Inspection on 25/04/06 for The Cedars

This inspection was carried out on 25th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 30/09/09

The Cedars 26/09/07

The Cedars 26/10/06

The Cedars 10/10/05

The Cedars 05/05/05

The Cedars 25/01/05

The Cedars 13/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE The Cedars 45 Queens Road Oldham OL8 2AH Lead Inspector Carol Makin Unannounced Inspection 25th April 2006 09:30 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 The Cedars DS0000005488.V289805.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. The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Cedars Address 45 Queens Road Oldham OL8 2AH 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) 01616264665 0161 626 4665 Mrs Eileen Ashton Mrs Eileen Ashton Care Home 12 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (4), Old age, not falling within any other of places category (12) The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users to include up to 12 OP, up to 2 DE and up to 4 DE (E). No service user to be admitted into the home under 60 years of age. A Manager, working a minimum of 30 hours each week, must be in place at all times who has the qualifications, skills and experience necessary for managing the home, and who is registered, or has an application for registration pending, with the Commission for Social Care Inspection. 10th October 2005 Date of last inspection Brief Description of the Service: The Cedars is a small, family run care home for up to 12 service users. The home is situated one mile from Oldham town centre, close to local amenities and public transport. Accommodation is provided in six single bedrooms, four of which have en-suite toilet facilities, and three twin rooms with en-suite toilets. Privacy screens are provided in the shared rooms. There is a large lounge and a lounge/dining room; there is also a small separate lounge at the rear of the property, which is a designated smoking area for service users. Level access to one of the dining rooms is not provided, service users must negotiate one step; grab rails are in place for those service users who may need assistance. The front of the home provides a large garden area overlooking the park with seating areas for service users. A small amount of car parking space is available at the rear of the property. The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on 25th April 2006, by two inspectors. The inspectors spoke with all of the residents, three relatives, the manager and members of care staff, carried out a partial inspection of the premises, and examined records. Several residents who were able to give their views at the last inspection, had deteriorated physically/mentally since then, and the information from them was therefore very limited on this occasion. Since the last inspection, questionnaires had, however, been returned to the commission, four of which had been completed on behalf of residents, and three were from relatives/visitors. Most of the comments were positive, but one resident felt that day and night time staffing levels needed to be increased. Some requirements from the last inspection had been addressed, but others remained outstanding from previous inspections. What the service does well: What has improved since the last inspection? Some improvements had been made to the front entrance since the last inspection, which included new patio furniture, a new wrought iron gate and some repainting. The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 6 Internally, a new carpet had been fitted in one of the bedrooms and alterations had been made to radiator guards in residents’ bedrooms to allow access to the controls for temperature adjustment. There had been a significant improvement in the procedures used for recruiting new staff, making the process safer and providing some protection for residents. 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 DS0000005488.V289805.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 The Cedars DS0000005488.V289805.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 Quality in this outcome area is good. Assessments of prospective residents’ care needs were completed before they moved into the home, thereby ensuring that the home is able to meet residents’ needs. This judgement has been made using available evidence, including a visit to the service. EVIDENCE: The care files which were selected for inspection contained assessments of the residents’ care needs which had been completed before they were admitted to the home. Intermediate care is not offered at The Cedars. Standard 6 is therefore not applicable. The Cedars DS0000005488.V289805.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, 8, 9 and 10 Quality in this outcome area is poor. Care practices needed to be improved, to ensure that all the health, personal and social care needs, and rights of residents are recorded and fully met. Some of the home’s practices and procedures for dealing with medicines were unsafe, which potentially places residents at risk. This judgement has been made using available evidence, including a visit to the service. EVIDENCE: Individual care plans and risk assessments were in place on the care files which were selected for inspection, but due to the repetitive nature of the recording, it was very difficult to ascertain the actual plan to provide care on a day to day basis. The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 10 The day-to-day communication records were not consecutive, and were not completed on a daily basis. Recordings in one resident’s care planning file described two serious incidents during the night/evening. In one report it was stated that the lady was ‘lifted’ from the floor by the member of staff on waking night duty, with the assistance of the person who was providing ‘on call’ support in the home. (See also standards 27,37 and 38). Care plans lacked details for the guidance of staff when dressing or attending to individual residents’ personal needs. One care plan showed that a resident had a pressure sore on discharge from hospital, but there were no details of how to care for this, or to indicate whether the community nurses were involved. Inspectors observed that several ladies were not wearing dentures, some had soiled nails and one person had very soiled hands. One lady had matted (sticky) eyes and was unable to open her right eye and had great difficulty opening the left eye. These issues are indicative of poor care practices, and have implications for residents’ dignity, and staffing levels within the home. It was observed that on this inspection, and on previous inspections, one resident was being cared for in his room. The manager said that this was because of his behaviour problems. Records showed the gentleman’s relatives had complained to the manager about him being isolated in his room. The manager said that he was taken downstairs every day, and sometimes sat outside or was taken out to the park by a member of staff. The inspectors talked with the manager about the home’s ability to meet residents’ needs. The manager explained some of the issues involved and the difficulties which staff had in meeting certain residents’ special needs. The inspectors explained the need for her to be proactive in contacting care managers in the community, to request a review of the placements, with all interested parties, and that she must not accommodate residents in the home if their needs could not be met. One file seen showed that the resident’s weight was being monitored, but the inspector observed that the prescribed high protein drink had been left in front of the resident, who was very frail, and it was out of her reach. A visitor assisted her to drink. A further high protein drink was then brought to her and once again left in front of her. A cup of cold tea, which had been present since the early morning, was removed at the inspector’s request by the carer during the afternoon. It was noted that the carer did not check the fluid chart, which was available in the room, to monitor the resident’s intake of fluid. The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 11 In a questionnaire returned to the Commission, a visitor commented positively about the care provided for the resident who they visited. The inspector looked at the medication for a resident who had had recently returned from hospital, with a subsequent change in medication. The manager was unable to locate the discharge documentation for the resident. The manager said an item of medication for one resident had been reduced, but this was not shown on the Medication Administration Record (MAR) sheet. Two items of medication were being stored in the domestic fridge in the kitchen. Staff were unable to give an explanation for this. One was a bottle of Calogen, which had been prescribed for a resident. It was about 2/3rds empty and the label stated to dispose of it 14 days after opening. Staff did not know when it had been opened and the date had not been recorded on the bottle. The second item was a bottle of Paldesic, (liquid Paracetomol). There was no name or prescription label on the bottle. The manager stated said that she had purchased this for a particular resident as the doctor had prescribed (over the phone) an antibiotic for a chest infection and Paracetomol to reduce the fever. The prescription was for the antibiotic only, and the pharmacist had recommended the Paldesic. The medication had been administered, but it was not documented on the MAR sheet. Other MAR sheets that were seen during the inspection were satisfactory, as was the practice of the staff who were observed when administering medication to residents. The monitored dosage system was stored in a specialist locked cabinet, which was secured to the wall close to the lift. The system used for returning unused medication to the pharmacy was also satisfactory. The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 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 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 poor. Activities were not sufficient to meet residents’ individual needs and capabilities, and provide them with enough stimulation. Residents were able to maintain contact with relatives and friends, providing them with links with the wider community. There was little evidence that residents were offered a wholesome and varied diet, or that they were able to exercise any control over their diet. This judgement has been made using available evidence, including a visit to the service. EVIDENCE: Residents and visitors said that there was very little in the way of stimulation. The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 13 Inspectors also noted this, and that staff interaction with the residents was limited. One resident was seen to have a cup of tea put on the table next to her and be offered biscuits by a member of staff with no speech or eye contact. Visitors said they could visit at any time, and were made to feel welcome. They are able to see residents in the communal areas and in the bedrooms. A resident’s relative said to the inspector, “it’s very relaxed here”. There was not enough detail in the menu to indicate the nutritional content or balance of the meals and there were no choices of meals shown. The cook said that all the vegetables that were used were frozen and no fresh fruit was noted. The evening meal was observed to be spaghetti on toast or meat paste sandwiches. One lady was having great difficulty cutting her toast and there were no staff in the dining room to provide assistance to residents or provide supervision if needed. Some residents ate in their rooms. Information about meals was not displayed for the residents, although there was a ‘chalk board’ in the dining room. The whole meal was over in a short period of time and residents returned to their usual places in the lounge with no interaction whatsoever. In comments made to inspectors, one resident said the food was “nice”, and another resident said she had not enjoyed her meal. In addition to these comments, questionnaires completed on behalf of two residents which were returned to the commission since the last inspection, showed a positive response regarding ‘food’. Two carers were on duty from 3.00pm – 9.00pm and were expected to make the tea and do the ironing in the afternoon, as there were no ancillary staff on duty at that time. (See also staffing Standard 27). The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 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 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 poor. Information about the procedure for making complaints needed to be clarified and displayed in the home, to ensure that all interested parties know how to make a complaint. Arrangements for protecting vulnerable adults from abuse are not sufficient thereby placing them at possible risk of harm. This judgement has been made using available evidence, including a visit to the service. EVIDENCE: There was a copy of the complaints procedure in the care plans, which were seen, but it needed to be updated with details of the Commission for Social Care Inspection. The procedure should also be displayed in the home to make it accessible to all interested parties. A record was kept of complaints that had been made to the home, which included details of the complaint, the action taken by the home and communication between the manager and the complainant. The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 15 A requirement made following the last inspection, for staff training in relation to ‘abuse’ to be updated by 9 January 2006, had not been addressed, although the manager provided a FAX to show that she had requested the training from Oldham SSD earlier this month (April 2006). A POVA investigation, which was carried out by Oldham Social Services also earlier this month, had reinforced the need for the manager and all her staff to have their training updated. Up to date training is needed to ensure that all members of staff are able to recognise different forms of abuse, and to know what to do if an incident of abuse was to occur in the home. The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 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, 22, 24 & 26 Quality in this outcome area is poor. The accommodation was clean and decorated to a satisfactory standard, but residents were not able to benefit from a programme of routine maintenance and renewal of furniture and fittings. The lack of suitable of aids and equipment, and a fully maintained emergency call system, compromises the safety and welfare of residents and staff. This judgement has been made using available evidence, including a visit to the service. The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 17 EVIDENCE: The front entrance to the home was clean and tidy, and the gardens looked attractive. Some improvements had also been made to this area since the last inspection, which included new patio furniture, a new wrought iron gate and some repainting. Internally, a new carpet had been fitted in one of the bedrooms and alterations had been made to radiator guards in residents’ bedrooms to allow access to the controls for temperature adjustment. The inspectors questioned why there were several large circular holes dotted about in the radiator safety guards. The manager said that her husband had done it to let out more heat, because they had found that the ‘custom-made’ wooden safety guards were so thick that they were keeping the heat out of the room. The standard of cleanliness and the décor in the lounge/dining areas and the bedrooms that were seen, was satisfactory, and bedrooms were personalised to suit individual residents’ choice/needs. Issues in relation to vanity units, which were damaged, and the emergency call system remained outstanding. A requirement made previously for a call point to be secured to the wall in one bedroom had been addressed, although the wires from the call point were hanging loose from the wall and around the door architrave, and needed to be secured. The manager said that the resident pulled the wires away from the wall and had previously knocked the call point off the wall. It was later noted that the call point in another bedroom was loose, which was not the fault of the resident. The system itself is ‘home made’ and, in some rooms, consists of a bell push and wire, which is not concealed, and can easily be pulled from the wall; it is also not possible for an extension facility to be fitted to this type of call point, which means that residents need to be capable of reaching the bell push. The manager told the inspectors that she would measure the damaged vanity units in residents’ bedrooms and buy new ones. This matter had been outstanding since an inspection in July 2004. The manager’s attention was also drawn to missing drawer handles. Both handles were missing from one drawer seen. This issue had also been raised at previous inspections, and a requirement was made for the registered person to ensure that furniture and equipment in service users’ private accommodation is well maintained at all times’. The requirement has been reiterated in this report. This demonstrated a need for a programme of routine maintenance and renewal of furniture and fittings to be provided and implemented. The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 18 In terms of equipment, the bath on the first floor was fitted with a hoist, but there was no general hoist in the home and there was evidence in the communication records that residents who had fallen were being lifted up from the floor by the staff. The manager was unable to demonstrate to the inspectors how she would get a resident up off the floor without physically lifting them up. A wheelchair which was in use did not have foot plates, the armrest on the left hand side had no padding and was down to the bare metal, and the tyre on one of the front wheels looked to be in poor condition. The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 19 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 poor. The staffing levels and training provided are insufficient, resulting in the basic care needs of some residents not being met to an adequate standard. Shortfalls in the recruitment process potentially put residents at risk. This judgement has been made using available evidence, including a visit to the service. EVIDENCE: The manager provided three staffing rotas for inspection, all of which were identical in content, as follows: Mon-Fri manager 9-4pm, deputy manager 83pm (duties catering/care), one carer 8-3pm, one domestic 9-11.30am, two carers 3-9pm; Sat - one senior carer 8-2pm, one carer 8-9pm, one domestic 8-2pm, one carer 2-9pm; Sunday two carers (one senior) 8-9pm, one carer 82. Night staffing (9pm-8am): one carer on waking duty and the manager’s daughter, who lives on the premises, providing an ‘on-call’ service. The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 20 There is continued failure to show catering hours and the role of some members of staff on the rotas. The manager must write to the Business Relationship Manager at the Commission for Social Care Inspection, regarding her daughter doing the sleep-in duties and to explain why she had previously given false information on rotas, which stated that named members of staff were doing the sleeping-in duties. The manager said that the number of residents in the home was down to ten at the time of the inspection. The dependency levels of the residents were high, and two residents who needed specialist care and supervision were being cared for in their rooms on the first floor of the building. One of these residents needed two carers to help her to transfer and both residents needed assistance with eating. The inspectors observed that for much of the morning only one member of staff was available to provide care to the residents, in particular, assisting them with toileting, as the deputy manager was working in the kitchen and the manager was working in the office. The two carers who were on duty from 3pm to 9pm were also busy with duties other than care. One was preparing the evening meal and the other was ironing in the hallway, which in itself posed a health and safety risk. During this time an inspector requested that a resident had her soiled hands and fingernails washed, and her incontinence pad changed, and at the same time that another resident asked to have her colostomy bag changed. In conversation with the inspector, one of the carers confirmed that more help was needed on the shift, particularly when both carers were attending to a resident in an upstairs room who needed two carers to transfer her to her bed or commode. In a questionnaire returned to the commission, a resident commented that day and night time staffing levels needed to be increased, to “share the workload”. Many of the staff had achieved an NVQ level 2 but, in most cases, it was in 2002/3. The manager said that she was aware of this and she was in the process of organising refresher training, e.g., abuse (standard 18) and safe working practices (standard 38). The manager provided documentary evidence that she had applied for training courses for staff regarding medication, abuse and infection control. The manager was reminded that the timescales of the requirements for training, which had been made following the last inspection, had lapsed. She said that she had put her efforts into ‘sorting out the medication’. Training in basic care practices also needed to be updated and specialist training to meet the specific needs of the residents was also needed, e.g., dementia, falls prevention. The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 21 Induction records that were seen were undated and the there was no evidence that the work had been assessed. All work needs to be dated and input from the assessor needs to be recorded. On discussing this with the manager, she said that she was the assessor and she had given the ‘booklet’ to the member of staff to complete ‘when she had time to do it’. Recruitment practices were much improved, but the manager needs to ensure that specific dates of previous employment are noted on the application form, any gaps in employment are explained, a reference from the current or last employer and those relevant to the job are obtained where possible and that the applicant completes the declaration regarding previous convictions. The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 22 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, 37 & 38 Quality in this outcome area is poor. Management and administration systems are in place but they are not consistency adhered to by the manager, resulting in the home not being well managed or run in the best interests of the residents. The health, welfare and safety of residents and staff is compromised by the lack of suitable training for staff. This judgement has been made using available evidence, including a visit to the service. The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 23 EVIDENCE: The manager provided written information, which showed that she had enrolled for the Registered Managers Award on 3 March 2006. The manager said that someone from the training company was coming on 28 April 2006 to discuss and plan the nine months’ course with her. The manager said that she felt quite confident about doing the training and agreed that it should be beneficial to her in all aspects of her role, e.g., care planning, supervision of staff, monitoring the quality of service provision. The issues regarding care practices and safe working practices noted elsewhere in this report also have an impact on this standard (31). There was no information to indicate that there was any formal quality monitoring system in operation at the time of the inspection. Questionnaires were available but those which were dated had been done in 2004. This was discussed with the manager, who said that she hadn’t realised that it was so long since she had done them. She agreed to do another survey and provide an analysis of the findings. The manager said that informal meetings were held with staff and with residents. Records of money held in safekeeping for residents were selected at random for inspection and were found to be in order, with one exception, whereby the cash held was in excess of the balance shown one transaction record sheet seen. The manager thought that she must have forgotten to take out the money for a purchase made on behalf of the resident. It is recommended that the manager audits the records each week, to check for errors. The accident book was being not maintained in accordance with the Data Protection legislation. An accident which was noted in the day to day records had not been recorded in the accident book and a notification in accordance with Regulation 37 had not been sent to the Commission for Social Care Inspection. Only one service record for the passenger lift was available and that was dated 2004. Records of services and independent inspections must be available for inspection by the Commission for Social Care Inspection. The inspector received conflicting information about training in relation to safe working practices. The manager provided a record of staff training, which showed dates between 2002 and 2004. The inspector asked the manager about this, as two carers had said that they had received some training in 2006. The manager was adamant that there had been no recent training and seeing a carer passing the office door at the time, she reminded her of this. The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 24 The inspectors observed a number of issues which demonstrated failures to operate safe working practices, e.g., a wheelchair was in use without footrests, had damaged armrests and was generally in poor state of repair; a mobile hoist was not available – staff were having to lift residents up from the floor if they had fallen; loose wires were trailing from the emergency call system; A call point was not secured to the wall and there was a potential risk of compromising infection control protocols by care staff assisting with residents’ personal care and returning to their duties in the kitchen. There is also a potential risk from staff doing the ironing in the hallway, particularly as the member of staff is one of only two staff on duty and may need to respond to a call for emergency assistance. Management and staff require training in all aspects of health and safety, and risk assessments are needed for all working practices which involve risk to residents and/or staff. An examination of the fire precautions records indicated that tests and checks in relation to fire precautions and fire drills had been done at the prescribed intervals. The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X 2 X X X 3 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 2 X 2 1 The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The registered person must ensure that care plans include specific details of residents’ care needs and the manner in which the care must be delivered. The registered person must ensure that a Care Management review of a resident’s placement in the home is requested when the home is unable to meet the resident’s needs. The registered person must ensure that day-to-day communication records are consecutive and completed on a daily basis. The registered person must ensure any specific instructions regarding the treatment/care of pressure sores are included in care plans, together with any involvement by the community nurses. The registered person must ensure that staff check and complete the fluid charts, for residents whose fluid intake needs to be monitored. Timescale for action 31/05/06 2 OP7 14 31/05/06 3 OP7 14 31/05/06 4 OP8 12,15,17 31/05/06 5 OP8 17 31/05/06 The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 27 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. 6 Standard OP9 Regulation 14 Requirement The registered person must ensure that all medication administered to residents is recorded on the medication administration record sheet. The registered person must ensure that medication is not stored in the domestic fridge. The registered person must ensure that the date of opening medication is noted on the container and that medicines are not used beyond the expiry date. The registered person must ensure that all homely remedies clearly show the individual resident’s name on the container. The registered person must ensure that all staff members employed by the home, with responsibility for medication administration have received appropriate training. The training must also include a formal assessment of competency. (Timescale of 13/12/05 not met). The registered person must ensure that the provision of activities is increased to meet the needs of the residents, including those with specialist needs. DS0000005488.V289805.R01.S.doc Timescale for action 31/05/06 7 8 OP9 OP9 13 13 31/05/06 31/05/06 9 OP9 13 31/05/06 10 OP9 13, 18 30/06/06 11 OP12 16 30/06/06 The Cedars Version 5.1 Page 28 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. 12 Standard OP15 Regulation 12,16,17 Requirement The registered person must ensure that the menu is displayed for residents to see and that the food on the menu is recorded in sufficient detail to show that a balanced and nutritious diet is provided, and that choices of food are available. The registered person must ensure that food and drinks are easily accessible to residents and that staff provide assistance for residents who need help to eat and/or drink. The registered person must ensure that the complaints procedure is amended in accordance with the National Minimum Standards and the Regulations. (Timescale of 13/12/05 not met). The registered person must ensure that all staff receive training regarding abuse and the protection of vulnerable adults. (Timescale of 09/01/06 not met). The registered person must ensure that emergency call points are securely fixed to the wall at all times. (Timescale of 31/10/05 not met). Timescale for action 31/05/06 13 OP15 12,16 31/05/06 14 OP16 22 31/05/06 15 OP18 13 30/06/06 16 OP22 13,16,23 31/05/06 The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 29 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. 17 18 Standard OP38 OP22 Regulation 12,13 14,16,23 Requirement The registered person must ensure that bell wires are securely attached to the wall. The registered person must ensure that a hoist is provided to prevent the need for staff to lift residents. The registered person must ensure that equipment provided for the use of residents is maintained in good working order. The registered person must ensure that furniture in service users’ private accommodation is well maintained at all times. (Timescale of 1/12/05 not met). The registered person must review and increase staffing levels within the home to ensure that there are sufficient staff on duty at all times to meet the needs of the residents and ensure that their health, safety, and welfare are maintained. The registered person must ensure that job application forms are fully completed and include an explanation for any gaps in employment. Timescale for action 31/05/06 30/06/06 19 OP22 23 31/05/06 20 OP24 16,23 31/05/06 21 OP27 12,18 30/06/06 22 OP29 19 31/05/06 The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 30 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. 23 Standard OP30 Regulation 18 Requirement The registered person must supervise and assess staff during the induction process and demonstrate that she has done so by recording her input in the induction records, which must also be dated. The registered person must ensure that management and staff receive specialist training to meet the specific needs of residents, e.g., dementia, falls prevention. The registered person must ensure that management and staff receive updated training in relation to basic care practices, moving and handling, first aid, infection control, health and safety, and safe food handling. The registered person must ensure that quality assurance and quality monitoring systems are provided in line with the National Minimum Standards. The registered person must ensure that records required by legislation are maintained in accordance with the Data Protection Act 1998 and other statutory requirements, and do not contain false information. Timescale for action 31/05/06 24 OP30 18 30/09/06 25 OP38 18 30/06/06 26 OP33 24 30/09/06 27 OP37 17 31/10/06 The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 31 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. 28 Standard OP38 Regulation 17,23 Requirement Timescale for action 31/10/06 29 OP38 13 The registered person must ensure that records of services and independent inspections of the passenger lift are available for inspection by the Commission for Social Care Inspection. The registered person must 31/05/06 ensure that all working practices, are reviewed and risk assessed, to ensure that the safety of residents and staff is maintained at all times. 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. 2. Refer to Standard OP19 OP35 Good Practice Recommendations The registered person should ensure that a programme of routine maintenance and renewal of furniture and fittings is provided and implemented. The registered person should ensure that records in relation to money held in safekeeping for residents, is audited each week to check for errors. The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD 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 The Cedars DS0000005488.V289805.R01.S.doc Version 5.1 Page 33 - 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. 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