedars 04/11/04

The Cedars 21/08/04

The Cedars 29/03/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

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

CARE HOMES FOR OLDER PEOPLE The Cedars 23/25 Threshfield Road Baildon Bradford West Yorkshire BD17 6QA Lead Inspector Ashley Fawthrop Unannounced Inspection 21st October 2005 10:00 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 DS0000001304.V260286.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. The Cedars DS0000001304.V260286.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Cedars Address 23/25 Threshfield Road Baildon Bradford West Yorkshire BD17 6QA 01274 531125 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) Mrs Nada Green Mrs Nada Green Care Home 12 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (9), of places Physical disability over 65 years of age (2) The Cedars DS0000001304.V260286.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th November 2004 Brief Description of the Service: The Cedars is a large terrace property situated on the main road approximately half a mile from the centre of Baildon. The home accommodates twelve older people in both single and twin rooms a number have had en-suite facilities added. There is one lounge and dining room on the ground floor which opens out to a decked seating area in an enclosed garden. There are toilets and bathrooms to both floors access to the first floor is by staircase only there is no passenger lift. The home is on a direct bus route between Bradford and Baildon and the rarest bus stop is directly outside the home. The Cedars DS0000001304.V260286.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was undertaken within one day by one inspector. The inspection process consisted of talking with the registered person, staff, service users and visitors where possible. Reading records and observing practices, The registered person was available throughout the inspection and was given feedback on completion. The home provides information to prospective service users prior to admission insufficient detail to enable them to make a decision on whether the home can meet their needs. Pre admission assessments are undertaken the registered person ensures the individual needs could be met and visits to the home are offered. All service users have an individual plan these are well documented and met the health and social needs of the individual. Medications are administered appropriately and the care of the dying is undertaken with care and empathy the service user is cared for with respect and their dignity is maintained at all times. The home does provide activities, however, many service uses organise their own day’s families and friends are encouraged to visit and the home has a very informal and homely atmosphere. Service uses are treat with respect their privacy is maintained at all times. The registered person has continued to invest in the environment the standards of furnishings and decorations are very good. The bedrooms are individually decorated and furnished and service users have their personal possessions around them ensuring ownership. The turnover of staff is low promoting consistency of care. Training in NVQ and care related practices. The recruitment policy protects service users by obtaining references and checking for criminal offences. The home is run for the benefit of the service users they are at the centre of decision making both as group and individually. What the service does well: The registered person and the staff focus their energies on building the care around the individual. The atmosphere is that of an extended family where the family and visitors have a real part to play in the care of their relatives. The The Cedars DS0000001304.V260286.R01.S.doc Version 5.0 Page 6 home concentrates on the person as a whole rather than a specific problem but the records relating to the care plan are very good the care of the dying is excellent and the environment exceeds the standard required. 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 Cedars DS0000001304.V260286.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 The Cedars DS0000001304.V260286.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): 1, 3, 4 and 5 The home does provide appropriate information before admission, assessments of mobility are particularly important, as access to the first floor is by stairs only. EVIDENCE: There is a statement of Function and Purpose and Service User Guide that is available to prospective service users prior to admission. Pre admission assessments are undertaken prior to admission and service users or their representatives visit the home prior to admission. The Cedars DS0000001304.V260286.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 11 EVIDENCE: Each service users has an individual plan that sets out their individual needs. There is a past history recorded either from information given by the individual or their family, this information assists staff to continue with daily activities of life such as hobbies. There are daily needs assessments that document individual needs relating to the physical care as well as social and emotional needs. The care plans are updated on a monthly basis and reviewed on an annual basis with the involvement of the service users or their families or representative. The medication administration policy includes procedures for selfadministration. The medications kept in the home on behalf of service users are stored and administered appropriately. Where ever possible service users that are dying are cared for in the home and are only transferred to hospital where treatment is required. The Cedars DS0000001304.V260286.R01.S.doc Version 5.0 Page 10 There is evidence that the home has involved other professionals including nurses that are experts in caring for the terminally ill and have used special equipment. The Cedars DS0000001304.V260286.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 and 14 The home has very homely atmosphere families and friends visit often the home is very clear about the type of service user that would benefit from the home and it works well. EVIDENCE: There is information available to the service user before to admission details the physical layout of the home the size of the lounge and dining room and the physical abilities that serviced users would need to climb the stairs. Though there are service users with short-term memory loss the home does not cater for individuals that suffer from dementia that might have inappropriate behaviour that may cause distress to existing service users. The home is a locally based service and the atmosphere is that of an extended family. Families are encouraged and do visit regularly and many visit families at home. Activities are offered on a weekly basis, however, many organise their own days. The Cedars DS0000001304.V260286.R01.S.doc Version 5.0 Page 12 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 The registered person takes the quality of the service provided seriously and communicates with relatives and service users on a regular basis, she is very approachable and this contributes to the way concerns are acted upon. EVIDENCE: There is an appropriate complaints procedure available to service users and relatives. A copy is available in the Service Users Guide and one is on display in the home. The registered person is on the premises and is able to deal with concerns promptly and the way service users and relatives are involved in the decision making in the home ensures concerns are addressed quickly. No formal complaints have been made since the last inspection. There are procedures available to staff regarding protection from abuse. Training is also offered in the area of adult protection. The Cedars DS0000001304.V260286.R01.S.doc Version 5.0 Page 13 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): The registered provider has invested in the environment and the facilities exceed the requirements. EVIDENCE: The home is very well maintained both inside and out the sitting area has patio doors that open out onto a decked sitting in a small-enclosed garden. The home is maintained to a good standard and the standards of décor and furnishings are good. There are bathrooms and toilets on both floors one of which has been re furnished. Service users bedrooms are individually decorated and furnished giving the feeling of individuality and ownership. There are dedicated cleaning staff employed and the home is clean and free from odours. The Cedars DS0000001304.V260286.R01.S.doc Version 5.0 Page 14 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 and 30 The staff undertake the appropriate training to meet the needs of the service uses. They are protected by the policies that are in place. EVIDENCE: The turn over of staff is extremely low this creates consistency of care and staff have the skills to meet the needs of the service users. The home does have a recruitment policy that protects the service users. All staff complete application forms that are checked references are required and Criminal Bureau Checks are undertaken on all staff prior to employment. The Cedars DS0000001304.V260286.R01.S.doc Version 5.0 Page 15 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, 32, 33, 35, 36 and 37 EVIDENCE: The registered provider is also the registered manager and has many years experience in the care profession. The registered person works with the staff team on a daily basis and communication both formal and informal is continuous. Decisions are made quickly and the involvement of individual service users is evident. Wherever possible the registered person does not involve herself in the management of service users finances these are the responsibility of the individual themselves or their representative. Staffs are supervised on a day-to-day basis though formal supervision is undertaken on an ad-hock basis, however, due to the way staff work and communicate with the service users the supervision is effective. The records, policies and procedures relating to the care of service users are up to date and are stored in a safe place. The Cedars DS0000001304.V260286.R01.S.doc Version 5.0 Page 16 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 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 X 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 4 4 4 4 4 4 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 X The Cedars DS0000001304.V260286.R01.S.doc Version 5.0 Page 17 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. Refer to Standard Good Practice Recommendations The Cedars DS0000001304.V260286.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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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