CARE HOMES FOR OLDER PEOPLE
THE CEDARS The Cedars Nursing Home Balby Doncaster, South Yorkshire DN4 9HU Lead Inspector
Sarah Powell Unannounced 18 July 2005 : 07.00 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 J55-J07 S15852 The Cedars V193608 180705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Cedars Nursing Home Address 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) The Cedars, Cedar Rd Balby, Doncaster, South Yorkshire, DN4 9HU 01302 310668 01302 310852 Four Seasons Healthcare (England ) Limited Vacant Care home with nursing 66 Category(ies) of Old age, not falling within any other category registration, with number (66) of places THE CEDARS J55-J07 S15852 The Cedars V193608 180705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One named client under the age of 65 years will be allowed to remain in the home. This condition will cease to apply when the client leaves the home. Date of last inspection 3-may-2005 Brief Description of the Service: The Cedars is a care home located in Balby, Doncaster it is set in a residential area with shops and amenities nearby. It is comprised of two units. The units accommodate up to 66 service users over the age of 65. One unit accommodates service users that require nursing care and the other is residential.Both units are on two floors accessed by stairs and a passenger lift. There is one kitchen and laundry for both units. THE CEDARS J55-J07 S15852 The Cedars V193608 180705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes second inspection in the year 2005/2006 the home has also had an additional visit in between the two inspections to check on compliance with the requirements. This inspection took place over one day the inspection commenced at 07.00 and finished at 16.30 two inspectors were present for most of the day. The previous requirements were looked with the manager and administrator. 21 Service users, 7 staff and 8 representatives were spoken to. A tour of the building took place, observing staff and practices including the serving of breakfast and lunch on both units. What the service does well: What has improved since the last inspection?
The manager and qualified staff have been gradually reviewing and updating the plans of care for the past four months they are gradually improving. The staff training has improved greatly a training matrix has been devised to determine what training staff require and the training has commenced. This was a huge task as all staff training was out of date it has been well organised and thorough. The staff files have all been reorganised for easy reference and it was easy to find information required including training, supervision, application forms and references. Moving and handling techniques observed during the inspection had improved greatly since the last inspection the manager has purchased some belts to aid lifting and these were being used. THE CEDARS J55-J07 S15852 The Cedars V193608 180705 Stage 4.doc Version 1.40 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 J55-J07 S15852 The Cedars V193608 180705 Stage 4.doc Version 1.40 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 J55-J07 S15852 The Cedars V193608 180705 Stage 4.doc Version 1.40 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 & 4 Assessments carried out are poor and unable to determine if service users needs will be met in the home. EVIDENCE: The service user assessments seen were poor did not give enough information to determine if the needs of the individual service user could be met in the Cedars. It was also clear from case tracking some service users that they may be inappropriately placed. It was not evident in the plans of care that specialist services were offered to service users staff documented that referrals should be made but there was no documentation to support this had been carried out. THE CEDARS J55-J07 S15852 The Cedars V193608 180705 Stage 4.doc Version 1.40 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 Service users have a plan of care, which sets out their needs. EVIDENCE: Each service users has a plan of care these have been gradually improving over the last few months but still have a lot of work required in order that all service users needs are documented and are able to be met. Some care plans looked at gave wrong information and contradictions so it was impossible to determine some service users needs so staff were unable to meet their needs. Risk assessments remain poor with lack of information and action to be taken in order to reduce risk to service users. THE CEDARS J55-J07 S15852 The Cedars V193608 180705 Stage 4.doc Version 1.40 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 standard(s) 12 & 15 Social, culture and recreational needs of service users are not met. The meals are wholesome, appealing and balanced. EVIDENCE: Service users told the inspector that they were bored there was very limited activities carers tried when they got time however this was not very often as they were very busy. Some outings were arranged but again service users said this was not enough. The home had employed an activities co-ordinator but they had left to go onto care, so again the post was being advertised. In the interim the manager needs to arrange for additional care staff to be on duty in order that the social and recreational needs of service users can be met. The service given by staff at meals was observed during the inspection and at the previous visit this has much improved. The staff treated the service users with respect and dignity. Assistance with eating was given discreetly, sensitively and individually staff sat with the service users to do this not standing over them as they had previously. Communication had also improved staff were seen to communicate effectively with the service users explaining what was for lunch, offering choices and telling them what they were about to do.
THE CEDARS J55-J07 S15852 The Cedars V193608 180705 Stage 4.doc Version 1.40 Page 11 Some records were looked at in the kitchen and it appeared that temperatures of food were not being taken or recorded this needs to be addressed in order to determine that food is thoroughly cooked and safe. THE CEDARS J55-J07 S15852 The Cedars V193608 180705 Stage 4.doc Version 1.40 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) 18 The home does not have all procedures in place to protect service users from abuse. EVIDENCE: The home has an adult protection policy, which all staff are aware of and all staff could identify different types of abuse and stated they would report any suspected abuse to the person in charge to safeguard the service users. The home has had two adult protection notification this year and both were reported late, at the last inspection the manager assured the inspector that he is now aware of the importance of reporting any suspected allegations immediately and all staff have been informed of this again through supervision and staff meetings in order to protect service users. However is was ascertained through speaking to relatives at the additional visit on 29 June 2005 that three complaints had been reported to the manager alleging abuse but this had not been reported to CSCI, Adult Protection or service users Social Workers. This has been addressed with the manager who has now assured CSCI that all incidents will be reported. THE CEDARS J55-J07 S15852 The Cedars V193608 180705 Stage 4.doc Version 1.40 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 & 26 The home is clean and hygienic and the manager is slowly improving the environment. EVIDENCE: The standard of cleanliness observed throughout the home was to a high standard. The maintenance in the home is on going and the manager is slowly improving the home, two bathrooms are currently being completely refurbished to meet the needs of the service users. Two other bathrooms are in need of repair the Manager is aware of this and it is in the homes business plan. THE CEDARS J55-J07 S15852 The Cedars V193608 180705 Stage 4.doc Version 1.40 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) 29 & 30 Service users are not protected by the homes recruitment policy. Staff training has improved since the last inspection. EVIDENCE: The home has a thorough recruitment procedure however it was discovered on looking at various personal files that the home was not always obtaining a POVA check prior to appointment of new staff and must work under supervision at all times until CRB clearance is received. The manager took this very seriously once told and followed up on a large number of checks while the inspection was taking place. The Manager told the inspector that POVA checks would be obtained for all new staff prior to appointment immediately to ensure service users are protected. The staff training has improved and there is now a training matrix in place to determine what training is required and when and staff are currently undertaking training that is required in order that they are up to date and competent to do their jobs. THE CEDARS J55-J07 S15852 The Cedars V193608 180705 Stage 4.doc Version 1.40 Page 15 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) 36 Staff are appropriately supervised. EVIDENCE: Supervision records were seen and were up to date for all care staff and covered all aspects required by the standards. The qualified staff supervision were not up to date this needs to be addressed by the manager. THE CEDARS J55-J07 S15852 The Cedars V193608 180705 Stage 4.doc Version 1.40 Page 16 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 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x x x x 2 x x THE CEDARS J55-J07 S15852 The Cedars V193608 180705 Stage 4.doc Version 1.40 Page 17 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 5 Requirement The registered provider must ensure all servcie users are issued with a contract (previous timescales 1 April 2005 and 1 June 2005) Full assessments must be undertaken to ensure service users needs can be met in the home. Ensure specialist needs of service users are met and document evidence in plans of care. update all plans of care to ensure all needs of service users are met (old timescale 1 July 2005). Timescale for action 1.9.05 2. OP3 14 1.9.05 3. OP4 12 1.9.05 4. OP7 15 1.10.05 5. OP7 13 Ensure all service users have risk 1.9.05 assessements carried out and documented in the plans of care to ensure the safety and wellbeing of staff and service users are not potentially put at risk. (old timescale 1 July 2005) THE CEDARS J55-J07 S15852 The Cedars V193608 180705 Stage 4.doc Version 1.40 Page 18 6. OP12 16 Ensure social, cultural, religious and recreational needs of service users are met (old timescale 1 July 2005). All allegations of abuse must be reported. All staff must have a satisfactory POVA check prior to commencment of employment. Ensure all supervision is carried out every two months for all staff. 1.9.05 7. 8. OP18 OP29 12 19 1.8.05 1.8.05 9. OP36 18 1.9.05 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 OP15 Good Practice Recommendations Ensure food temperatures are taken and recorded. THE CEDARS J55-J07 S15852 The Cedars V193608 180705 Stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection First Floor Barclay Court Heavens Walk Doncaster DN4 5HZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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