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Inspection on 02/06/05 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 2nd June 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 provides a comfortable standard of accommodation. Service Users bedrooms are very personalised and homely. Both communal rooms are bright and well furnished. The home provides a clean environment for Service Users to live in. The activities programme is varied and Service Users are given a choice as to what activities they wish to attend. Service Users were complimentary of the care provided and health care needs are monitored.

What has improved since the last inspection?

The home has worked hard to improve the standard of care records with only one care planning format now in use. The care records are more updated with care needs more clearly identified and addressed. Where Service Users require bedrails protectors are now in place. The standard of medication procedures has improved. Employment procedures are now robust and all appropriate employment checks had been made. The staff are now receiving formal documented supervision.

What the care home could do better:

Although the care records have improved two areas of the care records need to be more fully addressed. The pressure area risk assessment will be reviewed monthly ensuring Service Users receive the appropriate care relating to pressure care. All wound care must be fully documented and reviewed ensuring the healing process of any wound is taking place. The homely remedy policy will be amended ensuring time scales for giving medication are clearly defined. The shared rooms will be cleaned more frequently ensuring that both Service Users occupying the rooms are living in a clean environment.

CARE HOMES FOR OLDER PEOPLE Cedars Nursing Home (The) Northlands Landford Salisbury Wiltshire, SP5 2EJ Lead Inspector Karen Mandle Unannounced 2nd June 2005 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. Cedars Nursing Home (The) D51_D01_S15897_CedarsNursingHome_V214330_020605_Stage4.doc Version 1.30 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 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 with Nursing 31 Category(ies) of OP Old Age (31) registration, with number PD Physical Disability (10) of places Cedars Nursing Home (The) D51_D01_S15897_CedarsNursingHome_V214330_020605_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 The maximum number of service users who may be accommodated in the home at any one time is 31 2 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 3 The minimum staffing levels set out in the Notice of Decision dated 6 November 2003 must be met at all times Date of last inspection 27th January 2005 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 Alphcare Ltd and the Registered Manager is Mrs Marilyn Bulmer who has been in post since autumn 2000. Cedars Nursing Home (The) D51_D01_S15897_CedarsNursingHome_V214330_020605_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection commenced at 10.33am and was completed at 3.30pm. The inspector was able to freely tour the building and visit with many of the Service Users. The Registered Manager assisted the inspector during the latter part of the inspection. Care records were reviewed, as were medication records. Health and Safety issues were assessed. What the service does well: What has improved since the last inspection? The home has worked hard to improve the standard of care records with only one care planning format now in use. The care records are more updated with care needs more clearly identified and addressed. Where Service Users require bedrails protectors are now in place. The standard of medication procedures has improved. Employment procedures are now robust and all appropriate employment checks had been made. The staff are now receiving formal documented supervision. Cedars Nursing Home (The) D51_D01_S15897_CedarsNursingHome_V214330_020605_Stage4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cedars Nursing Home (The) D51_D01_S15897_CedarsNursingHome_V214330_020605_Stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Cedars Nursing Home (The) D51_D01_S15897_CedarsNursingHome_V214330_020605_Stage4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 5 A clear admission procedure is in place and all needs are assessed during the pre admission assessment. Service Users and families can visit the home prior to admission. EVIDENCE: All Service Users are fully assessed by the Registered Manager prior to admission to The Cedars Nursing Home to ensure that through the assessment process the home is able to meet the nursing needs and social needs of the Service User. The assessment is detailed providing information of all current health care needs and social needs. A record of the assessment is kept on the Service Users’ file. Service Users and families are encouraged and invited to visit the home prior to admission, to meet with staff and other Service Users and view the accommodation provided. However due to poor health care pre admission visits do not always take place. Cedars Nursing Home (The) D51_D01_S15897_CedarsNursingHome_V214330_020605_Stage4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Health care needs of Service Users are monitored and appropriate action taken when health care needs change. The care records do not fully address all aspects of care. Medication procedures are safe. The privacy and dignity of the Service Users is supported by the care team. EVIDENCE: Individual care plans are in place, which have generally improved in detail. The home is now using one format of care planning. The care records identify care needs and management of needs. Clear and detailed information was available regarding Service Users likes and dislikes. The pressure area risk assessments had not been reviewed monthly or when changes had occurred. Many of the current Service User group is at risk of pressure breakdown, regular reviews of this area of care will reduce the risk. Wound care was not fully detailed in the care records providing up to date information of the wound healing process and current treatment being used. All Service Users are registered with a local GP. Service Users reported they could see the doctor anytime, which the staff would arrange. Service Users who were able to communicate with the inspector were complimentary of the Cedars Nursing Home (The) D51_D01_S15897_CedarsNursingHome_V214330_020605_Stage4.doc Version 1.30 Page 10 care provided and they felt that their health care needs were met. The Registered Manager holds annual reviews for all the Service Users with family involvement if the Service User wishes. A Service User confirmed that a review had just taken place. The trained nurses are responsible for administering medications. The method of administration was safe. However the homely remedy policy will need to be reviewed and time scales written for the amount of time a medication can be used before the GP is contacted ensuring the safety of the Service User whilst taking the medication. All medication was stored correctly and signed into the home. Service Users confirmed that any nursing care or personal care always took place in the privacy of their own bedroom or bathroom. This was also observed taking place during the inspection. Cedars Nursing Home (The) D51_D01_S15897_CedarsNursingHome_V214330_020605_Stage4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15 The activities provided are appropriate to the Service User group. Service Users are supported to maintain links with families and friends. Meals are of a good standard with a varied menu and daily choice. EVIDENCE: Activities are provided for Service Users 3 to 4 days a week by the Activities Co-ordinator. The activities programme is varied, with Service Users making a good reference to the art group, which appears to be a popular choice. Service Users who do not wish to attend activities reported they can do as they like and that the staff respect this. Service Users can receive friends and families at any time they wish in the privacy of the Service Users bedroom or a communal area. The visitors signing in book provided evidence of this taking place. The main hot meal of the day was observed, which was well presented and Service Users informed the inspector that the food was good and had recently seemed to of improved. Service Users were seen using the dining room or if they wish having their meal in their room. Service Users needing assistance with their meal were seen being assisted by the care team on a one to one basis. The menu was displayed clearly on the dining room wall, with a choice available. Cedars Nursing Home (The) D51_D01_S15897_CedarsNursingHome_V214330_020605_Stage4.doc Version 1.30 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 There is a complaints policy and procedure in place and Service Users were confident that any complaint made would be dealt with appropriately by the home. A vulnerable adults procedure is in place and staff are fully aware of the local procedure and how to use it. EVIDENCE: There is a complaints policy and procedure in place, a copy of which is situated in the entrance hall to the home for anyone to see. Service Users confirmed with the inspector that if they had a complaint they would speak with a member of staff or if it was a serious complaint they would report it to the Manager. Service Users expressed confidence that the complaint would be dealt with. All staff has recently received training on local vulnerable adults procedure from the police. A copy of the “No Secrets” document is available to all staff and a copy of the document is in the entrance hall of the home for visitors. An “Abuse” policy and procedure is in place as is a “Whistle Blowing” policy. Cedars Nursing Home (The) D51_D01_S15897_CedarsNursingHome_V214330_020605_Stage4.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24 and 26 The home is well maintained providing a safe environment for Service Users. The bedrooms are nicely decorated with Service Users encouraged to have personal items around them. The home is clean through out apart from a shared room. EVIDENCE: The Cedars is an older building, which is homely, well furnished and generally well maintained. The main communal room is light and spacious offering plenty of space and seating areas for Service Users to use during the day. The décor of the home is now of a good standard. The gardens mainly to the rear of the home are very well maintained with plenty of seating provided for Service Users to enjoy the garden. Many of the bedrooms are single and provide a comfortable standard of accommodation. The bedrooms visited were personalised and homely. Service Users were complimentary of the standard of accommodation. All areas of the home were clean to a good standard apart from Room 29, which is a shared room and space rather limited. Cross infection issues were addressed and staff were observed using plastic gloves and aprons whilst Cedars Nursing Home (The) D51_D01_S15897_CedarsNursingHome_V214330_020605_Stage4.doc Version 1.30 Page 14 attending to Service Users personal care needs, and using appropriate hand washing methods, reducing the risk of cross infection between Service Users. Cedars Nursing Home (The) D51_D01_S15897_CedarsNursingHome_V214330_020605_Stage4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 The number of staff available is sufficient to meet the nursing needs and personal care needs of the Service Users. The procedures for the recruitment of staff are robust and provide the necessary safeguards to offer protection to the Service Users of the home. EVIDENCE: The home is registered to provide nursing care therefore a minimum of one trained nurse is on duty at all times supported by a team of carers, ensuring that all nursing needs and personal care needs of the Service Users are met. Service Users care needs were observed being supported with the staffing level available during the inspection. The staff were seen to be organised and interacting well with Service Users. The staff files of three members of staff were reviewed. Appropriate references and CRB checks were complete ensuring satisfactory safeguards are in place to protect the Service Users and all other required employment documents were in place. Cedars Nursing Home (The) D51_D01_S15897_CedarsNursingHome_V214330_020605_Stage4.doc Version 1.30 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 36 and 38 Health and Safety issues are fully addressed. The staff are now provided with regular supervision. Quality assurance measures in place to not provide an opportunity for Service Users opinions to be fully heard. EVIDENCE: Quality assurance procedures are limited. The home does not carry out Service Users surveys or family surveys to gain the opinions of both parties regarding the service the home provides. Documented supervision has now commenced ensuring the staff are provided with support and guidance in their role within the team. The care team are provided with hands on clinical supervision from the trained nurses. Fire records were satisfactory as was evidence of fire training for all staff. All accidents are recorded and regularly audited. Electrical equipment through out the home is tested annually and servicing of hoists takes place. The home is generally well maintained. Cedars Nursing Home (The) D51_D01_S15897_CedarsNursingHome_V214330_020605_Stage4.doc Version 1.30 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x 3 x 2 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 Standard No 16 17 18 Score 3 x 3 x x 2 x x 3 x 3 Cedars Nursing Home (The) D51_D01_S15897_CedarsNursingHome_V214330_020605_Stage4.doc Version 1.30 Page 18 No 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. 2. 3. Standard OP7 OP7 OP9 Regulation 15 15 13 (2) Requirement The Registered Person will ensure the pressure area risk assessment is reviewed monthly. The Registered Person will ensure all wound charts are complete and up to date. The Registered Person will ensure the homely remedy policy clearly states how long a medication can be used before the attending GP is notified. The Registered Person will ensure that adequate cleaning of all shared rooms is provided. The registered Person will introduce a quality assurance system which fully involves the Service Users. Timescale for action By 1st July 2005 By 1st July 2005 By 15th July 2005 4. 5. OP26 OP33 16 (2,J) 24(3) By 15th July 2005 By 15 th August 2005 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 OP9 Good Practice Recommendations The Service User pulse should be taken and recorded prior to being given Digoxen. Version 1.30 Page 19 Cedars Nursing Home (The) D51_D01_S15897_CedarsNursingHome_V214330_020605_Stage4.doc Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, 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. Extracts may not be used or reproduced without the express permission of CSCI Cedars Nursing Home (The) D51_D01_S15897_CedarsNursingHome_V214330_020605_Stage4.doc Version 1.30 Page 20 - 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!