Inspection on 06/11/07 for The Cedars

This inspection was carried out on 6th November 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Cedars 04/09/08

The Cedars 22/01/07

The Cedars 29/11/05

The Cedars 28/07/05

The Cedars 21/02/05

The Cedars 23/08/04

The Cedars 18/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cedars (The) High Street Purton Wiltshire SN5 9AF Lead Inspector Alison Duffy Unannounced Inspection 09:40 6 November 2007 th 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) DS0000028140.V343484.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) DS0000028140.V343484.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedars (The) Address High Street Purton Wiltshire SN5 9AF 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) 01793 772036 01793 772635 www.osjct.co.uk The Orders Of St John Care Trust Mrs Michelle Lisa McKeever Care Home 49 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia – code MD – maximum four places of places Dementia - code DE - maximum of 12 places Old Age, not falling within any other category – code OP - maximum of 42 Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Date of last inspection 22nd January 2007 Brief Description of the Service: The Cedars was built in the 1980s as a purpose built residential care home. Originally managed by Wiltshire County Council, the home is now registered to the Orders of St John Care Trust. Mrs Michelle McKeever is the registered manager. The Cedars is situated in the village of Purton and is in close proximity to the various amenities. The home did offer intermediate care, within a specialised unit. However the service was withdrawn. In its replacement, the organisation applied CSCI, to increase its numbers from 48 – 49 residents. It also applied for 12 of those places, to accommodate residents with a diagnosis of dementia. In June 2007, we agreed the organisation’s application. There are now 4 places allocated to mental disorder, 12 to dementia and the remaining to older people. The home also provides day care facilities for up to 15 people. Residents bedrooms, offering single occupancy are located on the ground and first floor. A passenger lift is in situ. There is a large dining room and adjoining lounge. Additional seating areas have been created within the main entrance and within some areas of the corridors. Staffing levels are maintained at one care leader and five carers in the morning and one care leader and four carers in the evening. At night there are three waking night staff. There are also housekeepers, catering staff, an activities organiser, a maintenance person and an administrator. Designated staff work in the day centre. Fees for living in the home are based on dependency levels and the type of room occupied. The fees range from £387.00 to £495.00. There is an additional supplement for premier en-suite rooms. Items such as chiropody, hairdressing, dry cleaning and personal items are not included in the fee. Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place initially on the 6th November 2007 between the hours of 9.40am and 5pm. Mrs McKeever was not on duty. The care leaders assisted us, as required. Mrs McKeever was then on annual leave. Due to this, there was a delay, until the inspection was concluded. This took place on the 29th November 2007 between 9.30am and 4.30pm. Mrs McKeever and Ms Stenning, a lead manager within the organisation, received feedback. We met with a number of residents in the privacy of their bedrooms. We spoke to staff members on duty. We examined the medication systems and the management of residents’ personal monies. We observed the serving of lunch. We looked at care-planning information, training records and recruitment documentation. As part of the inspection process, we sent surveys to the home for residents to complete, if they wanted to. We also sent surveys, to be distributed by the home to residents’ relatives, their GPs and other health care professionals. The feedback received, is reported upon within this report. We sent Mrs McKeever an Annual Quality Assurance Assessment (AQAA) to complete before the inspection. Mrs McKeever completed this thoroughly and in detail. Some of the document’s content is taken into account within the evidence sections of this report. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Residents are able to follow their preferred routines. This includes how and where they spend their day, what time they get up and whether they have meals in their room. Staff have built positive relationships with residents and rights, such as privacy and dignity are promoted. Good teamwork was apparent and staff appeared friendly and motivated within their roles. Residents have regular access to health care professionals with district nurses visiting, almost on a daily basis. Meal provision is of good standard with a choice available at every mealtime. Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 6 Residents are able to personalise their own room and spend time, on their own as they wish. Visitors are welcomed and hospitality is evident. A robust recruitment process is in place, which gives residents additional protection. 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 Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. Cedars (The) DS0000028140.V343484.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) DS0000028140.V343484.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): 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Potential residents are assessed before admission, which enables an appropriate placement. The content of assessments is variable. Further clarity within documentation would enable staff to have clearer information about residents’ needs and the support required. EVIDENCE: The care leader told us that prospective residents are generally assessed in their own environment, before being admitted to the home. On occasions, a resident may be transferred from another home within the organisation. When this occurs, an assessment may not always take place. The care leader told us, there would be discussion between home managers, concerning the resident’s needs. We looked at the assessment documentation of the three most recent admissions to the home. One was very detailed and contained a range of Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 10 information. However, the other two assessments were more limited. The front sheet of the assessments, detailing basic personal information, was not signed or dated. In one assessment, short-term memory loss and vision impairment were both identified. However, there was no detail to describe the support the resident might require. The assessment identified ‘moderate confusion’ yet there was no explanation, as to how this presented in the resident’s every day life. Similar entries requiring clarity included ‘anxiety – very often’ and ‘pain – yes.’ A dependency assessment tool had been used, as part of the assessment process. There were copies of assessments on file, which had been undertaken by the placing authority. These were detailed. However, not all information had been identified on the resident’s care plan. One example included the need to monitor and observe signs of a urinary tract infection. There was no evidence of this, within the care plan. The Cedars no longer provides intermediate care and therefore Standard 6 is not relevant to this service. Cedars (The) DS0000028140.V343484.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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While the general experience of care practice is good, care plans do not always reflect the support residents require. Residents benefit from regular access to health care professionals yet the records of practitioners, such as the district nurse, should not be relied upon. Residents are protected by the home’s procedures for the safe handling of medicines. Residents’ rights to privacy and dignity are maintained. EVIDENCE: Residents told us they were totally satisfied with the care they received. All said they were helped, as required. Some mentioned their call bell, which could be used at any time to request assistance. Residents were very complimentary about the staff. One said ‘they are absolutely marvellous.’ Another said ‘they couldn’t be better. I couldn’t have chosen a better place.’ Within surveys, five relatives confirmed satisfaction with the care provided. One said ‘I feel my XX is getting very good care and s/he seems very happy in the environment provided.’ Another said ‘they give a lot of support and care Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 12 but also give XX the encouragement s/he needs to do things for him/herself.’ As a means to improve the service, one relative told us ‘I feel those with physical disabilities are well cared for. However those with mental disability (dementia) are left a little to their own devices.’ Another relative said ‘on talking with my XX it would seem to be difficult to have a bath on a weekly basis, sometimes it is a two week wait for a bath, which in my opinion is unacceptable.’ These views were discussed with Mrs McKeever. Mrs McKeever believed those residents with dementia, received good support. She also said residents could have a bath when they wanted one. Mrs McKeever felt this view might be associated with one particular resident. Some residents told us they have set days for their bath. We looked at a sample of care plans. They varied in content. Some areas explained the support required. There was good detail of poor mobility and the need to offer the use of a wheelchair. Other areas giving clarity were strategies to assist a resident with eating and individual preferences, of a male or female carer when providing intimate personal care. Some key aspects within care plans, lacked detail. One plan highlighted agitation and depression. There were no details of potential triggers or in fact, measures, which might promote relaxation. The management of some behaviours identified in daily records, were not evident within the care plan. One member of staff had documented that they had given a resident ‘mouth care’ and offered a food supplement drink. There was no evidence of these needs on the resident’s care plan. Also, despite a concern that a resident was not drinking enough, systems to encourage and monitor fluid intake were not identified. One resident self-administers their insulin yet the procedure for this was not clear. There were no details of the parameters of the resident’s blood sugar levels to maintain their wellbeing. The care plan stated ‘must eat regularly’ yet no other information was evident. One resident receives domiciliary care support. Guidelines clarifying this should be identified within the resident’s care plan. Staff told us that they are in the process of implementing a new care plan format. They have received training in its implementation. Staff believed the new format to be positive and an improvement on the existing system. Mrs McKeever confirmed this and believed existing shortfalls would be addressed, through the format of the new plans. One resident had a turning chart in place to minimise the risk of developing a pressure sore. A written instruction from the district nurse, gave guidelines of times, when the resident needed assistance to change their position. However, the resident’s pressure care management care plan, stated ‘staff to keep eye out for pressure areas…inform care leader.’ There was no reference made to enabling the resident to change their position, the special mattress in situ or the barrier creams in use. Clearly, ‘keeping any eye out for pressure areas’ is insufficient and too late, as the damage may already have occurred. Another Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 13 resident was receiving support from the district nurse, for a pressure sore. Information about the sore within their care plan was limited. Staff told us, the district nurse maintained these records. The home must however, keep their own documentation. This must include areas such as relieving pressure, pain relief, nutrition and maintaining clean dressings. Each care plan contains a record of all health care appointments. This may include the GP, the district nurse or chiropodist. A district nurse told us they often visit daily, to administer insulin or undertake dressings. They said ‘the staff are lovely. They are very caring and will ask for help, if they need anything or any advice. They provide good care here.’ Within surveys, two health care professionals confirmed satisfaction with the service. However, they told us about ways in which staff could improve care practice. These were ‘sometimes I am aware of basic care needs that are not met. For example, patients sometimes wear cotton or compression stockings. These are often found gathered around the foot or calf causing indentation and constriction. Despite providing moisturising cream for individuals, at times these do not seem to be used by the care staff.’ Also ‘senior care staff are excellent. Some junior staff are not always aware of problems and can either over react or under react. There is generally a good atmosphere within the home. Medical history of new patients not always available, which makes assessment difficult.’ These comments were forwarded to Mrs McKeever for her consideration. Subject to the risk assessment process, residents are able to manage their own medication. The majority however, rely on staff administration. A monitored dosage system is used. The system is stored securely within locked trolleys in a locked cupboard. Staff only have access to and administer medication, if they have had medication training. When administering medication, staff wear a fluorescent tabard. This is to alert residents and visitors, so that they are not interrupted. All medication was orderly stored. However, current liquid medications were stored at the bottom of the trolley. They were therefore unsecured when completing a drug round. We advised that the medication trolley be reorganised, so all items, could be locked securely. This had been undertaken on the second day of the inspection. The medication administration records demonstrated receipt of medication. Staff confirmed that the GP is now contacted to verify resident’s medication before admission. There was one gap in the record yet this had been highlighted and was in the process of being rectified. As recommended at the last inspection, all handwritten medication instructions, had been countersigned. Medications with a short shelf life had been dated, when opened. Some residents had been prescribed a number of creams. ‘Apply as directed’ instructions, were stated on the medication record. It was recommended that documentation should detail the reasons for the creams, the frequency and the areas, needing attention. Records must demonstrate that the creams have been applied. As many residents self-administer their creams, a system to enable the effectiveness of the treatment should be in place. Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 14 Residents spoke positively of staff and said their rights to privacy and respect were maintained. A number of residents told us they could spend uninterrupted time in their room. They said staff would knock and wait to be asked in, before entering. One resident, said ‘I live in a muddle, but it’s home. The staff don’t mind, even though there’s not much room.’ We observed staff being polite and respectful to residents. We overheard one resident thanking a member of staff for their help. In reply the staff member said ‘you’re very welcome.’ Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 15 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A programme of activity provision is offered yet further allocated activity hours would further enhance residents’ opportunities. Residents are able to follow their preferred routines and receive visitors as they wish. Residents’ expressed enjoyment from a menu, which contained a varied selection of traditional meals. EVIDENCE: There is an activity organiser who works 20 hours a week. Ms Stenning explained that the organisation is looking to develop this provision in the future. The activity organiser explained they were new in post. They were beginning to find out about residents likes and dislikes. They explained that their working hours were divided over a period of three days. On the days, which they did not work, activity provision was not provided for. Mrs McKeever said this was being addressed. All staff are being encouraged to facilitate activity, with the organiser as the lead. The activities organiser was asked how the needs of all residents, including those with dementia, were met. They explained this was very difficult, as many residents enjoyed one to one work. They confirmed that undertaking Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 16 individual work and occupying all other residents successfully, was a challenge. They said, with greater time, more time consuming activities such as developing memory boxes for reminiscence, could be undertaken. During the inspection, the activities organiser was undertaking their other role, as a carer. There were no activities taking place in the home. A number of residents said they spent their time in their room, reading or watching television. One resident told us ‘there is always something for everyone. They cater for a wide range of tastes.’ The majority were satisfied with activity provision yet one resident said ‘the worst thing is that there’s nothing to do.’ Within a review forum, one resident said they ‘would like to go out more.’ While day-to-day activities available to residents appeared irregular, there was a detailed organised, entertainment programme. Calendar events are celebrated and many parties were evident. A number of events, such as tea dances, skittles and quizzes are arranged with other care homes within the organisation. Notice boards displayed old events. A number of residents had Halloween napkin rings in their rooms. The activities organiser said she had made these, for each resident. Residents said they were able to follow their preferred routines such as getting up and going to bed. All said they could eat where they wanted to and spend time, independently in their room. One resident said ‘staff don’t disturb you. You can be independent as you want to be, but the support is there if you need it.’ Information within the AQAA, states residents are encouraged to maintain their network of friends and community based social activities. Residents confirmed this and said they could have visitors at any time. A number of residents said they looked forward to going out with their family. Residents expressed satisfaction with the food. Comments included ‘the food’s really good, I’ve put on weight since I’ve been here’ and ‘there’s a good choice and it’s varied.’ Currently, there are a number of diabetic and vegetarian diets. The cook said that the second choice of the menu is usually a meat free meal. In addition to the two choices, residents can have a salad or a snack, such as soup. On the day of the inspection, the main meal was steak pie or cheese and onion pasties. Two meals were liquidised. It was noted as good practice, that all items were being liquidised separately. The menu for the day was displayed in the dining room. Sample menus are displayed on the notice boards. Within surveys, two relatives commented ‘the food is good.’ It was the view of one relative that there was a lack of choice. They said ‘the food in general lacks imagination and it seems almost impossible to have meat sliced thinly. This is a complaint made by many people and I have met with the home manager of the Cedars on several occasions, but little if anything has changed.’ This view was discussed with Mrs McKeever and she said it was being monitored regularly. Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 17 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to enable concerns to be raised. However, a userfriendlier procedure may assist those residents with dementia, to express their views more readily. Appropriate use is made of the Safeguarding Adults Unit. With well-managed systems in place, residents are assured greater protection from abuse. EVIDENCE: Residents told us they would tell a member of staff or their family if they were unhappy. The home has a detailed complaint’s procedure. This was displayed in the entrance area. It was not displayed on other notice boards, within the home. Mrs McKeever said residents had chosen not to display the procedure due to its formality. They wanted notice boards to be bright and informal. We suggested a more-friendlier format. This would be more pleasing to the eye and be more appropriate, for those residents with dementia. Five relatives told us within their survey, that they were aware of the home’s complaint procedure. One was not. Three said concerns are always dealt with appropriately. Three said they usually are. One relative said ‘I have regularly asked 1) for my XX’s washing to be done 2) for his/her to be showered and 3) for him/her to see an incontinence nurse. I know my XX does not cooperate/respond well, but I shouldn’t have to keep raising these points.’ This view was discussed with Mrs McKeever. Mrs McKeever said she was not aware of the situation but would look into it further. Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 18 A record of formal complaints is maintained. Documentation detailing the outcome, forwarded to the complainant, is located on file. During the inspection, we asked a member of staff, a hypothetical question about abuse. They said they would immediately inform a senior member of staff. The senior member of staff would then make a referral to the Safeguarding Adults Unit. In the manager’s absence, they said they would contact one of the senior managers within the organisation. Mrs McKeever said that all staff have been given a copy of the local Safeguarding Adults policy entitled ‘No Secrets in Swindon and Wiltshire.’ The majority of staff have had recent adult protection training. Over recent months, there has been a high level of thefts within the home. All incidents have been reported appropriately to the Safeguarding Adults Unit. Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 19 Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 20 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from an environment that is clean, well maintained and furnished to a good standard. EVIDENCE: Residents have a single bedroom on the ground or first floor. There is a passenger lift or various staircases giving access to the first floor. Those rooms visited were personalised to a high degree. Residents told us they brought items of furniture with them, on admission. All had a number of important possessions including pictures and photographs. Residents said they had a call bell, which they could use, day or night. All told us that staff answered the bells, as quickly as they could. Residents said they could have their own telephone. They also had a key to their room and lockable storage space. Since the last inspection, the area that was allocated to the intermediate care unit has been totally refurbished. This has included re-decoration of the Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 21 corridor and residents’ bedrooms. New furniture and carpets are in place. Two en-suite facilities have been constructed. This has significantly improved the area. In addition, an upstairs corridor has been redecorated. The roof is also in the process of the being replaced. All areas were cleaned to a good standard. There were no unpleasant odours. At the last inspection, a requirement was made, as the standard of toilet cleaning, did not meet infection control standards. The standard observed during this inspection, was much improved. Staff have access to the Department of Health’s infection control guidelines. Staff have also received infection control training. The laundry facilities were ordered and clean. Staff said they were adequate for existing need. Residents said there were no problems with the laundry. One resident said ‘I put my laundry out on a Monday and usually by Tuesday; Wednesday at the latest, it’s back. It’s always in a lovely pile and neatly ironed.’ Staff have access to protective clothing, as required. Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 22 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well trained, motivated staff team. Residents have built positive relationships with staff. Residents are protected through a clear, well-managed recruitment procedure. EVIDENCE: There are generally five carers, a care leader and a care support worker on duty, during the morning shift. This reduces by one carer during the evening shift. At night there are three waking night staff. Mrs McKeever told us, 70 additional care hours, had been allocated to the staffing budget earlier in the year. Residents spoke favourably about the staff. They said ‘they are lovely, ’ ‘all staff have a wonderful attitude’ and ‘staff are marvellous. They can’t do enough for us.’ Within surveys, six relatives told us that care staff have the right skills and experience to look after people properly. They said ‘I have always found the care staff to be very caring and experienced’ and ‘all the staff encountered have been very kind and pleasant and always ready to spend time with you when necessary – very helpful to residents.’ Another relative said ‘the majority (but not quite all) of the staff are extremely pleasant and very good with clients. They have time to talk to them and the atmosphere in the home is cheerful and calm.’ Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 23 In addition to the care staff team, there are housekeeping and catering staff, an administrator, an activities co-ordinator and a maintenance person. The housekeeping staff said they were busy, as one member of the team had left to attend an appointment. The staff were understandably, not able to spend time, talking of their role in detail. They did however explain the importance of getting to know residents and developing relationships. A number of residents spoke highly of the housekeeping staff. One said ‘they work really hard and are proud of what they do. A while ago, they had over looked debris in the light fittings. I told them about it and ever since, the lights have been perfectly clean. They were very apologetic.’ Within a survey a relative told us, ‘I know that the housekeeping staff work hard to complete all of their jobs but it would be nice if occasionally XX’s room could be hoovered, even if its just up the middle of the room.’ This view was shared with Mrs McKeever. Staff told us they have been very short staffed due to staff vacancies, annual leave and sickness. Many staff have undertaken additional shifts, to ensure coverage of the staffing roster. Some agency staff have been used. Staff said that staff have been recruited but have not started due to waiting for their clearance checks. Staff said, that once inducted, the staffing situation should improve. One staff within their survey said [as a means to improve the service] ‘have more staff so that quality time could be spent with the residents.’ We looked at the recruitment documentation of three most recent members of staff. All files contained the required information. Staff told us that there is always training going on in the home. A number said ‘there is all the mandatory courses and other things such as care planning. You can ask for something, you think might be useful.’ Staff said they had completed infection control, fire, medication, adult abuse, dementia care, manual handling and first aid training. Care planning training in relation to the planned introduction of new care plan format, is being arranged. Another staff member told us they had completed tissue viability, mental health awareness and death, dying and bereavement training. A care leader explained that levels of staff training within the home are high. They said they had recently undertaken supervisory management and care planning training. They were also planning to undertake equality and diversity training. The majority of staff have completed a dementia course facilitated by the Alzheimer’s Society. One member is to be appointed a ‘dementia champion.’ This will involve formulating a support group and developing an on going training programme of dementia care. Another care leader told us that the majority of the staff team have NVQ level 2 in care. Many staff have also completed level 3. The care leader said that the home has used its allocation for funding. However, once more funding is secured, those staff waiting to register for NVQ level 3, will do so. Within the AQAA, Mrs McKeever said that the home consistently exceeds the required 50 ratio of staff with NVQ. All new staff are expected to register for this training. Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 24 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from an experienced manager who is motivated and resident focused. Systems are in place to regularly audit and improve the service given to residents. The safe keeping of residents’ personal monies is well managed therefore minimising the risk of error. Residents’ well being is promoted through clear health and safety systems. EVIDENCE: Mrs McKeever has been the registered manager of the home since November 2005. Mrs McKeever is a registered nurse and has varied experience of working with older people within hospital and residential settings. Mrs McKeever has NVQ 4 in management and has also undertaken various short courses. Mrs McKeever is keen to further develop the home and enable a good Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 25 quality of life for residents. One relative, within their survey told us, ‘The Cedars is a well run home that I would not hesitate to recommend.’ The home has a quality assurance system that is used within all of the homes within the organisation. The system consists of various audits and questionnaires. Within the summer period, all residents were asked to complete a questionnaire. The feedback was coordinated and shortfalls were identified. These have been addressed. The home evidenced compliance with all aspects of the home’s annual audit. Detailed monthly operational visits were in place. A number of residents have placed small amounts of their personal monies, for the home to hold safely. We looked at the systems for managing this. Cash amounts corresponded with the balance sheets. Staff sign and check each transaction. The resident or another member of staff countersigns the record. Receipts were in place to demonstrate expenditures. The records are regularly audited within the home. There are also external audits. Mrs McKeever told us regular health and safety audits take place. Systems are in place to monitor issues such as hot water temperatures. There is a range of environmental risk assessments. Some individual risk assessments are located on residents’ care plans. One resident was using bed rails yet there were no bumpers. A special mattress had been applied to the bed, which raised the resident to the level of the bed rails. Staff had identified this. Measures were in place to resolve the risk. Mrs McKeever told us bumpers had been applied to the rails and the bed had been lowered. Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 26 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 X X 3 Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement The registered individuals must ensure that the admission details form is always fully completed and that all sections of residents’ assessments are fully completed and in sufficient detail. The assessment form must also be signed and dated by both the resident and member of staff completing the form. This requirement was identified at the last inspection and previous inspection. It remains outstanding in part due to inconsistent detail and the assessment form not being signed or dated. As a new assessment and care-planning format is being introduced, a revised timescale has been identified. The Registered Person must ensure that the management of specific health care conditions are clearly addressed within the resident’s care plan. This was identified at the last inspection yet remains Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 28 Timescale for action 31/01/08 2 OP7 15 31/01/08 outstanding. 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 The registered person should ensure that all food and fluid charts are evaluated on a regular basis, with clear guidelines on when specialist advice should be gained. This should be documented accordingly. This was identified at the last inspection, yet there was no evidence to demonstrate that it had been addressed. The registered person should ensure that the application of topical creams are clearly identified and addressed within the resident’s care plan. The registered person should ensure that a review of activity provision is undertaken in line with residents’ preferred interests. Following this, the amount of hours required to implement such provision should be recalculated. This was identified at the last inspection, yet there was no evidence to demonstrate that it had been addressed. The registered person should ensure that the complaints procedure is developed within a user-friendly format. This was identified at the last inspection, yet there was no evidence to demonstrate that it had been addressed. The registered person should ensure that systems are devised to enable other stakeholders to give their views as part of the home’s quality assurance system. This was identified at the last inspection, yet there was no evidence to demonstrate that it had been addressed. 2 3 OP9 OP12 4 OP16 5 OP33 Cedars (The) DS0000028140.V343484.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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) DS0000028140.V343484.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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