Inspection on 03/08/07 for The Cedars

This inspection was carried out on 3rd August 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 07/08/06

The Cedars 26/01/06

The Cedars 16/09/05

The Cedars 13/12/04

The Cedars 21/09/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE The Cedars Sudbury Road Halstead Essex CO9 2BB Lead Inspector Kathryn Moss Key Unannounced Inspection 3rd August 2007 10:15 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 DS0000017957.V347940.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 DS0000017957.V347940.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cedars Address Sudbury Road Halstead Essex CO9 2BB 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) 01787 472418 01376 334892 Cedarshalstead@hotmail.com Mr Balkrishna N Patel Mrs Anjana Balkrishna Patel Mrs Anjana Balkrishna Patel Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24) of places The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th August 2006 Brief Description of the Service: The Cedars is situated in Halstead, Essex, close to the town centre and local communities. The home was built in the 18th century and has had a newer annex built onto the rear of the premises. Inside it has retained many of its original features (e.g. fire places). It is a two-storey building with access to the first floor by stair lifts in both parts of the building (new and old). There is a pleasant sunroom and external patio area facing the rear garden. The owners are in the process of building a second unit in the grounds of the home. The home is suitably furnished, decorated to a good standard and offers a homely and caring environment to the service users who live there. The home is registered to provide care for 24 older people over the age of 65 with dementia, and provides 24 hour personal care and support. There were 23 people in residence on the day of this inspection. The current fees charged at The Cedars range from £434 to £485, not including personal items such as hairdressing and chiropody services. The manager advised that the home’s Service User Guide is available in the office. The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that was carried out on the 3rd August 2007 and lasted eight hours. The inspection included: discussion with the manager; inspection of communal areas, a sample of bedrooms and the laundry; inspection of a sample of records and policies; conversations with 4 staff, 1 resident and 3 relatives; observation of activities; and feedback questionnaires from 10 relatives and 6 residents (completed on their behalf by their relatives). This report also draws on any other information relating to the home received by the CSCI since the last inspection (e.g. Annual Quality Assurance Assessment, notifications from the home, complaints, internal monitoring reports, improvement plans, etc.). As most of the people living in the home suffer with dementia, and many would therefore have difficulty telling us what it is like to live in the home, a second inspector spent two hours in the home prior to the date of the inspection, observing the care and well-being of four residents. Feedback was provided to the manager afterwards, and any relevant issues have been included in the body of this report. Outcomes relating to 24 Standards were inspected: there were 4 requirements resulting from this inspection, and 8 good practice recommendations have been made. The manager and staff were welcoming, helpful and constructive throughout the inspection. The home provides a consistent level of care and support, with positive feedback from relatives. What the service does well: The home has a warm, friendly, lively atmosphere and sounds of laughter and activity from around the home were noted on the inspection. One relative reported that the home ‘provides a very warm, homely atmosphere and staff spend time talking to the residents’, and another felt that they were ‘always made to feel welcome at any time’. Positive feedback was received regarding the approach and attitude of the manager and care staff. When asked what they felt the home did well, relatives’ comments included: ‘looks after people in a kind and friendly manner’, ‘they are very patient when residents are uncooperative’ and ‘everything and anything they can do for the people who live in the home’. One relative added that they felt that ‘the people who live in the home are allowed to live as they wish, with dignity’, and another felt that their parent The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 Page 6 was given respect and love within the home. Observations of people as part of this inspection showed a good level of staff interaction and engagement with residents, with positive responses. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. Standard 6 is not applicable at The Cedars. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service The home’s admission processes ensure that residents can be confidant that the home can meet their needs. EVIDENCE: Information about the home is available in the home’s Service User Guide: this was not reviewed on this occasion, but the manager advised that a copy of this is available in the office at the home. Feedback from residents and relatives indicated that they felt they had received enough information about the home to be able to make their decision to come to live there. The Service User Guide does not currently detail the fees in the home, and the manager was advised that this must be amended to include this information. The manager confirmed that individual fees are detailed in people’s contract of residence. The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 Page 9 The manager confirmed that, except in emergency situations, the home always meets and assesses prospective residents before they agree admission, and also obtains full information where people are referred through social services. This ensures that the home can be confidant that they have the resources to meet a person’s needs. The records were viewed for one person who had recently come to live in the home, and contained a clear assessment carried out before their admission, covering relevant information on their needs, wishes and background. Although the style and age of the building means that some areas of the home are not ideally suited to frail older people (e.g. stairs, steps in corridors, etc.), the owners make the best use of resources and provide equipment to overcome physical barriers (e.g. stair lift, etc.). Staff have attended training appropriate to the needs of the people they care for (see Staffing section), and many had recently completed a distance learning dementia course. Staff spoken to were positive about the training they had attended, showing an interest and understanding of what they had learnt. The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service Residents’ health care needs are well met within the home, and medication practices promoted and safeguarded their welfare. EVIDENCE: All the feedback received from relatives (either directly, or on residents’ behalf) indicated that they felt that the home ‘always’ or ‘usually’ provided the care and support that people needed (including healthcare support) and that staff had the skills and experience to look after people properly. Several relatives commented that the care home keeps them well informed about the resident’s welfare. One relative reported that “X always appears well looked after, their personal and medical needs are always met”. Staff were observed to treat residents’ respectfully, and care practices promoted privacy and dignity. During the observation that took place prior to the inspection, one staff member was observed holding a person’s hand and stroking it in a warm The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 Page 11 and reassuring manner, and another was seen to adjust a person’s clothing to protect their dignity and make them comfortable. This was good to see. Two residents’ records were inspected for evidence of how the home plans and meets personal and healthcare needs. There were a variety of assessment forms covering general needs, moving and handling, risk of pressure areas, mental health, behaviours, falls, etc., with appropriate information recorded. A ‘Needs and Preference’ form provided a care plan, with sections covering different needs (e.g. physical and mental abilities, health and hygiene, food and diet, etc.), and a subsequent page identifying ‘action plan’; some good information was recorded on the forms viewed, which will help staff know how to meet people’s needs. However, in some cases the care plans lacked sufficient detail of the action required by staff to meet a need. For example, one care plan identified that the person needs all personal care seen to with supervision and needs assistance to go to the toilet, but did not describe the level of supervision or assistance required, or what the person could do for themselves. There was evidence that care plans were reviewed monthly, and it was good to see one instance where a person had been involved in their care plan, and had signed it to confirm this. Staff reported that they have had training this year from the district nurse or specialist nurses on use of continence pads, diabetes and pressure sores. The manager stated that one person was at risk of developing pressure sores and had a special pressure relief mattress on their bed; however, this was not referred to in their care plan, and all pressure area preventative care should be clearly documented. Files contained a record of contact with healthcare professionals, either on a separate contact sheet or daily records, confirming that medical advice and support was promptly sought when required. Many residents are still independently mobile, and it was good to see mobility being encouraged. A number of residents experienced regular falls, and there was generally good evidence of the monitoring and recording of any falls and injuries, e.g. good accident records (showing all follow-up action), bruise charts and falls risk assessments. In one case daily records did not show a fall that was logged in the accident book: daily records should show all falls, to enable staff on duty to monitor any ongoing effects. For a person who had regular falls, although a falls risk assessment was completed, the care plan did not describe action to be taken to minimise risk. The home’s medication administration policy and procedure was not viewed on this occasion. A senior carer explained the home’s procedures, and showed good knowledge of correct medication practices. The manager stated that senior staff attend an annual one-day medication training course; training records showed that all five senior carers had completed training in this subject. Since the last inspection the manager had devised a checklist on which to record competency assessments of staff medication practice, and said she intended to assess staff every three months: although this had only The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 Page 12 recently been implemented, it was good to see that action was being taken to assess and monitor practices. Medication stocks were safely stored in appropriate storage facilities, including a controlled drugs cabinet and a medication fridge. Stocks were stored in a clean and orderly manner. Not all liquid medication (prescribed or homely remedies) had been dated on opening. Medication administration records (MAR) were pre-printed by the pharmacist with details of each person’s medication. The manager checks and records on the MAR all medication received into the home, and where no new supplies were received, any medication carried over from a previous month was clearly recorded. Systems were in place to record any medication returned to the pharmacist. Each person’s MAR was accompanied by a clear photo of the person to ensure accurate identification, and administration records viewed were generally well completed. Any controlled drugs were clearly recorded in a dedicated controlled drugs book. Any homely remedies administered were being recorded on individual daily communication records: the manager was advised that these medications should be recorded on MAR (e.g. on the reverse of the form), to ensure they form part of the person’s medication administration record. The Cedars DS0000017957.V347940.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 and 15 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service The home provides a good lifestyle that offers choice and meets peoples’ social and recreational needs. EVIDENCE: On the day of the inspection, people were seen to have the freedom to wander around the home, and to be able to spend time in their rooms or in the lounges, as they wished. Routines were discussed with the manager, and appeared flexible (e.g. when people got up and went to bed). Bathing took place in the mornings or after tea, and did not interupt daily routines. Residents could make choices about what they did and how they spent their day, subject to their individual abilities. Staff were present in communal areas and were observed to spend time with residents, and to initiate activities during the afternoon (including a game of dominoes, sudoku, and cake making). On the inspection and also during the The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 Page 14 two hour observation carried out prior to the inspection visit, it was noted that residents mainly showed a postive state of well-being, appearing content and engaging well with staff, with no signs of ill-being. Most staff interacted well with residents, actively engaged with them, and were warm and affectionate in their approach. During the two hour observation, there were a few examples of poor interaction (e.g. staff handing out drinks to people without a word, waking someone up for no apparent reason, or taking someone to another room or to the toilet without any verbal exchange): staff need to endeavour to always communicate with people when carrying out tasks. The inspector also observed someone ‘being fed’ a biscuit that they did not appear to want, but the carer held the biscuit to their mouth until they had eaten it. Staff need to be sensitive to people’s reactions, and use different strategies for encouraging people to eat. Care records contained some good personal profiles on residents, describing their background, significant events and interests. One relative said that they were impressed that the home wanted “to know as much as possible about the residents so they can relate to them as individuals”, and reported that the manager had spent some time with them obtaining information on their parent’s life history. A staff member spoken to said that they had found this information very helpful in getting to know residents, and understood the importance of this information when working with people who suffer with dementia. They reported that in some cases the home has been able to obtain photos of peoples’ families and life events, and found these useful for stimulating conversation and interaction. The home is commended on this. Care plans contained some information on meeting social needs, and daily records noted activities that a person had engaged in. The home does not have a set activities programme. Staff are allocated each afternoon to carry out activities, but no one has specific responsibility for the development of activities in the home. It appeared that whilst staffing levels allowed some time for staff to carry out activities, staff did not have time to explore and develop different activities (e.g. one staff member wanted to develop a reminiscence box). One relative consulted felt that activities were not the home’s ‘strong point’, and the home is encouraged to look at ways of developing the range and amount of activities in the home. The manager reported that some outside people come into the home to provide activities (e.g. a fortnightly ‘movement and music’ session, musical entertainment every couple of months, a weekly visitor who comes and chats to residents, etc.), and a church service is held in the home once a month. Residents cannot use the garden at present due to building work, and the manager stated that staff have been trying to take people out for walks up the road, and try to have a trip out each week (e.g. to shops or garden centre). One relative confirmed that they had seen staff taking a resident out to local shops. Several visitors were seen in the home throughout the day, and were clearly able to come and go as they wished, and appeared to feel at home. Those The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 Page 15 consulted were very positive about the staff and manager, saying that they always felt welcomed in the home, and that the manager always made time to talk to them. The home has a four weekly menu that is changed seasonally. Menus viewed showed a range of meals, with choices on most weekdays but just one main meal option on menu on Wednesdays and at weekends; the range of food served at tea times appeared quite limited in variety. On the day of the inspection, lunch consisted of a choice of gammon or fish cakes served with boiled potatoes, peas and baked beans, followed by lemon meringue pie or angel delight. Feedback questionnaires received on behalf of six residents indicated that one person ‘always’ liked the meals, four ‘usually’ liked the meals, and one ‘sometimes’ liked the meals. A resident spoken to felt that meals were varied, and that whilst some were good others were not so good. One relative who provided feedback felt that some of the meals they had seen had not looked very appetising; another reported being pleased that their relative had put on weight since living in the home. Lunch and tea were served quite early (12pm and 4.30pm): the manager explained that this was because many residents wake early and have their breakfast early, but that a mid-evening supper is served to ensure that there is not too long a gap between tea and breakfast. It was good to see the home ensuring meal times met residents needs and routines. Where people needed assistance with eating their meal, staff were observed to sit alongside them to offer support. A relative commented that staff were very patient in feeding one resident when they were reluctant to eat. The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service Practices in the home ensure that residents are protected, and concerns are taken seriously. EVIDENCE: The Cedars has a clear complaints procedure, which was noted to have been reviewed earlier this year. Feedback from relatives confirmed that they knew how to make a complaint: most stated that they had not needed to make a complaint, but felt able to speak to the manager if they had any concerns; those who had raised concerns had been happy with the way the home had dealt with them. Although some residents would be unable to voice concerns and complaints themselves, it was noted that the manager spends time around the home and residents were seen to relate well to her and spoke to her readily and confidently. One relative commented that, even though their parent didn’t always fully understand situations, they continued to show an ability to speak their own mind, and felt this indicated a sense of well-being. The home had complaint record form, with the last recorded complaint made about a year ago. The nature of what constitutes a complaint was discussed with the manager, who said that minor concerns would not usually be recorded. She was encouraged to ensure that all concerns are logged, even The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 Page 17 those that are resolved quickly, as details of these concerns can provide the manager with useful monitoring information about practices in the home and also provide evidence of how concerns are dealt with in the home. The home’s Protection of Vulnerable Adults (POVA) policy was not reviewed on this occasion. The manager had responded promptly and appropriately to an adult protection concern raised in the home over the last year. The manager stated that fifteen staff received POVA training last October, and that new staff had received some guidance on POVA during their induction. New staff attend an external induction course: it was confirmed that this covered the Common Induction Standards, which include a unit on POVA. Training records showed that only eleven current staff had evidence of POVA training (as some staff had left since the last training); there was no evidence of POVA training for ten other care staff, but it was noted that several had been recruited within the last six months and a new carer spoken to during the inspection confirmed that their induction had covered POVA issues. The manager stated that she was looking into further POVA training, and needs to ensure that all staff (care and auxillary) have received this training. The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 Page 18 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, 20 and 26 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service Residents’ benefit from a well-maintained, comfortable and clean environment. However, not all infection control practices adequately protected residents. EVIDENCE: The Cedars provides a warm and homely environment for residents, with a variety of communal space available for personal use and activities. A sample of bedrooms were viewed during the inspection: these were in a satisfactory state of decoration, with a sufficient range of furniture; several of the rooms viewed were well-personalised, showing that residents could bring their own posessions into the home with them. It was noted that some furniture was looking worn (e.g. veneer peeling from cabinet edges, chair fabric torn, etc.), The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 Page 19 and in need of replacement or repair, The manager stated that all beds have been replaced in last two years. The home does not have any specific plan of redecoration, but the manager stated that they check rooms every two weeks, and arrange for their decoration when they need doing or when vacant. Records of decoration used to be kept, but had not been maintained. Nine of the bedrooms in the home are shared bedrooms: it was noted therefore that the home was unable to provide people with much choice over who they shared with, when new residents came to live in the home. Shared rooms had curtains between beds and around sinks to provide some privacy. The home is currently in the process of building a second unit in the grounds of the existing home, plus a small extension to the existing building that will house a new laundry, sluice room, staff rest room, and disabled toilet. This means that the gardens are currently out of use due to the building work, apart from small patio area with some seating. The manager stated that when the building is complete, they plan to landscape the remaining garden area to make it safer and more suitable for residents. This was good to hear. On the day of the inspection the home appeared clean and hygienic, and rooms viewed were clean and tidy with minimal unpleasant odour. Feedback questionnaires completed on behalf of residents confirmed that the home was ‘always’ or ‘usually’ fresh and clean. The home currently has a small external laundry room containing two washing machines and two drying machines: one machine had a ‘sanitary’ wash, which the manager stated provided a sluice wash with a 90°C temperature cycle, and confirmed that this was used for items soiled with body fluids. The home does not currently use red bags for soiled linen: this is recommended if machines have a sluice wash cycle, in order to minimise staff handling potentially infectious laundry. The laundry area had a large porcelain sink; no liquid soap or paper towels were present in laundry for staff handwashing, and this must be addressed. It was also noted that there was only a cloth towel present in one toilet and in a bathroom: the manager was advised that use of communal hand towels may present an infection control risk, and paper towels should be available for use by staff and (where possible) residents when washing hands. Only one bedroom has an ensuite toilet, and most residents are provided with a commode in their room. The home does not currently have a separate sluice facility, and it was noted that commodes were being cleaned and soaked in the communal bathrooms that were in daily use by residents. Whilst it was noted that the home currently lacks suitable alternative facillities for cleaning commodes, the manager was advised that this practice presents a risk of cross infection to residents. She was required to seek the advice of the Health Protection Agency on the best practice options available to the home, and to ensure that procedures are reviewed. The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 Page 20 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 and 30 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service Staffing levels and skills meet the needs of residents and ensure they are in safe hands. However, recruitment records do not sufficiently demonstrate that residents are protected by the home’s recruitment practices. EVIDENCE: From a sample rota viewed, staffing levels appeared to be consistently maintained in the home. Current staffing levels consist of four carers during the day (7am to 10pm), and two at night (plus one on call). The manager is supernumerary, but helps out within the home when required. Daily domestic and catering staff are on duty, and the home has a full-time maintenance person. The home currently employs about 22 care staff, which the manager confirmed is sufficient to cover shifts (so no agency staff are currently being used). There had been some turnover of staff in the last year, with about eight staff leaving and a similar number recruited. The manager was aware of reasons for staff leaving the home, most of which were due to staff moving away from the area or for health reasons. Staff spoken to felt that currently staffing The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 Page 21 levels enabled them to meet residents’ needs, although felt that they had limited time for developing activities. Surveys completed on residents’ behalf by relatives confirmed that there were ‘always’ or ‘usually’ staff around when residents needed someone to assist them. The files of two new staff were inspected for evidence of the home’s recruitment practices. Both files contained a photo and evidence of identification, and a completed application form that included a health declaration, a criminal record declaration, and their employment history. Although the form requested their last ten years of employment history, one file only detailed the most recent employment, indicating that their previous employment history had not been checked for any gaps. The second application showed a gap in the employment history: the manager was aware of the reason for this, but had not ensured that a written explanation was recorded, as required by the Care Homes Regulations 2001. Both application forms contained the names of two referees, including the last employer, and references had been sent for. In one case the last employer reference had not been received: the manager stated that she had chased this, but had not recorded her phone calls to the referee. An additional personal reference had been obtained instead, after the person had started work. The other file contained two references received back: it was noted that the home’s standard reference form did not contain space for the referee to date their reference, so it was not possible to confirm if these references had been obtained before staff started work. For one applicant, the manager had not sent off for a Criminal Records Bureau (CRB) and POVA check because the carer had supplied a copy of a CRB check recently obtained for another job, and the manager thought this would be sufficient. She was advised that care home’s are legally required to obtain a POVA check on every new staff member before they start work. The other file contained a CRB check received shortly after the person started work, and a brief note of a phone call received on the day the carer started work, notifying the manager that a satisfactory POVAfirst check had been received. The manager stated that new staff attend an external two day induction course, covering moving and handling and the ‘Skills for Care’ Common Induction Standards. This was confirmed by a new carer spoken to during the inspection. A summary of training submitted by the manager following the inspection visit listed twenty care staff, of whom five had completed NVQ level 2 or 3, and a further 4 were working towards achieving this. The manager stated that she aims to arrange a training course each month, and a carer spoken to felt that training was one of the areas in which the home had improved over the last year. New staff spoken to had already attended several training courses since joining the home, which was good to see. Training completed by staff over the last year included a distance learning The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 Page 22 dementia course (9 staff), and training by district nurses on tissue viability and pressure sores, diabetes and incontinence. The summary of staff training showed that, with the exception of the newest staff, all staff had completed food hygiene training, moving and handling, health and safety and fire safety training within the last year. Further fire safety training was booked, infection control training was arranged for the week after the inspection, and the manager was in the process of arranging first aid training. This is a good level of training being provided and completed within the home. The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 Page 23 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 and 38 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service Residents’ benefit from the sound management of the home. Health and safety practices in the home protect residents, and promote a safe environment. EVIDENCE: The registered manager has achieved the Registered Manager’s Award (NVQ level 4 in management). She attends other training to update her knowledge and skills, including over the last year: an essential skin care study day, an infection control course for managers, a bereavement seminar, an End of Life seminar, and a staff supervision workshop. It was also good to hear that she The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 Page 24 had booked to attend a Mental Capacity Act training session, as this is a subject very relevant to the management of the home. The manager has also trained to be a moving and handling trainer: although staff still attend formal external training, the manager uses her own training to give new staff initial training and to supervise and assess staff practices within the home. All staff spoken to during the inspection were positive about the manager, finding her approachable and supportive. Staff felt they received good management support, and they receive regular supervision. The manager is available to staff at all times and can be contacted when she is not on duty. No formal quality auditing processes are currently used in the home: the manager stated that she has obtained a form to audit the home against the National Minimum Standards, and had also obtained an infection control audit form, and intended to implement these. The CSCI had recently sent the home an Annual Quality Assurance Assessment (AQAA) form to complete: although this had been completed, the information provided had not described how the home meets the Standards, or their plans for improvement. The purpose and completion of this assessment was discussed with the manager during the inspection. The home does not have a formal annual development plan: the manager stated that planning takes place on an ongoing basis. The home carries out an annual survey to seek the views of relatives and healthcare professionals about the home, and produces a report to summarise the outcomes. Most residents are unable to complete feedback questionnaires, and there are no other formal processes for evaluating the quality of life from their perspective; however, the manager monitors their well-being and care through daily observation. The home does not look after any money on behalf of residents, but will pay for anything they need and invoices relatives for the money spent. The manager reported that relatives provide most items required by residents, and the main costs paid for by the home are hairdressing, chiropody and any trips out. The home keeps evidence of any expenditure, and provides families with copies of this. The home’s health and safety policies and procedures were not reviewed on this occasion. As noted in the previous section, training records showed that staff were kept up to date in relevant health and safety training, ensuring that they understand safe practices. The home maintained evidence of the regular servicing of equipment and utilities (e.g. fire alarm system, stair lifts, hoists, electrical installation and portable equipment, etc.) and of regular internal tests and checks carried out (e.g. wheelchair maintenance, kitchen checks, checks on sample hot water tap temperatures, emergency lighting and fire alarms, etc.). There was evidence that the home had updated its fire risk assessment and sent a copy to the fire service, and records showed that regular fire drills took place. The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 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 2 X 3 3 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 3 X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 Page 26 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 OP1 Regulation 5 Requirement Residents and prospective residents must have clear information available to them about the range of fees in the home, and what these cover. The manager must therefore ensure that these are detailed in the Service User Guide. To ensure that staff know what action needs to be taken to meet healthcare needs, the home must ensure that care plans clearly details any pressure area care or preventative care required by a person. To protect residents from risk of cross infection, the home must review its practices in relation to the cleaning of commodes, and seek advice on best practice for the home. To ensure the protection of residents, the home must ensure that all the required recruitment checks are carried out before new staff start work. This particularly relates to obtaining: (a) A full employment history and written explanation of any DS0000017957.V347940.R01.S.doc Timescale for action 30/09/07 2 OP8 17, schedule 3 (m) and (n) 30/09/07 3 OP26 13(2) 30/09/07 4 OP29 19, schedule 2 31/08/07 The Cedars Version 5.2 Page 27 gaps in employment; (b) A CRB and POVA check for all new staff; and (c) Two written references (including last employer) 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 OP7 Good Practice Recommendations It is recommended that the home continues to develop care plans, ensuring that they contain sufficient detail of the action required by staff to meet each need, including information on what each person is able to do for themselves. It is recommended that all bottles of liquid medication are dated on opening, to ensure they are used within the timescales directed. It is recommended that the manager review whether current staffing levels provide sufficient time for staff to plan, develop and provide activities for residents. It is recommended that menus are kept under review, to ensure they provide sufficient variety and meet the individual preferences and needs of people in the home. It is recommended that the home implement a programme for replacing or repairing worn furniture. The home should progress arrangements to ensure more staff are qualified to NVQ level 2 or above. It is recommended that the manager could improve evidence of recruitment processes by: 1. Ensuring reference request forms have space for the referee to date the reference; 2. Clearly recording any phone calls to chase references, or reasons for seeking an alternative reference; and 3. Ensuring a clear, formal record of any POVAfirst checks notified to the home. The home should develop its quality assurance and monitoring processes, through implementing internal auditing, annual development plans, and ways of evaluating the quality of care from residents’ perspective. 2. 3 4 5 6 7 OP9 OP12 OP15 OP19 OP28 OP29 8 OP33 The Cedars DS0000017957.V347940.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 DS0000017957.V347940.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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