Inspection on 25/10/07 for The Cedars

This inspection was carried out on 25th October 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 31/01/07

The Cedars 12/06/06

The Cedars 17/03/06

The Cedars 02/11/05

The Cedars 25/02/05

The Cedars 17/08/04

The Cedars 24/02/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Cedars (The) Angel Lane Shaftesbury Dorset SP7 8DF Lead Inspector Gloria Ashwell Key Unannounced Inspection 11:00 22nd October 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedars (The) Address Angel Lane Shaftesbury Dorset SP7 8DF Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01747 852860 01747 852722 admin@shaftesburyhealthcare.com The Community Health Association of Shaftesbury Limited Mrs Nora Bernadette Ballard Position Vacant Care Home 26 Category(ies) of Dementia - over 65 years of age (26), Old age, registration, with number not falling within any other category (26) of places Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing- Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia aged 65 years and over on admission- Code DE(E) 2. Old age, not falling within any other category- Code OP The maximum number of service users who can be accommodated is 26. 31st January 2007 Date of last inspection Brief Description of the Service: The Cedars is a converted and extended detached premises close to the centre of Shaftesbury providing accommodation for 26 residents. The home is registered to provide nursing and social care to older people, including those with dementia type illnesses. The Cedars is owned by the Community Health Association of Shaftesbury; a charitable company limited by guarantee. Ownership of the home is represented by a Board of Trustees. Since the previous inspection Mrs Ballard has become the registered manager. Laundering of clothing and household linen is carried out at the home and arrangements can be made for chiropodists, opticians and other health and social care professionals to visit individual residents. The home has a fully enclosed courtyard style garden, an open garden to one side and car parking at the front of the home. The home is located in the centre of Shaftesbury, close to shops and other amenities including bus services. The fee range quoted in the service user guide at the time of inspection was £565 to £709 per person per week. For respite care these charges are raised by £100 per week. Up to date fee information may be obtained from the service. Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 5 Information regarding the subjects Value for Money and Fair Terms in Contracts can be obtained from the web link: www.oft.gov.uk A report entitled Care Homes in the UK - A Market Study is available on web link http:/www.oft.gov.uk/NR/rdonlyres/5362CA9D-764D-4636-A4B1A65A7AFD347B/0/oft780.pdf Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was a statutory inspection required in accordance with the Care Standards Act 2000. The inspection was unannounced; the inspector arrived at 11.00 on 22 October 2007, toured the premises and spoke to residents and staff. By arrangement with registered manager Mrs Ballard she arranged the next visit which took place at 12.30 on 24 October 2007 when documentation relating to care provision and the premises was discussed and examined. The duration of the inspection (both days combined) was 3 hours. The inspector spoke to Mrs Ballard and the deputy manager, nursing, care and household staff and most of the residents accommodated at the time. The inspector observed staff interaction with residents and the carrying out of routine tasks. During the inspection, particular residents were ‘case tracked’; for example, for evidence regarding Standards 3, 7 and 8, records relating to the same resident were examined and the resident spoken with The care records of four people who live at the home were examined in detail. The inspector was able to meet and speak with most of the residents both individually and in small groups in the communal areas. Additional information used to inform the inspection process included the Annual Quality Assurance Assessment completed in advance of the inspection by Mrs Ballard and ‘’Have Your Say’ questionnaires completed and sent to the Commission by 7 residents, 13 representatives (e.g. relatives, friends) of residents and 4 social care professionals and one doctor. During this inspection compliance with all key standards of the National Minimum Standards was assessed. What the service does well: People considering moving into The Cedars receive a full assessment and are provided with the opportunity to visit and spend time at the home to make sure that it is able to meet their needs. Discussion with service users indicated they are very satisfied with the home; comments included “it’s very good…”. Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 7 ‘Have Your Say’ questionnaires stated that the staff “look after X with great care and attention…always answer my queries and make myself and friends very welcome when we visit…it gives me peace of mind to know X is well cared for and is happy”, The Cedars “provides a good nursing environment to those in need” in a “nice warm, homely atmosphere”. Other comments included “A caring environment with high standards” and “I am very satisfied with the care X gets…don’t change a thing!” On the day of inspection the home was clean, comfortably warm and adequately staffed. It is well equipped, attractively decorated and suitably furnished. The standard of nursing and social care is excellent and each resident has a documented plan of care. Food is well-presented, varied and nutritious. Staff are enthusiastic and competent, and receive training. 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. Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 9 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 good. This judgement has been made using available evidence including a visit to this service. The service user guide contains relevant information about the home providing prospective residents and their representatives with an accurate understanding of the people for whom the service is intended although the format of the information may not be suitable for service users who have specific needs for example those with impaired sight. Prior to admission, the needs of each proposed resident are assessed to ensure the home will be properly able to meet them. EVIDENCE: The service user guide is made available to all residents and prospective residents. Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 10 The Statement of Purpose and service user guide are available in a standard format; it is recommended that this information be made available in alternative formats, appropriate to the needs and capacity of individual prospective residents or their representatives who might find the standard format difficult to read and fully understand. The records of two recently admitted residents included details of preadmission assessments which had been carried out by the registered manager when she visited the prospective residents at the previous address. In advance of making the decision to enter the home one of the prospective residents and the closest relatives of the other prospective resident visited The Cedars to view the premises and meet residents and staff. Following pre-admission assessment of the persons needs and circumstances the home writes to them confirming agreement and ability to accommodate and care for them. Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 11 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 & 11 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The health and social care needs of residents are fully met by suitably trained staff; doctors and other professionals visit as necessary and the home employs nurses and care workers who properly respect and promote the privacy and dignity of the residents. EVIDENCE: Residents’ representatives believe they are properly cared for; comments received in advance of the inspection included “the residents are looked after very well and the home is very clean and the catering is good. The atmosphere in the home…is always very good …I go in twice a week for the whole day; I know what the care is like and what the food is like”. Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 12 Care provision is in accordance with a written plan of care for each resident thereby ensuring that staff have sufficient information upon which to base their care practice. Whenever possible, residents are actively involved in planning their own care and are encouraged to sign records to confirm their agreement. Care records of 4 residents were examined and contained risk assessments forming the basis for care plans and daily records describing the care of each resident. To ensure correct identification of residents, records contain a recent photograph of each resident. Medicines prescribed by doctors are safely stored and carefully administered to residents by staff trained in this work, thereby protecting residents from medicine errors. Medication administration records were properly kept indicating that residents receive prescribed medicines at the correct times and in correct amounts those wishing to do so can manage their own medicines in accord with a risk assessment process; none of the currently accommodated residents manage their own medicines. In the presence of staff residents appeared relaxed, confident and at ease; staff interactions with residents were of a friendly and considerate manner and the atmosphere throughout the home was calm and tranquil. Residents are treated with respect and their privacy and dignity is protected at all times. Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged and assisted to maintain as much independence as possible. Social and leisure activities are varied and suited to the preference and ability of each resident. Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home. Meals are appetising and of good quantity and quality. EVIDENCE: The inspector spoke to a number of residents; all expressed satisfaction with all aspects of the home, including the range of activities, meal provision, staff and premises. Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 14 The home employs an Activities Organiser who arranges occasional local excursions, one-to-one and small group social and recreational activities. ‘Have Your Say’ questionnaires completed and sent to the Commission in advance of the inspection stated that The Cedars provides “Freshly cooked food…notice taken of any requests” and operates a “key worker scheme…social events with service users involved…very caring staff… catering for special diets…cook mixes with clients and talks to them”. Visitors are welcome at any time and those the inspector spoke to said they are always made to feel welcome and placed at ease by the staff. Residents said they were very satisfied with the quality, choice and quantity of food provided, variously describing it as “plenty” and “very good”. Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 16 & 18 The complaints procedure provides information on the procedure to follow to persons wishing to make a complaint; all complaints are recorded and investigated and the home has implemented an adult protection procedure. EVIDENCE: To ensure residents and their representatives have access to the complaints procedure it is included in the service user guide to the home which is displayed at the entrance and a copy is provided to each residents’ relative/representative. Residents know how to complain and feel confident that if they had concerns or complaints they will be listened to and taken seriously. Comments received in advance of the inspection included “…they have responded promptly and when I have made special requests they have always accommodated me”, “when there was a problem a meeting was arranged with all relevant carers to discuss the way forward”. The home keeps records of all complaints received and investigated. Since the last inspection no complaints against the home have been received or investigated. Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 16 The home has developed and implemented written policies and procedures for the protection of residents from abuse or neglect and provides all staff with training in the understanding of abuse and their role in protecting residents from abuse in its many forms, including neglect. Care staff spoken with during the inspection said they think the standard of training available to them is very good and they are encouraged to undertake training in subjects that interest them. Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 17 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 excellent. This judgement has been made using available evidence including a visit to this service. The premises are comfortable, clean, suitably equipped and subject to a continuous programme of updating and refurbishment to ensure the standard is routinely maintained. The garden is now fully accessible to service users. EVIDENCE: This mainly purpose-built home is well appointed and in good repair. All bedrooms are for single occupancy and provide sufficient space for the personal items of residents and provision of nursing equipment (including specialist beds) as necessary. Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 18 There are baths fitted with lifting aids, and showers suitable for use by residents with impaired mobility. The premises are well laid out with wide corridors, appropriate directional signs, level access to all parts of the building used by residents, very good hygiene facilities and suitably furnished day areas. Access to the garden has been recently improved and is now suitable for wheelchair users. There are well maintained flower beds, a water feature and seating areas. Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 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. 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. The home employs enough staff to meet the needs of residents and to ensure their safety and comfort and maintenance of the good condition of the premises. Recruitment practices ensure the protection of residents from potentially unsuitable staff. The home promotes the achievement of nationally recognised care qualifications and supports staff to access the training they need to be able to properly care for residents. EVIDENCE: Trained nurses lead the care team and at all times the home is in the overall charge of an experienced nurse. Staffing levels are provided in accordance with the assessed needs of residents to ensure that at all times sufficient staff are available to properly meet their needs. Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 20 Staff are enthusiastic about their work and feel they provide a good standard of care to residents and are properly supported by the management and training provision. The records of 2 recently employed staff members were examined and found to contain all essential information including two written references, an interview assessment, health details, evidence of identity and of induction training. At present 60 of the care staff currently employed by the home hold a National Vocational Qualification in care; the home thereby meets the standard for at least 50 of the care staff to hold an NVQ in care. The registered manager and the deputy manager share an enthusiastic approach to staff training; recent topics have included Protection of Vulnerable Adults, the Mental Capacity Act and fire safety training. Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 21 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed, suitably staffed and much liked by residents. The quality assurance system ensures maintenance of standards and involvement of service users. Policies and practices promote the health, welfare and safety of residents and staff of The Cedars. Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 22 EVIDENCE: Registered manager Mrs Ballard is supported by a deputy manager and together they maintain a regular presence in the home; both are well respected and liked by staff and service users. The home has ongoing systems for quality assurance; satisfaction surveys are periodically issued and occasional meetings for residents and their relatives takes place. There is a selection of clear and appropriate policy and procedure documents, including those for care provision, management and the premises. Records of fire alarm tests, staff training and drills were in order. The home does not manage the personal finances of any resident; there are facilities for the temporary storage of monies and valuables which residents may no longer wish to personally hold. Staff trained in First Aid and health care are on duty in the home at all times. All staff are supervised and each has a personal profile containing records of appraisal. Records are kept of all accidents and there is subsequent review of the care plan and periodic audit to identify any trends e.g. time, place, person, activity. To further promote safety by ensuring that exposure to known risks is minimised the accident policy/procedure should be extended to include investigation of each accident. Details of equipment servicing and maintenance were provided to the Commission in a questionnaire. The inspector examined some records to verify this information including the records of regular checks/tests of fire safety equipment. The home has recorded a fire safety assessment; to ensure full compliance with current standards it is recommended that a detailed escape plan be also recorded, to include specific reference to the currently accommodated residents. There is a written assessment of the ‘Health & Safety’ of the premises and working practices designed to ensure the continued safety of all who live in, work and visit the home. Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 23 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The service user guide should be made available in alternatives to the standard format and should fully describe the conditions of registration with particular regard to the categories of persons who may be accommodated. A detailed escape plan should be recorded, to include specific reference to the currently accommodated residents. 2. OP38 Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 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 Cedars (The) DS0000020499.V353159.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!