CARE HOMES FOR OLDER PEOPLE
The Cedars 16 Queens Drive Ilkeston Derby DE7 5GR Lead Inspector
Stuart Hannay Unannounced 18 July 2005 10.00 am
th 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 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 C52 S2129 TheCedars V226182 220605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Cedars Address 16 Queens Drive, Ilkeston, Derbyshire, DE7 5GR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0115 9440166 Ashbourne Limited CRH 39 Category(ies) of OP & PD registration, with number of places The Cedars C52 S2129 TheCedars V226182 220605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 3rd October 2004 Brief Description of the Service: The Cedars is registered to provide personal care for up to 39 service users over the age of 65. It is also registered to take people with a physical disability. It is located close to the centre of Ilkeston in a purpose built building on two floors. The Cedars C52 S2129 TheCedars V226182 220605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Eight of the service users, 3 staff members and 1 relative were interviewed. An inspection was made of the premises and a number of records relating to health and safety and the care of service users were checked. What the service does well: What has improved since the last inspection?
Service users were now involved in the review of their care plans. The unit manager said that the home’s hot water system had been checked to ensure an adequate supply of hot water at the home and the home was free of unpleasant odours on the day of the inspection. A small number of recommendations were not checked and are carried forward. The Cedars C52 S2129 TheCedars V226182 220605 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Cedars C52 S2129 TheCedars V226182 220605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Cedars C52 S2129 TheCedars V226182 220605 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The home assesses potential service users to ensure that the home would be able to meet their needs. However the home must also take into account the needs of the existing service users and ensure there are sufficient staff at the home. EVIDENCE: Pre-admission assessments were seen in the three care plans checked and the home was aware of the need to ensure that they were able to meet the needs of the service users. The Unit Manager said that all the service users were now considered to be at the higher end of the dependency scale and this needs to be taken into account to ensure that potential admissions do not jeopardise the home’s ability to provide care for the existing service users. The Cedars C52 S2129 TheCedars V226182 220605 Stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 8 10 The care plans demonstrate that the home is generally able to meet and review the health needs of the service users. They said that they are treated with dignity and respect. EVIDENCE: Four service users’ plans examined contained information about their general health needs, medical history and medication. Visits by outside professionals such as GPs, chiropodists, district nurses, dentists and opticians are recorded. The care plans contained information about what staff needed to do in order to meet these needs and any treatments prescribed by visiting professionals. Service users spoken with said that they felt all their health care needs were met. Those not able to express themselves clearly looked clean and well-cared for. Service users’ glasses, hearing aids and dentures appeared to be properly cared for. One service user had ill-fitting dentures but it was recorded in the care plan that they did not wish to see a dentist. All the service users interviewed said that the staff treated them with respect and kindness. One person said, “it’s nice, it’s respectful but there’s no bowing and scraping”. Staff observed on the day were very friendly towards service users. The home had not fully addressed all the requirements and recommendations made in
The Cedars C52 S2129 TheCedars V226182 220605 Stage 4.doc Version 1.30 Page 10 previous reports about care plans. Those carried forward include the need for daily notes to fully relate to the needs identified in the care plan and to widen the scope of the home’s risk assessments. The Cedars C52 S2129 TheCedars V226182 220605 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 13 14 Service users are offered stimulating activities but the range of these appears to be reduced due to fluctuating staffing levels. Visitors are encouraged to visit the home and are welcomed by staff. EVIDENCE: Service users interviewed said that they were able to choose how they spent their day and could join in, or not, with activities as they wished. They all said that visiting hours were flexible and that visitors were always welcomed into the home by the staff. One relative spoken with confirmed that she could visit at any reasonable time. Two of the service users interviewed said that they would like to have more trips out and one person said that she was offered trips out but did not want to go. The home does have a person who is put on the rota to do activities, however staff said that she was often drafted in to help with the care when care staff were off sick. On the day of the inspection, she was doing manicures and organised a game of bingo in the afternoon. Both activities were popular. Three of the service users spoken with felt that staff had had less time to spend talking with them in recent months as they were increasingly busy. The Cedars C52 S2129 TheCedars V226182 220605 Stage 4.doc Version 1.30 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home has a formal complaints system. Service users and staff said that they could raise concerns and that these would be taken seriously. EVIDENCE: Service users said that they would have no hesitation in raising any concerns with the staff or the Unit Manager. Staff interviewed were aware of the need to report concerns and felt that these would be taken seriously. The home has a formal complaints procedure. The Cedars C52 S2129 TheCedars V226182 220605 Stage 4.doc Version 1.30 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 20 23 24 26 Service users live in a comfortable and safe environment. The home was generally well-maintained and clean but minor redecorations are needed. EVIDENCE: The home was clean with no unpleasant odours on the day of the inspection. The lounges, dining-room and hallways were clean with no obvious hazards. Service users spoken with said that they could sit outside the home. All said that they were happy with their bedrooms. Seven bedrooms were checked during the inspection; they were generally well-decorated and well-furnished and highly personalised with paintings and photographs. There were comfortable beds and the rooms contained wardrobes and storage space. Some of the bedroom carpets needed to be more thoroughly cleaned to remove stains and two of the bedrooms seen had areas on the walls which needed repainting. The hallway at the rear of the building had marks down the wall and needed repainting and part of the downstairs carpet needed to be replaced following a leak. The Cedars C52 S2129 TheCedars V226182 220605 Stage 4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Health care and basic personal care needs appear to be being met at the home, however the staffing levels are not always maintained and a review of staffing levels needs to be undertaken to ensure that emotional and social needs are also addressed. The staffing levels must also be reviewed in relation to the high dependency of service users. EVIDENCE: The care staffing levels are a 4 people on the early shift from 8 a.m – 2 p.m. including the senior carer or unit manager. An extra person is deployed between 7.30 a.m. and 10.00 a.m. to assist with breakfasts. Between 2 p.m. and 8 p.m. there are three staff on duty, including the senior person. From 8p.m to 8.a.m, there are 2 staff on duty. According to the rotas checked, these staffing levels were not always being met. The Unit Manager said that the home has had difficulty recruiting to vacancies and short-term sickness is not always covered. There was evidence that agency staff are used to cover planned absences, however staff interviewed felt that this was not always useful as the agency staff did not know the service users or the routines at the home. The Unit Manager said that all the service users had been assessed as being ‘higher dependent’ and this included two people who were currently permanently in bed. The home had ensured that that their needs had been reassessed recently to ensure they did not need nursing care. However, they require two staff to attend to their personal care, pressure area care and continence needs. As the above staffing levels demonstrate, this means that there would be a significant reduction in the time available to other service users. This would be further reduced when the staffing levels were not being
The Cedars C52 S2129 TheCedars V226182 220605 Stage 4.doc Version 1.30 Page 15 met. A full review needs to take place to ensure that the home is able to meet all the needs of all the service users. The Cedars C52 S2129 TheCedars V226182 220605 Stage 4.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 36 38 The home is run by a suitably experienced Unit Manager who fosters an open atmosphere which promotes the rights of the service users. EVIDENCE: The Unit Manager has a wide range of experience in working with older people. She is not the registered manager. Staff and service users said that she is approachable and that they would not hesitate to express any concerns to her or the other senior staff within the unit. Staff had received recent manual handling and fire training. One staff member interviewed was able to describe the procedure to follow in the event of a fire. Records showed that the majority of staff had received recent updated fire training. There were no obvious hazards noted around the building. Two staff interviewed said that they had formal supervision but one person had not had this at the required frequency. The Cedars C52 S2129 TheCedars V226182 220605 Stage 4.doc Version 1.30 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 3 x x 3 3 x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x x x x 2 x 3 The Cedars C52 S2129 TheCedars V226182 220605 Stage 4.doc Version 1.30 Page 18 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15, 17 Requirement Timescale for action 30/11/05 2. OP22 23 3. OP33 24 4. OP27 and OP38 18, 12 Individual care plans must detail a set of holistic objectives to guide staff in meeting residents’ needs. (Original timescale June 2005) A loop system for residents with 30/11/05 hearing impairment must be installed in one of the day rooms. This would be of value at residents’ meetings.(Original timescale June 2005) The registered persons must 30/11/05 establish and maintain a quality assurance system that includes consultation with residents and their representatives. Copies of reports in respect of these ‘quality of care’ reviews must be made available to the Commission for Social Care Inspection.(Original timescale June 2005). An assessment of staffing levels 30/8/05 must be completed for the home. This must include a review of the dependency levels of service users. It must take into account the safe supervision of service users, the layout of the building and the number of service users who need two staff
Version 1.30 The Cedars C52 S2129 TheCedars V226182 220605 Stage 4.doc Page 19 5. 6. 7. 8. OP19 OP19 OP19 OP36 23 (2) (d) 23 (2) (d) 23 (2) (d) 18 (2) to assist them with any tasks. A copy of this assessment must be sent to the CSCI. All marked or stained carpets must be cleaned. Marked or stained bedroom walls must be cleaned or repainted if necessary. The identifed hallway must be repainted. Staff supervision must take place at the required frequency. 30/9/05 30/11/05 30/11/05 30/12/05 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 OP4 Good Practice Recommendations The Home’s written admissions policy should address new residents’ emotional and social needs. It is recommended that a discharge/transfer policy be drawn up with similar objectives. Staff should be encouraged to use the residents’ individual daily notes to record evidence of care plan objectives being achieved. These notes then become a monitoring tool when residents’ needs are reviewed. The Home’s equal opportunities policy should be reviewed to include residents. 2. OP7 3. OP32 The Cedars C52 S2129 TheCedars V226182 220605 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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