Inspection on 26/09/07 for The Cedars

This inspection was carried out on 26th September 2007.

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

The Cedars 26/10/06

The Cedars 25/04/06

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 2AX Lead Inspector Sandra Buckley Unannounced Inspection 26th September 2007 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 DS0000005488.V347988.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Cedars DS0000005488.V347988.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cedars Address 45 Queens Road Oldham OL8 2AX 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) 0161 626 4665 F/P 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.V347988.R01.S.doc Version 5.2 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. 26th October 2006 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 weekly fee is from £333 to £343, that does not include hairdressing, clothes and newspapers. A copy of the Commission’s most recent inspection report is on display in the entrance hall. The Cedars DS0000005488.V347988.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection which included an unannounced visit to the service. This means the manager did not know in advance we were coming to inspect. This inspection looked at all the key standards and included a review of all available information received by the Commission for Social Care Inspection (CSCI) about the service provided at the home since the last inspection. During the site visit information was taken from various sources, which including observing care practices and talking to people in the home. The manager, relatives and some members of the staff team were also interviewed. Two safeguarding investigations have taken place since the last inspection. The manager has co-operated fully with the investigations and has acted upon what Social Services recommend she does. A tour of the home was undertaken and a sample of care, employment and health and safety records were seen. Comments from people in the home and their relatives are also included in this report. All the requirements made at the last inspection have been done. Before the inspection, we asked the manager of the home to complete a form, called an Annual Quality Assurance Assessment (AQAA), to tell us what they felt they did well and what they needed to do better. This helps us to determine if the management of the home sees the service they provide the same way that we see the service. We felt this form was completed honestly and reflected the manager’s understanding of the service they provide and how the home could be improved. What the service does well: The Cedars offers a small home environment, which has a long-standing staff team. Only one new member of staff has been employed since the last inspection. This offers residents good continuity in building up relations with staff. The Cedars DS0000005488.V347988.R01.S.doc Version 5.2 Page 6 Good interactions were noted between people in the home and staff. One staff member said, “ We are encouraged to sit and talk with people.” One person living in the home said, “I visited a few homes which looked like institutions, this was the first one that looked like a home.” People thought the soaps and activities but I because that is routines were flexible; one said, “I like to stay up and watch all we can go to bed when we want.” Another said “there are prefer not to join in, the manager buys me crossword books what I want to do.” One relative said, “We visit at all different times and my grandmother always looks clean and tidy.” What has improved since the last inspection? What they could do better: We think people are well looked after, however, the manager is aware that some things still need to be done. For example, ensuring all staff have undertaken training in the protection of vulnerable adults and that staff receive supervision on a regular basis to monitor competency and promote personal development. Two minor shortfalls were identified in the medication recording and having risk assessments in place for residents who put their own creams on. Discussions with the fire service must take place to ensure the safety for those people who wish to have their bedroom doors left open. The Cedars DS0000005488.V347988.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Cedars DS0000005488.V347988.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 The Cedars DS0000005488.V347988.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): Standard 3 Quality in this outcome area is good. A professional assessment of need is obtained for people before going into the home, to ensure their needs can be met. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Three care files were examined, all had a professional assessment of need. For those people who are self funding, the home undertakes their own assessment. The manager is required to complete an Annual Quality Assurance Assessment, (AQAA). In this document they recognised how they could improve their assessment process by consultations with professionals. The Cedars DS0000005488.V347988.R01.S.doc Version 5.2 Page 10 The AQAA also stated that people are encouraged to visit the home before making an informed choice. One person said, ‘I visited several homes which looked like institutions, I chose this because it looked like a home.’ The Cedars DS0000005488.V347988.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): Standards 7, 8, 9 & 10 Quality in this outcome area is good. Care plans and staff practice demonstrated that people’s assessed needs were being met. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Three people’s files were examined and were found to contain care plans in line with their assessed needs. Files contained assessments of physical, emotional and spiritual needs. Professional visits, weights and personal care needs were also recorded. A photograph of the person was placed at the front of the file to ensure new staff knew who they were providing care for. Risk assessments were completed and documents were reviewed on a regular basis. The Cedars DS0000005488.V347988.R01.S.doc Version 5.2 Page 12 Recently, the manager had recognised they could not meet the needs of two people in the home and had called for a reassessment of their needs. Assessments from medical professionals had been sought, for example, cognitive assessments. The recording of accidents provided full details of the incident, what action was taken and any follow up required. This information was also recorded in daily notes. Five staff had undertaken falls prevention training. The manager had recognised that staff had not been recording sufficient detail of care delivery in daily notes. There was evidence that this was brought up for discussion at a staff team meeting. People in the home appeared well cared for, clean and tidy. The manager had stated in the AQAA that she undertakes daily observations of people’s appearances and records findings in a monthly management review. One person said, ‘Staff are very good here, I like to talk to them.’ Another said, ‘I have had a health check today.’ One relative said, ‘My grandmother always looks well cared for.’ There was evidence of good practice, for example, daily notes had recorded that one person had refused medication. Staff had recorded that the person should be approached later. It was documented that half an hour later, staff had approached this person who was at that time willing to take their medication. Another example being, one person was sat uncomfortably in a chair, with sunlight shining in her eyes. Staff recognised this and closed the curtains and made the person more comfortable. Staff had received training in the administration of medication and there had been a recent audit undertaken by the PCT. Examination of medication administration and recording found two irregularities. One being night medication which had been given but not signed for and risk assessments were not in place for two people were self-administering skin creams. Interviews with staff showed their knowledge of the people in their care and how privacy and dignity are maintained. The Cedars DS0000005488.V347988.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): Standards 12, 13, 14 & 15 Quality in this outcome area is good. Routines in the home were flexible with people’s lifestyle expectations and spiritual needs being met. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: People’s interests were recorded in care files. Routines in the home were flexible. One person said, ‘I like to stay up and watch all the soaps, we can go to bed when we want.’ The inspector observed one person ask if she could make herself a drink in the kitchen, indicating this was common practice. Staff said they would assist her. Spiritual needs were addressed and there was evidence that one person continues to attend her local church. The Cedars DS0000005488.V347988.R01.S.doc Version 5.2 Page 14 Staff undertook activities with people in the home. One member of staff said, ‘We are encouraged to spend time and sit and talk to people.’ One person said, ‘I like to play bingo.’ Another talked about the summer trip to Chester Zoo and the planned autumn trip to Blackpool. The Cedars is situated close to Oldham town centre. One person said, ‘I like it here because I can manage to get into town on my own.’ Another said, ‘There are activities but I don’t like to join in. The manager buys me crossword books because this is what I like doing.’ Some people chose to spend time in their room; one person said, ‘I have my own television so I can choose what I want to watch. Another said, ‘I have a daily newspaper delivered which I pay for myself.’ The inspector dined with two people who were complimentary about the food. The menu board states the meal of the day and choices. At the time of the inspection, only ten people were in the home enabling the dining experience to be more family orientated. The Cedars’ small home environment allows staff to know people’s likes and dislikes. The dining experience could be enhanced by offering juice as an alternative to tea and the introduction of individual teapots for those people who have the capacity to manage this instead of asking staff for a drink. The manager holds meetings with people in the home to discuss any issues they may have. The AQAA stated how lifestyle in the home was going to be enhanced by staff gathering information to complete a lifestyle portfolio and provide a more in-depth view of people’s previous lifestyles, interests and hobbies and which of these, if any, could continue in the home. An example observed on the day of inspection was one person choosing to help staff lay the dining table. The Cedars DS0000005488.V347988.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): Standards 16 and 18 Quality in this outcome area is good. Allegations and concerns were addressed through appropriate channels. People and their relatives were aware how to make a complaint and there was evidence that the manager acted appropriately when concerns were brought to her attention. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The Cedars’ complaints procedure is displayed in the hallway of the home and was also in place on the three care files examined. A record of complaints was maintained with outcomes of the investigation. One professional said, ‘I am visiting a newly admitted person who really likes it here and would certainly complain if they did not.’ One relative said, ‘We were given information on how to make a complaint.’ People in the home said they would feel comfortable in raising any concerns they had. The Cedars DS0000005488.V347988.R01.S.doc Version 5.2 Page 16 Two allegations of poor care practices, lack of stimulation and poor recording in daily notes have been investigated by Oldham Safeguarding Adults Team, to which the manager had fully co-operated, and has done everything social services asked her to do. One incident which occurred between two people living in the home had been investigated by the Mental Health Team. They requested the manager monitor the situation closely until the people involved could be reassessed. The home had taken measures to address matters by increasing staff training in the protection of vulnerable adults. Two staff had completed the course; two others were waiting for their training dates through Oldham Social Services Training in Partnership. An additional two staff were completing NVQ level 3 , which includes training in the protection of vulnerable adults. The manager had acknowledged on the AQAA that they realised more staff training was needed and action had been taken to rectify these issues. The Cedars DS0000005488.V347988.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): Standards 19 and 26 Quality in this outcome area is good. The accommodation was clean, warm and decorated to a satisfactory standard. People benefited from personalisation of their rooms, providing a homely environment. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: A selected tour of the premises was undertaken and found to be clean, warm, free from offensive odours and decorated to a satisfactory standard. The manager conducts weekly checks and any repairs needed are addressed. The Cedars DS0000005488.V347988.R01.S.doc Version 5.2 Page 18 There is a choice of three seating areas: the main lounge, dining room which also has a seating area and the small rear lounge that provides a dining space and two comfortable chairs. An additional television is also in the rear lounge to offer an individual choice. Many people had brought furniture and personal items from home. Gardens provided a safe attractive area for people to sit in and enjoy. The Cedars is registered fro 12 people, some who would have to be accommodated in shared rooms. The manager had made the decision to turn two shared rooms into individual rooms to allow a greater degree of privacy. During the inspection it was noted that some of the upstairs doors were wedged open at people’s request. Discussions must take place with the fire service on how this can be provided for people and maintain fire safety. The manager said the doors are always closed at night. People spoken to were pleased with their accommodation. One person said, ‘I have my own television so I can choose to watch what I want in my room.’ One relative said, ‘We are really pleased with my grandmother’s room.’ The Cedars DS0000005488.V347988.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): Standards 27, 28, 29 & 30 Quality in this outcome area is adequate. Recruitment procedures were robust and provided protection for people in the home. Staffing levels and training should be kept under review to ensure positive outcomes for people in the home are maintained. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: At the time of this inspection, ten people were being accommodated in the home. Examination of the duty rota found that from 8am till 3pm the manager, two carers and a domestic, who worked from 9am to 11.30am, were on duty, Monday to Friday. Staff also undertook cooking and laundry duties. From 3pm to 9pm only two carers are on duty. There is one waking night staff and one staff doing sleeping-in duty. This number dropped to two staff all through the day at weekends, with one domestic covering a Saturday duty, 9am to 11.30am. In addition to delivering personal care and administering medication, staff have to carry out bed changes, laundry, cleaning and cooking. The Cedars DS0000005488.V347988.R01.S.doc Version 5.2 Page 20 At the time of this inspection outcomes for people in the home were not affected. However, staffing levels must be kept under review in line with people’s dependency needs to ensure standards are maintained. A core of staff had worked at the home a number of years, providing some continuity of care for people. Five staff have completed NVQ level 2 of which two are now undertaking NVQ level 3. Five staff had completed falls prevention training; all staff have completed a medication and administration course. Staff inductions were in line with Skills for Care and the manager said they were in discussion with Oldham Social Services training department to improve staff training. Only one new staff member had been recruited since the last inspection. The recruitment file was examined and found to have all appropriates checks completed and two references. One person said, “I have transferred from another home which I found difficult, however staff are very good here and I like to sit and talk to them”. The Cedars DS0000005488.V347988.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): Standards 31, 33, 35, 36 & 38 Quality in this outcome area is good. The improvement in management and staff training, together with additional consultations with professionals have obtained positive outcomes for people in the home This judgement has been made using available evidence, including a visit to this service. EVIDENCE: There has been a significant improvement in the overall management of the home since the last inspection. The manager has now completed NVQ level 4, Registered Manager’s award and continues their professional development by undertaking short courses, for example, medication and administration and the protection of vulnerable adults. The Cedars DS0000005488.V347988.R01.S.doc Version 5.2 Page 22 The manager acknowledged in their AQAA that improvements had been needed and acted upon these, and is continuing to monitor and review practices, especially in administration and record keeping. There was evidence that consultations had taken place through questionnaires to professionals, relatives and people in the home. There was only one negative comment made, with this being taken to a staff meeting for discussion. All other comments were positive. Three financial accounts of people living in the home were examined and found to be well maintained with receipts for any expenditure. There was evidence that staff supervision had taken place twice a year, which need to be increased to six times a year to identify training needs and promote accountability. Five staff had completed falls prevention training and accident recording provided full details of any interventions. All staff had completed Fire Marshall training and safe food hygiene. Discussions must take place with the fire service on how to maintain safety for those people who wish to have their bedroom doors left open. Checks had been completed on equipment in the home and the lift had been serviced. The Cedars DS0000005488.V347988.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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 The Cedars DS0000005488.V347988.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. 1 Standard OP9 Regulation 13 Requirement Medication that is administered to people in the home must be signed for immediately when given, to ensure their health care needs are met. Timescale for action 19/10/07 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 3 4 Refer to Standard OP9 OP27 OP36 OP38 Good Practice Recommendations Risk assessments should be in place for anyone administering their own medication, i.e., creams. Keep staffing level under review in line with people’s dependency needs, especially over a weekend period to ensure people’s needs are met. Increase staff supervisions from twice a year to six times a year to ensure training needs are identified and accountability promoted. Discussions should take place with the fire service to ensure the safety of people who wish to have their bedroom doors left open. The Cedars DS0000005488.V347988.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Manchester Local Office 11th Floor, West Point 501 Chester Road Old Trafford Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Cedars DS0000005488.V347988.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. 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