Inspection on 18/07/06 for The Cedars Care Home (Ashford) Ltd

This inspection was carried out on 18th July 2006.

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

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE The Cedars - Ashford 16 Fordbridge Road Ashford Middlesex TW15 2SG Lead Inspector Mary Williamson Key Unannounced Inspection 18th July 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Cedars - Ashford DS0000066148.V304520.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 - Ashford DS0000066148.V304520.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cedars - Ashford Address 16 Fordbridge Road Ashford Middlesex TW15 2SG 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) 01784 242356 01784 481794 Dr Ajit Prasad Vera Saunders Care Home 16 Category(ies) of Dementia (16), Dementia - over 65 years of age registration, with number (16), Old age, not falling within any other of places category (16) The Cedars - Ashford DS0000066148.V304520.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25/07/2005 Brief Description of the Service: The Cedars is a care home for older people. Service provision includes dementia care for up to nine service users. The home is located in a residential area, within walking distance of the town of Ashford and conveniently situated near to all community facilities. These include shops, banks, post office, and a day care resource for older people. The home is well served by public transport and there is off road parking facilities. Accommodation is arranged on three floors, the first accessible by passenger lift and the second by chair lift. Service users occupying the second floor bedrooms must be fully ambulant. Communal areas on the ground floor include a front lounge, a combined lounge/dining room with patio doors opening onto a sunroom overlooking a mature enclosed garden. Bedroom accommodation includes 13 single rooms, and one shared, there are bathing and toilet facilities on all floors, these include bathrooms, a shower room and a walk in bathing facility all within easy access of the service users. The range of fees charged in the home is between £450 and £500 per week. The Cedars - Ashford DS0000066148.V304520.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and was undertaken by Mary Williamson who is the lead inspector for the service. The registered manager Vera Saunders was present for the duration of the inspection. Mr Chander Parkash who is a part owner and his daughter Sonita who is the proposed responsible Individual were also present for an hour of the inspection. There was thirteen service users in the home, two service users in hospital, three care staff, one chef, and one cleaner on duty during the inspection. It was possible to talk with all the service users some in more detail than others. There was also the opportunity to talk with all the staff and the one relative who was visiting the home during the inspection. Ten service user comment cards, six relative comment cards, two GP comment cards and two health care professional comment cards were received by the inspector all with favourable comments regarding the care provided in the home. A tour of the premises was undertaken and records relating to the care of the service users and the management of the home were examined. The inspector would like to thank the service users and the staff team for their helpful input to the inspection process. What the service does well: The home provides a comfortable and homely atmosphere for the service users who live there. The manager is experienced in the provision of care for this client group and she operates an open and hands on approach. The catering arrangements meet the service users expectations and several service users stated that the food was very good. Privacy and dignity is observed and staff were interacting with service users in a respectful and professional manner. The Cedars - Ashford DS0000066148.V304520.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The standard of record keeping in the home is generally good. However when the manager was on a period of sick leave the fire safety records relating to testing the alarm system were not maintained and CSCI were not informed routinely of an event, which affected the wellbeing of service users. Suitable arrangements must be in place to cover the manager’s time off. It was disclosed during the inspection that the financial directorship of the home had changed and of the intention to appoint a new responsible individual. The provider had not informed the CSCI of this and a requirement was made accordingly. The Cedars - Ashford DS0000066148.V304520.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Cedars - Ashford DS0000066148.V304520.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Cedars - Ashford DS0000066148.V304520.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5, and 6, Quality in this outcome area is adequate. Judgement has been made using available evidence including a visit to the service. Prospective service users have a needs assessment undertaken prior to admission. They also have access to information to help make an informed choice about living at the home. Contracts of occupancy for several service users are out of date, and need to be reviewed. EVIDENCE: The home has a statement of purpose and service user guide in place. All service users and their relatives have access to a copy of this information. Prospective service users have a needs assessment undertaken by the manager prior to admission to the home. Assessments were seen for IS, DL, JC, and FD. These were detailed, and informative, and provides the manager with the required information to enable her to make a decision regarding the suitability of the placement. The Cedars - Ashford DS0000066148.V304520.R01.S.doc Version 5.2 Page 10 Trial visits are encouraged whenever possible however some relatives choose the home on behalf of the prospective user. Contracts of occupancy are in place. These need to be reviewed, as there has been a change of ownership and eight service users contracts are out of date. The responsible individual must ensure that The Commission for Social Care Inspection is informed in writing regarding the change in the ownership and senior management and administration of the home. The home does not provide intermediate care. The Cedars - Ashford DS0000066148.V304520.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. Quality in this outcome area is good. Judgement has been made using available information including a visit to the service. Arrangements in place meet personal, health and medication needs of service users as outlined in individual care plans. EVIDENCE: Individual care plans are in place including a “personal preference plan”. Care plans were seen for IS, JC, DL, and FD. These are written with input from the service user, relatives, information gathered during the pre admission assessment, and health needs report. The plans are well maintained include risk assessments for moving and handling, assessment of falls, and Waterlow skin assessment, and are reviewed and updated on a regular basis. Daily records on progress or change are kept in the care plans and also a record of doctor’s visits and hospital appointments. All service users are registered with local G P’s and are seen regularly. Chiropody treatment is provided every six weeks in the home. Service users access local dentists when required and an optician service is available six monthly by an outside service that visits the home. The Cedars - Ashford DS0000066148.V304520.R01.S.doc Version 5.2 Page 12 The home has a medication policy in place and all staff who administer medication are familiar with this policy. There is an audit trail of all medicine entering and leaving the home. The medication recording charts are well maintained. Breakspears the local pharmacist supply all medication for the home most of it in blister pack format. They will also provide training. Privacy and dignity is observed and staff were seen to knock on service users bedroom doors prior to entering. They also spoke to service users in a polite and respectful manner. Service users can have visitors in the privacy of their own room. The Cedars - Ashford DS0000066148.V304520.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15. Quality in this outcome area is good. Judgement has been made using available evidence including a visit to the service. Activities provided in the home meet individual and communal needs of service users. The catering arrangements are satisfactory. EVIDENCE: There is an “ activities list” displayed on the notice board outlining a programme of events provided in the home. This includes games, bingo, music and exercise group, art and craft, and films. The home used to provided an external musical entertainer weekly, but this has now been reduced to once a month. Family links are maintained and relatives are welcome in the home at any reasonable time. One relative confirmed that he is kept informed of any changing care needs and that he is consulted in the care planning process. Some service users visit the local shops and others visit the garden centre with family and friends. The local day centre can also be accessed if required. Spiritual needs are supported and ministers from the local Methodists Church undertake a service in the home every two weeks. The Cedars - Ashford DS0000066148.V304520.R01.S.doc Version 5.2 Page 14 The kitchen was visited and was clean and orderly. The last Environmental Health Inspection was on 31/01/06 and the requirements made have been met. There is evidence that fridge and freezer temperatures are recorded. The manager and the cook plan the menus on a four- week cycle with input and feedback from the service users. Lunch on the day of the inspection consisted of roast pork, vegetables, roast and boiled potatoes, followed by raspberry pie and custard. The cook stated that there is always an alternative to the menu when required. There was good feedback from service users regarding the food supplied. The Cedars - Ashford DS0000066148.V304520.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, and 18. Quality in this outcome area is good. Judgement has been made using available evidence including a visit to the service. The home has satisfactory policies and procedures and training in place for dealing with adult protection and complaints. EVIDENCE: The home has a complaints procedure in place, which is also included in the service user guide. One service user and her relative when asked were aware of this procedure and stated that they have never used this as any problems are solved “efficiently and promptly”. The home has an abuse awareness policy in place and staff confirmed that they had received training in abuse awareness during induction training. There is a copy of Surrey Multi Agencies Policies and Procedures on Safeguarding Vulnerable Adults in place. The manager must attend training arranged by her Local authority in these procedures and cascade this to the staff team. The Cedars - Ashford DS0000066148.V304520.R01.S.doc Version 5.2 Page 16 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): 19, 20, 22, 24, and 26. Quality in this outcome area is good. Judgement has been made from the available evidence including a visit to the home. The premises are suitable for its stated purpose and meets individual and collective needs of the service users who live there. EVIDENCE: The home was clean and tidy and free from offensive odour. Communal accommodation includes a lounge/dining area, and conservatory overlooking a garden to the rear of the property. There is also a lounge overlooking the front of the home, which is also a television lounge. A new call bell system has been installed since the last inspection and ramp access to the garden has been made safe. There is a lift to access the first floor and a chair lift to access the second floor. There is a programme of general maintenance and decoration in place and the inspector noted that the toilet seat in toilet 10 needed repair, and two bed tables in room 7 needed to be replaced. The Cedars - Ashford DS0000066148.V304520.R01.S.doc Version 5.2 Page 17 Bedrooms are single and individualised to reflect service users personalities. It is possible for service users to bring individual items of furniture into the home. There is a control of infection policy in place and the laundry is equipped to wash clothing on a sluice cycle if necessary. Arrangements are in place for the collection of clinical waste. The Cedars - Ashford DS0000066148.V304520.R01.S.doc Version 5.2 Page 18 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): 27, 28, 29, and 30. Quality in this outcome area is good. Judgement has been made using information available including a visit to the service. The number and skill mix of staff on duty was sufficient to meet assessed needs of service users. The recruitment policy in place protects the service users. EVIDENCE: The staff duty rota was seen and indicated three care staff are allocated to work in the home throughout the day. There are two night staff on duty. The home also employs a chef and a cleaner. No agency or bank staff are used. The manager demonstrated that all new staff have an induction-training period, which was confirmed, on staff training files. During conversation with staff they stated that they had received up dated training in food hygiene, manual handling. First aid, health and safety at work, fire safety, record keeping and medication administration. The employment records were seen for AE, AK, and SK. These are well maintained and included all relevant information including two written references, a full employment history and a CRB (Criminal Records Bureau) disclosure. Staff have been reissued with new contracts of employment and are in the process of discussion prior to signing. The Cedars - Ashford DS0000066148.V304520.R01.S.doc Version 5.2 Page 19 The Cedars - Ashford DS0000066148.V304520.R01.S.doc Version 5.2 Page 20 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): 31, 33, 36, 37, and 38. Quality in this outcome area was adequate. Judgement was made using available information including a visit to the service. The home is well managed and staff are appropriately supervised. The health and welfare of the service users are partly protected. EVIDENCE: The registered home manager has nine years experience of working in the home. She has an NVQ level 4 in management and operates a “hands on “ approach. She has a sound knowledge of the needs of the service users in her care. Since the new ownership of the home arrangements are in place for an administrator to work in the home when the manager is off duty. A written job description is required for this position outlining the clarity of his role and responsibilities, which must not include any involvement in service users care, or the management of the staff. The Cedars - Ashford DS0000066148.V304520.R01.S.doc Version 5.2 Page 21 Staff are appropriately supervised and this is formally recorded and retained on file. The standard of record keeping relating to the care of the service users is satisfactory. Records examined included care plans, risk assessments, needs assessments, medication recording charts, and menus. During a period of sick leave by the manager a relief manager was allocated to the home for two weeks, during which time the fire testing records were not maintained, and a Regulation 37 notification of a significant was not sent to The Commission for Social Care Inspection. The provider must ensure that appropriate cover is available for the home in the absence of the manager. Relatives stated that they are not happy with the new irregular invoicing system and they would like to be invoiced for sundries every month. Service users meetings, and one to one discussions with service users are used to monitor quality assurance. Questionnaires are sent out yearly to relatives and service users, and answers retained on file. There is a wide range of health and safety policies and procedures available in the home and staff are inducted in the basics during the first six weeks of their employment. Training is ongoing relating to these policies and procedures. Risk assessments are in place for safe working practice. COSHH procedures are followed and staff were aware of this when questioned. Fire safety procedures are in place and all staff have regular training in fire safety. A contract is in place with ATC fire service for the maintenance of the fire fighting equipment and the emergency lighting. Fire alarms are tested and recorded weekly with the exception of two weeks when the manager was not in the home. The procedure for recording and reporting accidents within the home is satisfactory. The Cedars - Ashford DS0000066148.V304520.R01.S.doc Version 5.2 Page 22 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 3 2 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X 3 X 3 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 X 3 2 2 The Cedars - Ashford DS0000066148.V304520.R01.S.doc Version 5.2 Page 23 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 OP2 Regulation 17(2) Requirement The registered person must ensure that all documents listed in Schedule 4 8. To include Contracts of occupancy are kept in the home and are up to date The registered person must ensure that equipment used in the care home are in good repair to include the toilet seat and two bed tables. The registered person shall give notice without delay of any event in the home, which affects the well being of the service users to include the outbreak of bed bugs. The registered person shall after consultation with the fire authority make adequate arrangements for the testing and recording of the fire alarms within the home. The registered person shall give notice in writing to The Commission where the registered provider is a partnership, there is any change in the membership of the partnership, DS0000066148.V304520.R01.S.doc Timescale for action 28/08/08 2 OP19 23(2)(c) 28/08/06 3 OP37 37 28/08/06 4 OP38 23(4)(c) (v) 28/08/06 5 OP2 39(d)(e) (iii) 28/08/08 The Cedars - Ashford Version 5.2 Page 24 And there is to be a change of responsible individual; 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 OP2 Good Practice Recommendations It is recommended that the responsible individual inform The Commission for Social Care Inspection in writing of the change in the financial directorship of the home and of the proposal to appoint a new responsible individual for the home. The Cedars - Ashford DS0000066148.V304520.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 The Cedars - Ashford DS0000066148.V304520.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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. 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