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Inspection on 15/11/05 for The Cedars Nursing Home

Also see our care home review for The Cedars Nursing Home for more information

This inspection was carried out on 15th November 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The Cedars is a large country house, which provides a good standard of accommodation and benefits from lovely grounds, which are well-maintained, and easily assessible to service users. The bedrooms are mainly single which are well furnished and personalised. The home provides a clean environment for service users to live in. The home provides a good activities programme, which has been well developed providing a range of activities, which service users reported as enjoying. Service users were also complimentary of the food provided. Health care needs are monitored and service users were complimentary of the care provided.

What has improved since the last inspection?

The home continues to make improvements to the individual care plans, which are now more detailed and personalised. The shared rooms were cleaned to a good standard and tidy. The homely remedy policy now clearly states how long a medication can be used before the attending GP is notified.

What the care home could do better:

Although the care plans have much improved regular reviews need to take place and all risk assessments will be completed. The Registered Manager must ensure that adequate lifting belts are available for the care staff to ensure the safety of the service user and the staff. The water temperatures of the bath water will be recorded. As required form the previous inspection a quality assurance procedure will need to be implemented to ensure the views of the service users are gained regarding the service that the home provides.

CARE HOMES FOR OLDER PEOPLE Cedars Nursing Home (The) Northlands Landford Salisbury Wiltshire SP5 2EJ Lead Inspector Karen Mandle Unannounced Inspection 15th November 2005 10:20 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 Nursing Home (The) DS0000015897.V267330.R01.S.doc Version 5.0 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 Nursing Home (The) DS0000015897.V267330.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cedars Nursing Home (The) Address Northlands Landford Salisbury Wiltshire SP5 2EJ 01794 390284 01794 390068 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) Alphacare Holdings Limited Mrs Marilyn Bulmer Care Home 31 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (31), of places Physical disability (10) Cedars Nursing Home (The) DS0000015897.V267330.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users who may be accommodated in the home at any one time is 31 No more than 10 service users over the age of 50 years with a physical disability may be admitted at any one time and admission criteria for those between the ages of 50 and 65 must be consistent with the home`s statement of purpose The minimum staffing levels set out in the Notice of Decision dated 6 November 2003 must be met at all times 2nd June 2005 3. Date of last inspection Brief Description of the Service: The Cedars Nursing Home is registered to provide nursing care for 31 older people aged 65 years and older. The home is an older building, situated in rural location on the A36 mid-way between Salisbury and Southampton. Many of the rooms are single, which are well-furnished providing comfortable accommodation. The home has large surrounding grounds and pleasant views of the countryside. The Cedars is owned by Alphacare Ltd and the Registered Manager is Mrs Marilyn Bulmer who has been in post since autumn 2000. Cedars Nursing Home (The) DS0000015897.V267330.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection commenced at 10.20am and was completed at 2.30pm. During the inspection the inspector toured the home visiting with many service users gaining their views of the service provided by the home. Care records were reviewed, as were some health and safety documents. The Registered Manager Mrs Bulmer was available to assist the inspector when needed. What the service does well: What has improved since the last inspection? The home continues to make improvements to the individual care plans, which are now more detailed and personalised. The shared rooms were cleaned to a good standard and tidy. The homely remedy policy now clearly states how long a medication can be used before the attending GP is notified. Cedars Nursing Home (The) DS0000015897.V267330.R01.S.doc Version 5.0 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. Cedars Nursing Home (The) DS0000015897.V267330.R01.S.doc Version 5.0 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 Nursing Home (The) DS0000015897.V267330.R01.S.doc Version 5.0 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): 3 A clear admission procedure is in place and all needs are fully assessed during the pre admission assessment ensuring the home is able to meet the needs of the individual service user. EVIDENCE: The Registered Manager conducts a pre admission assessment prior to an admission taking place to ensure the home is able to meet the nursing needs and social needs of the service user. An assessment, which had been completed for a service user who was being admitted to the home later in the week was seen which was detailed and provided information relating to current health and social care needs. Cedars Nursing Home (The) DS0000015897.V267330.R01.S.doc Version 5.0 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): 7, 8 and 10 The standard of the care records continue to improve, apart from monthly reviews not taking place. The health care needs of service users are closely monitored and appropriate action taken when health care needs change. The privacy and dignity of the service users is supported by the care team. EVIDENCE: Each service user is provided with a care plan. The care plans reviewed by the inspector provided evidence of continued improvement to the standard of information recorded in the care plans. The care records identified care needs and management of needs. Areas of improvement needed are to ensure that care plans are reviewed monthly and that all nutritional risk assessments are completed. Wound care documentation was not fully detailed which was required from the previous inspection ensuring that all current information relating to the healing process of a wound was recorded. All service users are registered with a local GP who visits the home weekly and on requests. A GP visit took place during the inspection. The GP spoke with the inspector and was complimentary of the care provided at the home. Service Users who were able to communicate were also complimentary of the care Cedars Nursing Home (The) DS0000015897.V267330.R01.S.doc Version 5.0 Page 10 provided and expressed that their health care needs were being met. The home was providing care for several very frail service users who appeared comfortable. Two air mattresses in use appeared to be set too high for the low weight of the service users, which could lead to the mattresses being not fully effective in preventing pressure breakdown. Manual handling belts should be purchased to assist with transfers following a manual handling assessment ensuring the safety of both the service users and the staff. The medications were not fully assessed during this inspection apart from the requirement made relating to the homely remedy policy from the previous inspection which was assessed as fully met. Service users able to communicate confirmed that personal care and nursing care always took place in the privacy of their bedroom or bathroom. This was also observed taking place during the inspectors’ tour of the home. All shared rooms were provided with screening to support the privacy and dignity of service users. Cedars Nursing Home (The) DS0000015897.V267330.R01.S.doc Version 5.0 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 the following standard(s): 12, 14 and 15 The home provides a very good activities programme, which fully supports the social needs of the service users. Service users are able to make choices about their daily lives. Service users were complimentary of the food provided. EVIDENCE: The home has worked hard to develop a good activities programme. The activities programme is varied providing a range of activities from arts and crafts groups, music and movement to quizzes taking place. During the afternoon of the inspection service users were observed making Christmas decorations. Service users are also actively involved in fund raising for various charities and appeals. Service users reported how much they enjoyed the activities provided. However service users are also fully supported to choose how they wish to spend their time and several confirmed they did not wish to attend activities but enjoyed their own company reading and listening to the radio. The care plans reflect good detail of service users likes and dislikes providing evidence of the home supporting service users to have choice and control over their own lives. Cedars Nursing Home (The) DS0000015897.V267330.R01.S.doc Version 5.0 Page 12 Unfortunately at the time of the inspection there was a problem with the main gas supply to the home with workman on site. The kitchen was therefore without gas. However the inspector visited the kitchen and spoke with the cooks who had managed to prepare a hot meal for lunch and had managed to make soup for suppertime. The service users were observed enjoying the lunch provided and had been fully informed of the gas problem. Service users reported to the inspector that the food provided was always good. The kitchen was clean and organised. Cedars Nursing Home (The) DS0000015897.V267330.R01.S.doc Version 5.0 Page 13 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 A complaints policy and procedure is in place and service users confirmed that they would report any complaints to the management and were sure that their complaint would be dealt with appropriately. Through training and the recruitment procedures service users are as much as possible protected from abuse. EVIDENCE: A complaints policy and procedure is in place, a copy of which is situated in the entrance hall to the home. Service users confirmed with the inspector that if they had a complaint they would speak with a member of staff or with the Manager. The home has not received any formal complaints since the previous inspection. The staff had received abuse awareness training and a copy of the local vulnerable adults procedure was available to all staff. A “Whistle Blowing” policy is in place. The recruitment procedure is inclusive of all staff having a CRB clearance before commencing employment with the aim of protecting service users as much as possible from abuse. Cedars Nursing Home (The) DS0000015897.V267330.R01.S.doc Version 5.0 Page 14 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, 24 and 26 The home is well maintained throughout apart from two bathrooms on the ground floor. The bedrooms provide a comfortable standard of accommodation, which are also personalised. The home is clean through out with cross infection measures in place. EVIDENCE: The Cedars is a large country house set in spacious grounds. The home is well maintained and well furnished throughout. A good size dining room is located on the ground floor, which is also used for many activities. The communal lounge is homely and provides a comfortable seating area for service users and their visitors. Two assisted bathrooms on the ground floor do need to be refurbished to provide adequate support to service users when bathing. The bathrooms currently are not homely or attractive. During the tour of the building the inspector was able to visit many of the bedrooms, which were homely and personalised. Many bedrooms are single which vary in size and shape providing a good standard of accommodation. The shared rooms were visited which were clean and tidy. Cedars Nursing Home (The) DS0000015897.V267330.R01.S.doc Version 5.0 Page 15 The home was clean through out with no unpleasant odours noted. Some of the en-suite facilities on the ground floor need to be kept cleaner and tidier. Cross infection issues are addressed and clinical waste appropriately dealt with. The laundry was seen which was very clean and organised. Cedars Nursing Home (The) DS0000015897.V267330.R01.S.doc Version 5.0 Page 16 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 and 29 The number of staff available appeared sufficient to meet the needs of the service user group. The recruitment procedures are robust and provide the necessary safeguards to offer protection to the service users of the home. EVIDENCE: At the time of the inspection the homes’ staffing levels were in accordance with the staffing notice. The staff available was two trained nurses and 4 carers, two domestic staff and the cook and kitchen assistant, supported by the Manager, the administrator and the activities person. The staffing rotas provided evidence that the staffing levels were maintained. The staff were observed as busy but calm through the morning period and were heard interacting well with service users. Three staff files were reviewed which had evidence of all appropriate employment checks being made prior to employment. CRB checks were completed ensuring satisfactory safeguards are in place to protect service users. Cedars Nursing Home (The) DS0000015897.V267330.R01.S.doc Version 5.0 Page 17 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 and 38 The Registered Manager Mrs Bulmer has a clear understanding of her role and responsibility to the service users and staff. Quality assurance procedures do not fully include the service users. Health and Safety issues are addressed apart from water temperatures being regularly recorded and some manual handling procedures . EVIDENCE: The Registered Manager Mrs Bulmer has been in post at The Cedars since 2000 with many years experience of managing homes prior to this post. Mrs Bulmer has a clear understanding of the aims and objectives of the home and how to ensure that they are met. Mrs Bulmer has recently completed the NVQ Level 4 Managers award. Cedars Nursing Home (The) DS0000015897.V267330.R01.S.doc Version 5.0 Page 18 A quality assurance procedures are not fully in place and it will be required that the Manager implements an appropriate quality assurance process for service users and families. The home is generally well maintained ensuring the safety of service users and staff. The fire records indicated that all appropriate fire checks and training were taking place. Electrical equipment through out the home is tested annually and servicing of hoists takes place. The Manager should also assess the manual handling equipment available to staff to ensure that service users and staff remain safe during manual handling procedures. Cedars Nursing Home (The) DS0000015897.V267330.R01.S.doc Version 5.0 Page 19 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 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X X 3 Cedars Nursing Home (The) DS0000015897.V267330.R01.S.doc Version 5.0 Page 20 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. 2. 3. Standard OP7 OP7 OP7 Regulation 15 15 15 Requirement The Registered Person will ensure the care plans are reviewed monthly. The Registered Person will ensure all wound charts are complete and up to date. The Registered Person will ensure that all nutritional risk assessments are completed and reviewed regularly. The Registered Person will refurbish the ground floor assisted bathrooms. The registered Person will introduce a quality assurance system, which fully involves the Service Users. The Registered Person will provide appropriate manual handling transfer belts. Timescale for action 15/01/06 15/01/06 15/01/06 4. 5. OP19 OP33 23(2c) 24(3) 30/06/06 15/01/06 6 OP38 13(5) 15/12/05 Cedars Nursing Home (The) DS0000015897.V267330.R01.S.doc Version 5.0 Page 21 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. 2 Refer to Standard OP8 OP26 Good Practice Recommendations The Registered Person should ensure that air mattresses are used as recommended by the manufactures guidelines. The Registered Person should ensure that the en-suite facilities are clean and tidy. Cedars Nursing Home (The) DS0000015897.V267330.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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. 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