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Inspection on 21/09/05 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 21st September 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 home provides spacious accommodation that is well maintained and decorated, comfortably furnished and clean. A resident made comments indicating her satisfaction with the care and accommodation and described the meals as excellent. There is a kind and caring staff team.

What has improved since the last inspection?

There were no requirements and recommendations made at the time of the last inspection. The redecoration and maintenance of the home to ensure good standards is on going. The bowel assessment form has been reviewed and provides a better system for recording information.

What the care home could do better:

There are procedures in place for staff to follow to obtain information about the help and support that residents` need however records kept of assessments and care plans would benefit from being more detailed to fully reflect care needs and how they are being met.

CARE HOMES FOR OLDER PEOPLE The Cedars Nursing Home Church Walk, South Street Bourne Lincs PE10 9UQ Lead Inspector Sue Hayward Unannounced Inspection 21st September 2005 10:10 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 Nursing Home DS0000002553.V252944.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. The Cedars Nursing Home DS0000002553.V252944.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Cedars Nursing Home Address Church Walk, South Street Bourne Lincs PE10 9UQ 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) 01778 421555 01778 421622 Cedars Health Care Limited Mrs M H Brewster Care Home 56 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0), of places Physical disability (5), Terminally ill (5) The Cedars Nursing Home DS0000002553.V252944.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th March 2005 Brief Description of the Service: The Cedars Nursing and Residential Home is situated close to the town centre of Bourne, which has a range of shops and facilities. The property was originally the vicarage and stands next to the church in its own landscaped grounds, leading down to a river with paths and seating for residents. The building has been extended over recent years and provides accommodation in twin and single rooms all en-suite, on the ground and first floor. There is a choice of lounges for residents to use. There is a circular driveway with car parking to the front of the property. The home is registered to provide nursing care for up to 56 people including older people, people with dementia, adults with a terminal illness and adults with a physical disability. There are also 5 beds contracted with the Primary Healthcare Trust for intermediate care. The registered providers of The Cedars are closely involved in the day-to-day running of the home. The Cedars Nursing Home DS0000002553.V252944.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection, which was announced the day before the visit, was the first of two inspections, which are required by law each year. It incorporated a complaint that had been raised with the Commission relating to aspects of care practices in the home. It was carried out by one inspector and took place from 10:10 to 15:45. The care records of one resident were inspected and four staff members were interviewed. There was discussion with the home manager and one of the providers who was present. The inspector was shown around the home and saw a sample of bedrooms and lounges. What the service does well: What has improved since the last inspection? What they could do better: There are procedures in place for staff to follow to obtain information about the help and support that residents’ need however records kept of assessments and care plans would benefit from being more detailed to fully reflect care needs and how they are being met. The Cedars Nursing Home DS0000002553.V252944.R01.S.doc Version 5.0 Page 6 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 Nursing Home DS0000002553.V252944.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 The Cedars Nursing Home DS0000002553.V252944.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): Standards 3 and 5 There is a clear assessment procedure, however records of this were not sufficiently detailed. EVIDENCE: Records and discussions with staff and the manager indicated that residents are assessed prior to their admission to the home. Residents if able or their relatives or friends are encouraged to visit the home if possible before making a decision to stay. A folder containing information about the home was seen in a vacant room and it was said that this information is provided to each resident. Staff knew the admission procedure and the needs of a resident asked about. There is a system in place to ensure that information about residents needs is communicated to staff, for example at meetings that are held at each change of shift. On admission a further assessment is completed to ensure that the most up to date information about residents needs is obtained. Information is documented and a care plan is developed. Comments from staff indicated that trained staff carry out the admission assessment. Residents are involved if The Cedars Nursing Home DS0000002553.V252944.R01.S.doc Version 5.0 Page 9 able or their relatives if they are present. Records indicated that information is also obtained from other professionals such as hospital nursing staff and physiotherapists. The records of a resident seen on this occasion demonstrated that a preadmission assessment as well as an assessment of need on admission had been completed however not all sections of the latter form were completed e.g. sleeping routines, eating and drinking and elimination. Those that had only contained brief details. Whilst both documents were available for staff to refer to it was not clear in some instances as to whether needs had changed. The Cedars Nursing Home DS0000002553.V252944.R01.S.doc Version 5.0 Page 10 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): Standards 7 and 8 Service users health care and social needs are met, however in one case the care plan was not completed in enough detail. EVIDENCE: A complaint was raised about a residents care needs not being properly assessed and met at the home. Copies of the assessment and care plan of this resident were checked. Staff said where possible care plans are completed with residents or their relatives. A form is in place for residents or relatives to sign agreeing the plan although in this instance it had not been completed. The daily records of the care the staff gave were very detailed and comprehensive. The care plan covers matters such as mobility, nutrition and continence needs. Risk assessments are also completed, however it was noted that a risk assessment in relation to the prevention of falls had not been completed at the The Cedars Nursing Home DS0000002553.V252944.R01.S.doc Version 5.0 Page 11 time of admission and was not included as part of the care plan. It is acknowledged that as soon as staff reported a possible risk (the night of admission) appropriate action was taken. Records demonstrated that staff had discussed and agreed with the resident the use of this equipment. Staff described the help and support they gave a resident with eating and drinking. For example they were all aware that a resident needed a “feeding” beaker for drinks, however this was not reflected in the care plan. The records seen showed that resident’s continence needs are checked on a regular basis. The chart for recording information about bowel routines has recently been reviewed. It enables staff to record more information. There is a procedure in place, which has been signed by residents G.P’s confirming the medications which can be given without the need to consult a doctor, but at the discretion of the nurse in charge. This includes two types of suppositories. Comments from a staff member confirmed that if suppositories or enemas were needed on a regular basis they would be prescribed. Other records are kept which demonstrate the way in which resident’s health needs are checked such as charts, which monitor fluid intake and output. There are systems in place such as shift handovers and communication records where relevant information can be passed on to each shift. Discussion with staff indicated that equipment is available to promote residents health, such as pressure relieving mattresses and cushions. The home also employs a physiotherapist. Records detailed any contacts with doctors and visits to hospital appointments. A doctor was visiting the home on the day of the visit. Staff commented that if they needed advice and guidance then the deputy manager or manager was always contactable. The Cedars Nursing Home DS0000002553.V252944.R01.S.doc Version 5.0 Page 12 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): EVIDENCE: These standards were not inspected on this occasion. The Cedars Nursing Home DS0000002553.V252944.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): Not inspected. EVIDENCE: This standard was not fully inspected on this occasion, however the previous two inspection reports of 17/03/2005 and 02/09/2004 indicated that the home has a comprehensive complaints procedure and records detail the action taken and outcomes. The owners and manager notify the Commission appropriately about complaints received. The Cedars Nursing Home DS0000002553.V252944.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, 20, 22 and 25 Residents live in a safe and comfortable home, which is maintained to a high standard and provides equipment to meet residents’ needs. EVIDENCE: Those parts of the home seen were very well maintained, clean and comfortably furnished. There is an on-going programme of redecoration and maintenance and a bedroom was in the process of being redecorated at the time of the inspection. Gardens are well kept. Various equipment and aids were seen around the home such as hoists, bathing equipment, passenger lift and handrails to assist those residents who are unable to or have difficulties walking. A physiotherapist is employed by the home. Additionally, discussion with the manager and records confirmed that there is consultation with other professionals such as hospital staff and NHS physiotherapists as to any specialist equipment needed. Staff comments confirmed that mattresses are all pressure relieving ones and pressureThe Cedars Nursing Home DS0000002553.V252944.R01.S.doc Version 5.0 Page 15 relieving cushions are provided as needed, as are bed rails. Staff said there is equipment to assist residents with drinks and meals such as feeding beakers and all were aware of the residents need for this who was asked about. A resident made a comment that she found her room to be comfortable and was very satisfied with the accommodation. The Cedars Nursing Home DS0000002553.V252944.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 There are sufficient staff to meet residents needs and they are kind and caring in their approach to their work. EVIDENCE: A resident seen at the time of the inspection made comments that she was satisfied with the care that staff provide. She said she received the help she needed and whilst staff were busy all had made time to come and wish her a happy birthday. The owner confirmed that the manager has the responsibility for ensuring the home is appropriately staffed. During the tour of the premises both qualified and care staff were seen assisting residents. The home is divided into three areas and a team of staff work in each area. Two staff were seen sitting with two residents during the afternoon. One was reading the newspaper to a resident and the other was talking to and holding a residents hand. The records of a resident seen on this occasion indicated that staff checked the resident on a regular basis through the day and night. Comments from staff indicated that there are arrangements in place for staff to receive advice when needed. For example a staff member confirmed that the manager or deputy is always on call when not on duty at the home. The owners are actively involved visiting the home on a day to day basis The Cedars Nursing Home DS0000002553.V252944.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): EVIDENCE: These standards were not inspected on this occasion. The Cedars Nursing Home DS0000002553.V252944.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 4 3 x 3 x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x x x x The Cedars Nursing Home DS0000002553.V252944.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? NO – None were made. 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 3 Regulation 13 (4)(c) 14 (2) Requirement Records of assessment must be more detailed to demonstrate all matters as identified at National Minimum standards 3.3 have been assessed. Care plans must be more detailed and demonstrate the outcomes of any risk assessments with particular attention to the prevention of falls. Timescale for action 21/11/05 2 7 15 (1) 21/11/05 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 7 Good Practice Recommendations To demonstrate the involvement of residents or relatives with their assessment and care plans it is recommended that they signed by residents if able or their relatives/representatives at the time of completion. The Cedars Nursing Home DS0000002553.V252944.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Nursing Home DS0000002553.V252944.R01.S.doc Version 5.0 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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