Inspection on 25/02/08 for The Cedars Nursing Home

This inspection was carried out on 25th February 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Cedars Nursing Home 04/02/09

The Cedars Nursing Home 01/02/07

The Cedars Nursing Home 06/10/05

The Cedars Nursing Home 18/07/05

The Cedars Nursing Home 03/05/05

The Cedars Nursing Home 03/02/05

The Cedars Nursing Home 30/09/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE The Cedars Nursing Home Cedar Road Balby Doncaster South Yorkshire DN4 9HU Lead Inspector Sarah Powell Key Unannounced Inspection 09:15 25 February & 3 & 12 March 2008 th rd 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 DS0000015852.V355675.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000015852.V355675.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cedars Nursing Home Address Cedar Road Balby Doncaster South Yorkshire DN4 9HU 01302 310668 01302 310852 cedars@sshc.co.uk www.fshc.co.uk Four Seasons Health Care (England) Limited (wholly owned subsidiary of Four Seasons Health Care Ltd) Post Vacant Care Home 66 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) Category(ies) of Old age, not falling within any other category registration, with number (66) of places DS0000015852.V355675.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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. For the home to be able to admit up to three service users aged 60 65 within the category of registration 1st February 2007 Date of last inspection 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 people over the age of 65. One unit accommodates people that require nursing care and the other unit accommodates people requiring personal care. Both units are on two floors accessed by stairs and a passenger lift. There is one kitchen and laundry for both units. Fees range from Residential Care £ 375:00 per week, Nursing Care £553:00, at the time of the visit additional charges are made for hairdressing, chiropody, optical, dental services and magazines. For further information contact the home. Information about the service is available to service users and their families via the home’s Statement of Purpose and the Service User Guide. DS0000015852.V355675.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience Adequate quality outcomes. This was an unannounced visit, which occurred on the 25th February 2008,and the 3rd and 12th March 2008. The visit commenced at 09:15 on the first day and ended at 13:30 hours. The second day commenced at 09:30 and finished at 15:00 hours. The third day commenced at 09:20 hours and finished at 12:45 hours. A random visit also took place in November 2007 to investigate an adult safeguarding referral. We accompanied the investigating officer who had been assigned by Doncaster council’s safeguarding unit. On the 25th February the first day of the visit we spent 2 hours in the lounge on the nursing unit observing what was happening and how care was delivered. This showed what life was like for people using the service. The visit also included talking with people living at the home, a number of relatives, the peripatetic manager, deputy manager, and nine staff. We also looked around the building and some records were checked. Some surveys forms were sent to people who live at the home and their relatives. At the time of this visit only one had been completed and returned to the Commission. The Acting manage had completed an annual quality assurance assessment (AQAA) and returned this prior to the visit this focuses on how well outcomes are being met for the people using the service. It also gives us some numerical information about the service. What the service does well: Staff provided a warm and welcoming atmosphere for the people and their visitors to the home. Visitors we spoke to said, “The staff always make you very welcome, look after you and always offer you a drink”. The general environment was pleasantly decorated, homely, well furnished and well maintained providing a safe environment for the people. DS0000015852.V355675.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 summary of this inspection report can be made available in other formats on request. DS0000015852.V355675.R01.S.doc Version 5.2 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 DS0000015852.V355675.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All people in the home had their needs assessed prior to moving into the home to ensure these could be met. EVIDENCE: Some records seen showed that pre admission assessments had occurred. Suitably qualified people carried out the pre admission assessments. The assessments were very detailed with all needs identified ensuring that the home could meet their needs before a place was offered to the person. The staff had also reviewed all people and updated their assessments in order to identify all their needs and put plans of care in place to ensure they were met. DS0000015852.V355675.R01.S.doc Version 5.2 Page 9 The home does not offer intermediate care so standard 6 does not apply. DS0000015852.V355675.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person in the home had a plan of care, however not all needs were identified. People were treated with respect. Medication was looked at by the pharmacy inspector and is in a separate report. EVIDENCE: Three people in the home were case tracked; this meant their plans and care provided was looked at in detail. The plans had identified most people’s needs and the measures to take to meet their needs. However not all needs were identified and risk assessments were not always followed. Putting people at potential risk of harm. A number DS0000015852.V355675.R01.S.doc Version 5.2 Page 11 of people had been assessed as being at risk of pressure sore, but professional advice was not obtained to ascertain if pressure-relieving equipment was necessary. The plans were not regularly reviewed, however they had all been reviewed in February 2008. It was not always evident if people and their relatives were involved in this process so it was not clear if their views were listened to or their needs met. The peripatetic manager acknowledged that the care plans still required work and was aware of the improvements required. He had commenced a care plan audit and was discussing the findings in staff supervision. This ensured people’s needs would be identified and met. The plans of care were much improved from the visit in November 2007 and staff had worked very had to improve the plans of care and ensure people’s needs were identified and could be met. People were treated with respect and privacy and dignity upheld. During the visit we observed staff interacting well with people and their relatives. One lady said, “The staff are lovely they look after you very well”. DS0000015852.V355675.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social and recreational needs were not met. Good contact with family and friends was maintained and an appealing balanced diet was provided. EVIDENCE: There was no activity co-ordinator employed at the time of the visit. People’s social and recreational needs were not met one lady told us, “I am bored there is no stimulation, and I am not even able to get outside for some fresh air. It is just get up, have breakfast, then wait for diner, then wait for tea, and then bed. I am getting very depressed”. Most people we spoke to told us, “Staff are lovely they work very hard but there are no activities”. DS0000015852.V355675.R01.S.doc Version 5.2 Page 13 Relatives and friends visit at any time and were always made welcome. Relatives said the staff are always polite and welcoming when they visit. One said, “I am always made welcome and offered a drink”. People in the home were offered choices in particular during the two-hour observation staff always gave choices and respected peoples decisions ensuring their needs were met. A varied balanced wholesome diet was provided for the people. One gentleman told us, “The food is great, and we certainly get fed well”. We observed a meal, which was well presented, there was good communication to the people from staff when it was served, seconds were offered and a choice of drinks were also offered ensuring peoples needs and choices were met. DS0000015852.V355675.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who lived in the home were listened to and protected. EVIDENCE: There was a comprehensive complaints procedure, which was clearly displayed, in the entrance hall. All people we spoke to were aware of the procedure but said, “If we had a concern, or complaint we would speak to the staff as they are always approachable and listen to us”. The peripatetic manager had received a number of concerns which had all been resolved, good records were kept of outcomes. This showed they had been fully investigated, acted on and taken seriously. An adult safeguarding investigation took place in November 2007 following two adult safeguarding referrals. At this time it was found that the home did not protect people. However the providers had put measures in place to rectify this, this included training all staff in adult safeguarding procedures, increasing the staffing levels to improve care and ensure people’s needs were met. They DS0000015852.V355675.R01.S.doc Version 5.2 Page 15 have also employed a deputy manager and care manager to oversee the home with the peripatetic manager, until a new manager is appointed. DS0000015852.V355675.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well maintained clean, pleasant and comfortable ensuring people lived in a safe environment. EVIDENCE: The environmental standards throughout the home had improved since the last inspection with new carpets in communal areas and many rooms redecorated. It provided a homely and welcoming home, which was maintained to a good standard of cleanliness. Ensuring a safe, well maintained environment for the people who lived there. One relative told us “the home is always very clean whenever I visit”. DS0000015852.V355675.R01.S.doc Version 5.2 Page 17 People told us that the staff work very hard keeping the home clean and their room looking nice. DS0000015852.V355675.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training was not up to date. The recruitment procedures were robust ensuring people were in safe hands at all times and were protected. EVIDENCE: There was a qualified nurse on the nursing unit, 24 hours a day to meet people’s needs. The residential unit had a unit manager and senior carers to ensure peoples needs were met. Care staff numbers were determined by the number and needs of the people on each unit. These had been increased following the adult safeguarding investigation to ensure people’s needs were met. The providers had also appointed a deputy manager and care manager to further improve the quality of care given and meet peoples needs. Staff training records had been put in place for each member of staff, which clearly showed what training was required. Staff training was not up to date with mandatory training required to ensure staff were competent to do their jobs, and meet people’s needs. DS0000015852.V355675.R01.S.doc Version 5.2 Page 19 A thorough recruitment procedure was in place, two staff files were seen on the day of the visit and contained all the required information. Protecting people who lived there. DS0000015852.V355675.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has been without a registered manager for nearly two years it has had a succession of acting managers and at present a peripatetic manager is overseeing the home. Since the adult safeguarding referrals the provider has continually advertised and interviewed for a suitable manager but as yet has not been successful. The peripatetic manager will stay in post until a permanent manager is appointed. The provider had improved the staffing structure to help the management of the home. A deputy is now in post and a care manager, which is ensuring people’s needs are met. DS0000015852.V355675.R01.S.doc Version 5.2 Page 21 The AQAA told us that people’s finances were safeguarded with robust procedures in place to ensure this. Quality monitoring systems based on seeking peoples views had not been carried out for some time, this did not ensure the home was run in the best interests of the people. Resident and relative meeting have recommenced to try to improve communication and seek people’s views. The home had a comprehensive health and safety policy. We were able to evidence that regular maintenance of equipment and systems was carried out. Risk assessments were carried out on all safe-working practices. The peripatetic manager had recommenced audits on health and safety, care plans and training. Accidents were not properly recorded or reported which did not ensure people in the home were safeguarded. This was discussed with the peripatetic manager who assured us this would be looked into and addressed ensuring people were safeguarded. DS0000015852.V355675.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 DS0000015852.V355675.R01.S.doc Version 5.2 Page 23 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. Standard OP7 Regulation 15(2)(b) Requirement Care plans must have full information to give staff direction with regard to activities, social, psychological and mental health needs. (Timescale 31/3/07 Not met) The registered person must check that all staff authorised to handle and administer medication follow the home’s procedures for medication administration and record keeping to help ensure medicines are always given as prescribed. The registered person must ensure that all medicines are stored securely and kept at temperatures recommended by the manufacturer so that staff know they are safe to use. All risk assessment must be followed to safeguard people. All people’s needs must be identified in plans of care to ensure they are met. Professional advice must be obtained when risk assessments show people are at risk. DS0000015852.V355675.R01.S.doc Timescale for action 30/04/08 2. OP9 13(2) 31/03/08 3. OP9 13(2) 31/03/08 4. 5. 6. OP7 OP7 OP8 13 15 17 30/04/08 30/04/08 30/04/08 Version 5.2 Page 24 7. 8. 9. 10. OP12 OP14 OP30 OP33 16 12 18 24 11. OP38 17 People’s social and recreational needs must be identified and met. Peoples personal choice regarding recreational needs must be met. All staff must receive training to ensure they are competent to do their jobs. Quality monitoring must recommence to obtain peoples views and run the home in their interests. Accidents must be properly recorded following your policy and procedures to safeguard people. 30/04/08 30/04/08 01/06/08 30/04/08 01/04/08 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 OP28 Good Practice Recommendations NVQ training must continue to ensure a minimum ratio of 50 of care staff trained to NVQ Level 2 or equivalent is achieved. people should be transferred into dining chairs at mealtimes; this aids pressure care and maintains the dignity. 2. 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