Inspection on 28/02/06 for The Cedars and Larches Care Home

This inspection was carried out on 28th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 and Larches Care Home 23/10/07

The Cedars and Larches Care Home 20/11/06

The Cedars and Larches Care Home 18/07/05

The Cedars and Larches Care Home 27/05/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Cedars, The 16 Queens Drive Ilkeston Derbyshire DE7 5GR Lead Inspector Steve Smith Unannounced Inspection 28th February 2006 09:30 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 DS0000002129.V285252.R01.S.doc Version 5.1 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 DS0000002129.V285252.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Cedars, The Address 16 Queens Drive Ilkeston Derbyshire DE7 5GR 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) 0115 9440166 Ashbourne Limited Vacant Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Cedars, The DS0000002129.V285252.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 24 Places for OP 3 Places for younger PD aged 50 and over included in the total above 15 Places for OP not included in the total above Date of last inspection 18th July 2005 Brief Description of the Service: The Cedars is registered to provide personal care for up to 39 Residents 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. Cedars, The DS0000002129.V285252.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 4 hours. Discussion took place with the Manager, a senior nurse and with the Home’s chief. Some of the Home’s records were looked at, and all public areas of the Home were examined. What the service does well: What has improved since the last inspection? At the time of the last inspection only a few Requirements and Recommendations were set by the Inspector, and all but one have been met. Since the last inspection the quality of the Residents files has been improved. Stained carpets had been cleaned, and decoration of parts of the Home had been improved A hearing loop system has been installed in one of the lounges. Quality assurance systems have been provided to ensure that Residents care and the quality of the Home is maintained. Cedars, The DS0000002129.V285252.R01.S.doc Version 5.1 Page 6 The supervision of care staff had been provided at two monthly intervals of time. 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. Cedars, The DS0000002129.V285252.R01.S.doc Version 5.1 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 Cedars, The DS0000002129.V285252.R01.S.doc Version 5.1 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 the following standard(s): Standard 3. New Residents moving to the Home were always provided with an assessment of need completed by either a Care Manager, from Social Services Depts, or the Manager to ensure all needs of Residents could be met by the Home. EVIDENCE: When new Residents were admitted to the Home, the Manager was provided with a summary of needs of each person, completed by the Care Manager, from Social Services Depts supporting each Resident. She also visited those potential Residents and undertook her own assessment of need before agreeing to their admission to the Home. If the Resident was self-funding, and therefore not supported by Care Managers, the Manager completed her own summary of need. Standard 6 does not apply to this Home. Cedars, The DS0000002129.V285252.R01.S.doc Version 5.1 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 the following standard(s): Standard 9. The administration of medication was, on occasions, poorly carried out and needed attention to appropriately ensure that Residents needs were met. EVIDENCE: All medication and the method of distributing it to Residents were examined, and a good record was found. However, three issues needed attention: Medication Administration Record (MAR) sheets regularly indicated that medical creams were to be applied to Residents ailments but the MAR sheet was not completed on all occasions this was carried out. In a number of places on the MAR sheets it was indicated that 1 or 2 medications were to be taken, but the MAR sheet completed by staff did not say how many medications were administered to the Resident. A review of the MAR sheets against the drugs supplied to the Home showed that staff were signing the MAR sheet to say a drug had been taken but the drug was found to still be on the dispensing card. Cedars, The DS0000002129.V285252.R01.S.doc Version 5.1 Page 10 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 the following standard(s): These Standards were not examined during this inspection of the Home. EVIDENCE: Cedars, The DS0000002129.V285252.R01.S.doc Version 5.1 Page 11 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 the following standard(s): Standard 18. The protection policies and procedures provided by the Home meant that Residents were well protected. EVIDENCE: The Registered Providers had a good policy to protect Residents from abuse and the Manager was aware of the Derbyshire Adult Protection Procedures sponsored by the Local Authority. The Manager agreed that she would refer unsuitable staff to the Protection of Vulnerable Adults register, now that it was operational. The Home had polices and procedures for handling Residents money, which included a section preventing staff from benefiting from or assisting in the making of Residents wills. Cedars, The DS0000002129.V285252.R01.S.doc Version 5.1 Page 12 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 the following standard(s): Standards 19, 24, 25 & 26 Generally, the Home was very well maintained throughout, however, slight improvements were needed to ensure all Residents lived in a safe, comfortable environment. EVIDENCE: Residents were provided with very pleasant surroundings. All bedrooms were naturally ventilated, and centrally heated, the heating being controlled in each Resident’s bedroom. Radiators were appropriately guarded and the temperature of hot water in the Home’s baths was appropriately monitored. The Home was found to be very clean, pleasant and hygienic. The laundry floor finish was found to be impermeable and the walls were readily cleanable. The Home had a number of sluicing facilities and sluicing disinfectors. The Home’s washing machines were able to provide a washing sequence of over 650 C. The Home’s kitchen and its storage facilities were satisfactorily maintained. Cedars, The DS0000002129.V285252.R01.S.doc Version 5.1 Page 13 However, under the staircase, beyond bedroom 1, combustible items were found to be stored, and needed to be removed as soon as possible. Cedars, The DS0000002129.V285252.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 27, 29 & 30. The Registered Providers were not providing sufficient care staffing, when compared to the Residential Forum, to meet the assessed needs of Residents. EVIDENCE: Staffing provided in the Home was compared with the details provided by the Residential Forum. This showed that during the four weeks beginning 30th January to the 20 February 2006, the Home was providing care staffing below that recommended by the Residential Forum for 30 Residents at the Low Dependency level. The Residential Forum recommended that at least 510 hours of care should be provided across the day and night shifts each week. During the four week period examined the Home provided between 68 and 86 hours of care less than the recommended Low Dependency figure of 510 hours per week. If the Home had Residents in the Medium or High Dependency level then staffing levels would be even further adrift. These figures were calculated without the Manager’s working time included, as recommended by the Residential Forum. During the above period of time examined some of both senior care staff and care staff were found to regularly work double shifts, amounting to 12 hours. During such long shifts it was felt that this would not encourage staff to meet the needs of Residents in a kindly, understanding or patient manner. Cedars, The DS0000002129.V285252.R01.S.doc Version 5.1 Page 15 The staffing records of two staff employed since April 2002 were examined. These showed that the Manager had obtained the majority of requirements necessary, although two items were missing. Photographs, CRB checks, qualifications, and assurance of the new members of staff’s physical and mental fitness for the job had been obtain. Two references had been obtained for one member of staff, but only one for the second. A full history of previous employment had again been obtained for one but not for the second member of staff. Staff induction and foundation training was provided for all new staff that came to work in the Home. The Manager also said that all care staff were provided with at least three paid days training a year. All staff also had an individual training and development assessment and profile. Cedars, The DS0000002129.V285252.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 & 38. The Manager was appropriately qualified and the Registered Providers regularly ensured that the Home was inspected, to ensure good standards were maintained for Residents. EVIDENCE: The Manager was able to say that she had completed her training to NVQ level 4 in Management. It was also found that the Registered Providers ensured that the Home was ‘inspected’ on at least a monthly basis, reporting any concerns to the Manager. The Manager said that the Home had an annual development plan and a quality assurance system that was reviewed annually. Residents also completed questionnaires with the results being published. The Home also obtained the views of family and friends of Residents on how well the Home was achieving goals for the Residents. Cedars, The DS0000002129.V285252.R01.S.doc Version 5.1 Page 17 A small amount of Residents money was kept in the Home for everyday expenditure. Records of these were examined. Money were appropriately stored and securely held. Records were kept, and a sample of these were examined, and found to be satisfactory. However, one Resident’s account examined amounted to over £100.00, and the Registered Providers and Manager were encouraged to limit the amount held on behalf each Resident to approximately £50.00. The training provided for staff was examined. This showed that the Registered Providers and Manager had ensured that all staff, where necessary, had received the required training in Moving and Handling, Fire Safety, Food Hygiene and Infection Control. All nursing staff provided First Aider cover in the Home at all times. However, care staff had not been trained in First Aid. All Residents had been risk assessed to determine their vulnerability and measures had been put in place to provide protection where necessary. The Home had complied with all necessary legislation, such as the Health and Safety at Work Act 1974, and the Manual Handling legislation of 1992. The Manager said that risk assessments had been carried out to ensure that safe working practices were provided within the Home that related to the care staff, catering staff or domestic staff tasks. However, she had not provided a written statement of the policy, organisation and arrangements for maintaining those safe working practices. The Manager ensured that all accidents, injuries and incidents of illness or communicable disease were recorded and reported to the relevant government bodies. She also had ensured that fire safety notices were posted in relevant places around the Home. Cedars, The DS0000002129.V285252.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X 3 3 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Cedars, The DS0000002129.V285252.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Whenever staff administer medical creams to Residents the Medication Administration Record (MAR) sheet must be completed on all occasions. When the MAR sheet indicates that 1 or 2 medications could be taken by a Resident, the record must shown how many medications were actually taken. Senior staff must not sign the MAR sheet to indicate that a medication has been taken when in fact it has not been taken. The combustible items stored under the staircase near to bedroom 1 must be removed. The Manager must check, and hold documentary evidence, that all staff employed in the Home since April 2002, have satisfied the requirements listed in Regulation 19 and Schedule 2 of the Care Homes Regulations 2001, as amended during 2004. All care staff must be urgently trained to carry out First Aid tasks. Timescale for action 25/04/06 1 OP9 13 2 OP9 13 25/04/06 3 OP9 13 25/04/06 4 OP19 23 25/04/06 5 OP29 19 25/04/06 6 OP38 13 & 18 30/06/06 Cedars, The DS0000002129.V285252.R01.S.doc Version 5.1 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Refer to Standard OP27 No. 1 Good Practice Recommendations The Registered Providers should provide day care and night care staffing at least in line with that recommended by the Residential Forum. This figure should not include the Managers working time. The Manager should review the length of time care staff are allowed to work each day, and where possible limit this to no more than approximately 8 hours each day. The Registered Providers should review the amount of money held on Residents behalf, limiting the amount to approximately £50 per Resident. The Manager should provide a written statement of the policy, organisation and arrangements for maintaining safe working practices in the Home. 2 3 4 OP27 OP35 OP38 Cedars, The DS0000002129.V285252.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 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 DS0000002129.V285252.R01.S.doc Version 5.1 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!