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Inspection on 03/05/05 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 3rd May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

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

What the care home does well

The cleanliness throughout the home was to a good standard.

What has improved since the last inspection?

The manager and qualified staff have been gradually reviewing and updating the plans of care and the ones that have been completed have improved. The plans now detail the action, which needs to be taken by care staff to ensure all aspects of health needs of the service users are met. Supervision of staff is now up to date and being carried out every two months all staff have also had their annual appraisals, this had been a requirement of the previous inspection. Since the last inspection many of the carpets had been deep cleaned in the communal areas providing a well presented environment for the service users.

What the care home could do better:

Some risk assessments in the plans of care did not give enough detail to enable staff to determine if a service user was at any risk. Stimulation through leisure and recreational activities are limited comments received from service user on the residential unit stated that there were not enough activities, they were bored and there was no stimulation and no outings. The home at present does not have an activities co-ordinator the post is advertised but have no applicants as yet. During the inspection it was observed that staff were sat together and not supporting service users, many bad practices were also noted by carers during the inspection including lack of communication, inappropriate moving and handling techniques, care not given sensitively and not always maintaining service users dignity.

CARE HOMES FOR OLDER PEOPLE THE CEDARS Cedar Road Balby Doncaster DN4 9HU Lead Inspector Sarah Powell Unannounced 03 May 2005 10:00. 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 V215348 030505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service The Cedars Address Cedar Road Balby Doncaster South Yorkshire DN4 9HU 01302 310668 01302 310852 None Tamaris Healthcare (England) Ltd (a wholly owned subsidiary of Four Seasons Healthcare) Vacant CRH (N) Care Home with Nursing 66 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) Category(ies) of Old Age 66 registration, with number of places THE CEDARS J55-J07 S15852 The Cedars V215348 030505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: One named client under the age of 65 years will be able to reside in the home. This condition will cease to apply when the client leaves the home. Date of last inspection 03 February 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 V215348 030505 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the homes first inspection in the year 2005/2006 and took place over one day the inspection commenced at 10.00 and finished at 15.30. The previous requirements were looked at with the administrator as the manager was on leave. 18 Service users, 5 staff and 6 representatives were spoken to. A tour of the building took place, observing staff and practices including the serving of lunch. 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 and the ones that have been completed have improved. The plans now detail the action, which needs to be taken by care staff to ensure all aspects of health needs of the service users are met. Supervision of staff is now up to date and being carried out every two months all staff have also had their annual appraisals, this had been a requirement of the previous inspection. Since the last inspection many of the carpets had been deep cleaned in the communal areas providing a well presented environment for the service users. THE CEDARS J55-J07 S15852 The Cedars V215348 030505 Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full 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 V215348 030505 Stage 4.doc Version 1.20 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 V215348 030505 Stage 4.doc Version 1.20 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) 2, 3 & 4 Four seasons have still to provide any service user with a written contract and statement of terms and conditions. Service users are unable to determine what overall care and services are covered by the fees and have no written confirmation that they are able to reside at the home making them feel vulnerable. The changes to the needs assessments had improved the overall assessment of each service users to enable their needs to be met by staff. Some risk assessments in the plans of care were poor and staff may be unaware of how to properly reduce risk to service users. Not all staff appear to have the skills and experience to deliver the service and care that the home provides, which could put service users at risk. EVIDENCE: The plans of care were currently being reviewed and updated as this was a previous requirement, the manager and qualified staff have completed some of these, the ones seen were improved and identified most of the needs of the service users and documented care for daily living and longer term outcomes enabling the service users to receive the appropriate care. THE CEDARS J55-J07 S15852 The Cedars V215348 030505 Stage 4.doc Version 1.20 Page 9 During the inspection some poor practices were observed care staff using inappropriate moving and handling techniques when assisting service users putting them at risk. There was a lack of communication when giving assistance to service users whilst eating, which can cause anxieties Service users were left without support and supervision while the care staff sat and ate their lunch together in the dining room. THE CEDARS J55-J07 S15852 The Cedars V215348 030505 Stage 4.doc Version 1.20 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 standard(s) 7 & 10 The plans that had been updated were good setting out in detail the action, which needs to be taken by staff to ensure service users needs are met. However, Some risk assessments were still poor and required more detail in order that service users risks are properly identified and staff, are aware of appropriate action to be taken to safeguard service users from potential risk. The needs of the service users were set out in the plans however many basic needs were not being met this included privacy and dignity and service users felt they were not always treated with respect. EVIDENCE: The updated plans looked at were improved the manager and staff are currently working on all the plans to ensure they were all reviewed and updated to meet the needs of service users in that service users health and personal needs are set out in the plan, this was generally seen in the plans completed however, In the completed plans risk assessments varied some were good and others poor requiring more information in order that service users are not put at risk of harm. THE CEDARS J55-J07 S15852 The Cedars V215348 030505 Stage 4.doc Version 1.20 Page 11 Basic needs of service users were not being carried out service users were observed wearing dirty cloths, nails filthy and uncut, face and hands not cleaned after meals and hearing aids not being worn. Service users relatives also made similar comments about care. Some staff were observed not showing respect to service users in that meals were placed down in front of them, with no communication and many service users were unable to assist themselves so were only able to look at the food and had to wait long periods of time before a carer was free to give assistance. Staff were also observed not communicating or even looking at service users when giving assistance with eating. Representatives spoken to also commented that some staff were rude and ignorant and obviously did not care and should not be in the job. THE CEDARS J55-J07 S15852 The Cedars V215348 030505 Stage 4.doc Version 1.20 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 standard(s) 12 & 15 The service users social, cultural and recreational interests are not met. The diet provided was wholesome, appealing and balanced. The dining room was clean and well maintained and meal times were flexible, however staff did not give assistance sensitively and discreetly. EVIDENCE: The home had no activities co-ordinator this post was advertised but there had been no applications, due to this most days there were no activities occurring. Service users said “we are bored with only the television to watch” and service users are not given opportunities for stimulation through leisure and recreational activities. Outside entertainers were still booked occasionally and the home had a VE Day celebration organised, however this was not adequate to meet the needs of the service users. It was observed during the inspection that staff did not give assistance in eating discreetly, sensitively or individually, staff stood over service users as well as the lack of communication, meals were placed in front of service users with no explanation and hands and face were not cleaned after meals. This did not meet the needs of the service users. Comments from visitors stated that when they visited their relatives they were often dirty, unshaven and smelt as if they had not been changed. THE CEDARS J55-J07 S15852 The Cedars V215348 030505 Stage 4.doc Version 1.20 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 standard(s) 18 Service users are generally protected 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, the manager 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. During the inspection many poor practices were noted and many could be identified as neglect as service users were not having some basic needs met. Many visitors also commented that basic care of their relative was poor one visitor said “ if the resident is unable to speak for themselves they are often left dirty and wet for long periods”. THE CEDARS J55-J07 S15852 The Cedars V215348 030505 Stage 4.doc Version 1.20 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 standard(s) none of these standards were assessed during this inspection. EVIDENCE: THE CEDARS J55-J07 S15852 The Cedars V215348 030505 Stage 4.doc Version 1.20 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, 28 & 30 Not all Service users needs were met by the staff, staff training was up to date but staff did not practice what they had been taught. EVIDENCE: Staffing numbers and skill mix on duty on the nursing unit were not always adequate to meet the needs of service users the carers were very busy and did not always have time to meet the basic needs of service users, clothes were dirty, nails were dirty and uncut, hands and face not cleaned following meals, not enough staff to give assistance with meals many service users had to wait long periods with food sat in front of them awaiting a carer to give assistance. On the residential unit staff were sat together talking and having lunch at the same time, the staffing allocation needs to be reviewed in order that the needs of all service users are met at all times. NVQ training for staff is ongoing and the home hopes to achieve 50 qualified to level 2 to meet the previous recommendation. Other staff training was up to date and staff confirmed they had attended all the training however various bad practices observed during the inspection showed that the training was either not appropriate or being ignored this needs to be addressed to protect service users from harm. THE CEDARS J55-J07 S15852 The Cedars V215348 030505 Stage 4.doc Version 1.20 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) 36 Staff receive formal supervision every two months. EVIDENCE: Records showed that since the last inspection staff have received supervision bi-monthly and all had a yearly appraisal, as this was a previous requirement. This appeared to be a paper exercise as nothing was followed through, the poor practices observed during the inspection should be covered at supervision in order for the needs of the service users to be met and ensure staff are not putting themselves at risk of harm. THE CEDARS J55-J07 S15852 The Cedars V215348 030505 Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 1 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 x 15 2 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 2 28 2 29 x 30 2 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 V215348 030505 Stage 4.doc Version 1.20 Page 18 yes 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 Timescale for action 1.6.05 2. Op3 14 3. 4. OP4 OP7 18 13 The registered provider must ensure all servcie users are issued with a contract (previous timescal 1 April 2005) The needs assessments are fully 1.7.05 reviewed and updated giving sufficient detail to provide clear guidence to staff to enable a plan of care to be drawn up which provides the basis fo the care to be delivered. (old timescale 1 May 2005) Ensure all staff have the skills to 1.7.05 deliver the services and care the home offers to provide. Ensure all service users have risk 1.7.05 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 May 2005) All the plans of care must be reviewed and include all relevent information to meet the health and welfare needs of the service users Service users must be treated with respect and their right to privicy be upheld. J55-J07 S15852 The Cedars V215348 030505 Stage 4.doc 5. OP7 15 1.7.05 6. OP10 12 1.7.05 THE CEDARS Version 1.20 Page 19 7. 8. 9. 10. 11. OP12 OP15 OP18 OP27 OP30 16 12 12 18 12 12. OP36 18 Ensure social, cultural, religious and recreational needs of service users are met. Assisstance with eating must be given discreetly, sensitively and individually. Service users are not subject to neglect. Ensure adequate staff with appropriate skills are on duty to meet service users needs. Ensure the training staff receive is appropriated and staff understand the training to meet needs of service users. staff supervision must be appropriate and cover all areas of practice. 1.7.05 1.7.05 1.7.05 1.7.05 1.7.05 1.7.05 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 OP28 Good Practice Recommendations 50 of care staff are trained to NVQ level 2 by 2005. THE CEDARS J55-J07 S15852 The Cedars V215348 030505 Stage 4.doc Version 1.20 Page 20 Commission for Social Care Inspection 1st 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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