Inspection on 04/02/09 for The Cedars Nursing Home

This inspection was carried out on 4th February 2009.

CSCI found this care home to be providing an Poor 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 25/02/08

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 19/06/2009.

CARE HOMES FOR OLDER PEOPLE The Cedars Nursing Home Cedar Road Balby Doncaster South Yorkshire DN4 9HU Lead Inspector Sarah Powell Key Unannounced Inspection 09:30 4 & 6th February 2009 th 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 DS0000015852.V374074.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. The Cedars Nursing Home DS0000015852.V374074.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) Manager 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 The Cedars Nursing Home DS0000015852.V374074.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 25th February 2008 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. The Cedars Nursing Home DS0000015852.V374074.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 0 star. This means that the people who use this service experience poor quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been revised or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This was an unannounced visit, which took place on the 4th and 6th February 2009. The first day commenced at 09:30 and ended at 17:15 hours. The second day commenced at 09:45 and finished at 12:30 hours. Two inspectors were present on the first day the lead Inspector and a pharmacy Inspector. A random visit also took place on 11th April 2008 by the pharmacy inspector following adult safeguarding concerns. This visit identified there were improved systems in place for the ordering, administration, recording and storage of medicines, most noticeably in the nursing unit. However safeguarding concerns were raised again in January 2009, some of which were regarding the administration of medication. This inspection visit included talking with people living at the home, a number of professionals, the acting manager and eleven staff. During the visit we also walked round the building to gain an overview of the facilities. We also checked a number of records. The acting manager was completing an annual quality assurance assessment (AQAA) at the time of the visit; we had bought the inspection forward so the date for the return of the AQAA had not passed. The AQAA focuses on how well outcomes are being met for the people using the service. It also gives us some numerical information about the service, the acting manager said she would complete this and return it to us, as soon as possible. The Cedars comprises of two buildings on the same site, one is for people requiring personal care, which it the lodge. The other known as the clinic is for people who require nursing care. During our visit it was found that quality outcomes for people who lived in each unit was vastly different. As a result of this we have differentiated between the two units throughout this report. The majority of outcomes for people who lived in the lodge were good, however it The Cedars Nursing Home DS0000015852.V374074.R01.S.doc Version 5.2 Page 6 is registered, inspected and assessed as one home so the poor outcomes for people who lived in the clinic determined the overall quality rating. The clinic has had a number of safeguarding referrals since January 2009, concerns have also been raised by Doncaster council contracts officers and visiting professionals. The providers had taken this extremely seriously and have placed a voluntary suspension of admissions on this unit, which will enable the new acting manager to concentrate on improving the outcomes for the people that are living there in order that their needs are met. The providers have also provided safeguarding with a comprehensive improvement plan, which is being updated weekly. A copy of this is also being sent to us. This enables us to see what improvements are happening each week to ensure people’s needs are met. The regional manager is also spending at least three days each week at The Cedars to help improve the service for the people who live there. The Cedars is also part of the providers, Four Seasons’ focus group, poor performing homes are placed on this in order to identify all shortfall, provide resources and rectify problems within short timescales, to improve outcomes for people living in the home. Full feedback was given during and at the end of the inspection to the acting manager and regional manager. What the service does well: The Lodge & The Clinic The majority of the care staff at the home were kind and well meaning in their approach to the people living at the home. An observation made by one inspector of the experiences of some of the people who live in the home showed that staff do have positive interactions with the people in their care. The meals provided were nutritious, wholesome and appealing, the cook was very knowledgeable on the needs of the people and how to meet them. She also had a good understanding of people who required enriched and fortified diets and had excellent measures in place to ensure these were provided. The Lodge The Lodge provided good care and met people’s needs. Assessments were carried out prior to admission to determine if the home could meet the needs of perspective residents. Care plans were developed detailing people’s needs and measures put in place to meet those needs. Care plans were regularly reviewed. The Cedars Nursing Home DS0000015852.V374074.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The Lodge & the Clinic Activities provided did not meet people’s social, cultural, religious and recreational needs. The Clinic Care plans did not clearly identify people’s needs, putting people at potential risk of harm. Care plans were not reviewed regularly or when changes occurred. Medication records in the nursing unit are not sufficiently clear or detailed. It is therefore not possible to know whether people always receive their medicines correctly. Safeguarding referrals had been received and people were put at potential risk due to lack of adequate and knowledgeable staff on duty. Adequate staffing was not provided only two qualified nurses were permanently employed and agency staff were covering shifts, which caused lack of a consistent management approach and poor communication. This had resulted in some people’s needs not being met. The Cedars Nursing Home DS0000015852.V374074.R01.S.doc Version 5.2 Page 8 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. The Cedars Nursing Home DS0000015852.V374074.R01.S.doc Version 5.2 Page 9 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 DS0000015852.V374074.R01.S.doc Version 5.2 Page 10 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 standard 6 does not apply 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: We looked at one new admission on The Lodge, a full assessment of needs had been carried out by the unit manager. New assessment documentation introduced by Four Seasons was used, the assessment was very thorough and clearly identified the person’s needs in order to determine if these could be met at The Cedars. The Cedars Nursing Home DS0000015852.V374074.R01.S.doc Version 5.2 Page 11 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 poor outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. On the nursing unit People’s health and personal care needs were not met. Care plans did not clearly identify people’s needs or have measures in place to determine how needs could be met. People’s changing needs were not reviewed and instructions given by professionals had not always been followed therefore putting people at potential risk of neglect or harm. Medication records in the nursing unit are not sufficiently clear or detailed it was therefore not possible to determine whether people received their medicines correctly. On the Lodge people’s needs were identified and met. Medication practices and records in the Lodge continue to be of a very high standard. The Cedars Nursing Home DS0000015852.V374074.R01.S.doc Version 5.2 Page 12 EVIDENCE: We case tracked five people during the visit, this means we looked at their plans of care and the care they received in detail, to determine if their needs were being met. The Lodge Medication practices and records in Cedar Lodge continue to be of a very high standard. We looked at two care plans and they were easy to follow, full assessments were in place and a full plan of care was developed from this. People’s needs were identified and action developed to meet those needs. Professional advice was obtained if required and followed. The Clinic We looked at three plans of care, which were disorganised, very difficult to find information and determine if people’s needs were identified or met. During the case tracking we identified a number of peoples needs had not been met. One person had challenging behaviour this was identified in the care plan, but lacked identified action for staff to take to address the behaviour, and protect the person. As a result of the staff not understanding the necessary actions to take, the person had been put at risk and a safeguarding referral had been submitted. We saw that one person had lost weight, the weight was recorded, however no follow up was seen. The care plans and risk assessment had not been reviewed in light of the decrease in weight, and no additional measures had been put in place to address the weight loss. One person’s monthly evaluation had not been assessed since March 2008. One person had been risk assessed, at high risk of developing pressure sores and to evaluate monthly, it had not been evaluated in the last two months. People’s needs were identified in care plans however these were not evaluated monthly, this did not ensure peoples changing needs were assessed and met. People’s risks were identified, however no reviews were taking place to determine if there were any changes, so people’s needs were not being met. The Cedars Nursing Home DS0000015852.V374074.R01.S.doc Version 5.2 Page 13 One person’s nutritional risk assessment had been completed on 6th February 2008 and stated they required fortified diet; this had not been reviewed to determine any changes to needs. One person was identified as at risk of falling, yet the risk assessment had not been reviewed since 5th November 2008. This should have been reviewed monthly. One person had been identified as having challenging behaviour, shouting out and becoming very loud. No behaviour record chart had been implemented, no assessment of pain was undertaken to determine if this was the cause. The care plan on pain had not been reviewed since 5th August 2008, yet stated they complained of pain in back and legs. The medication administration chart showed that pain relief had not been given for the last three weeks. Staff were not attempting to identify causes of behaviour and therefore not meeting people’s needs. Body maps were being completed for injuries noted or broken areas of skin, but there was no evidence documented on the plans of care and no evidence to determine if sores or broken areas were being treated or if they had healed. People were not always identified as requiring fortified or enriched diet when they were at risk of developing pressure sores, underweight or risk assessed as at risk of poor nutritional intake. The cook had a list of people she had been given as requiring fortified died. This list did not have the name of one person we case tracked and they needed a fortified diet to meet their identified needs. Fluid and food charts were being completed, however these were not filed in any order or evaluated to determine if adequate fluid and food intake had been received, therefore not meeting people’s needs. The standard of medication record keeping must be improved especially on the medication administration (MAR) charts. The record of staff authorised to administer medicines is not up to date. This makes it difficult to identify who might be involved if a problem or error was to occur. Ten of fourteen MAR charts examined lacked clear records of medication applied to the skin meaning it is not possible to know whether such medication is being used correctly. Four people’s MAR charts indicated they were receiving less than the prescribed doses of medicated skin creams. Not using such medicines correctly may affect someone’s medical condition. There is insufficient detail and inconsistency in handwritten entries on the MAR charts. One person’s medicine times were changed without a reason being given when the MAR chart was rewritten. This may have an effect on the medical condition being treated. The quantity supplied, the date of entry, the The Cedars Nursing Home DS0000015852.V374074.R01.S.doc Version 5.2 Page 14 signature of the person making the entry and a witness signature where possible should be included. This makes sure that there is an accurate record of any changes or new medicines. The quantity of medication brought forward from one monthly cycle to another is not recorded on the new MAR. This means it is difficult to have a complete record of medication within the home and to check if medication is being administered correctly. Staff should record the opening dates of medicines with a limited use once opened, such as creams and oral liquids. This will help to make sure these medicines are safe to use when needed. A number of MAR charts had medication listed that was no longer in use. The pharmacy should be advised of medication not in use and asked to provide up to date charts. This makes sure people are only getting medication that is currently prescribed. Controlled drugs checking and record keeping should follow the current policy & best practice guidance. The nurse in charge of ordering medication should see the monthly prescriptions before a supply is made. This good practice, which already takes place in Cedar Lodge, provides an opportunity to check if any new medicines or dose changes are included. Any problems with prescriptions can be addressed at this point rather than after the supply has been made. The checking of prescriptions is an important part of the medication management in a care home. We were told that, due to insufficient numbers of qualified nurses, actions identified last September to improve medication procedures have not yet been fully implemented. The practice & understanding of temporary nursing staff should be checked before they handle and administer medicines to people living in the home. Staff should indicate they have read and understood the medication policy document so that they know exactly what is expected of them. We will carry out a random inspection of medications to determine actions have been taken to ensure the requirements are complied with and people’s needs met. We observed most care staff treating people with respect and maintaining their dignity. The Cedars Nursing Home DS0000015852.V374074.R01.S.doc Version 5.2 Page 15 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: An activity co-ordinator was employed to work 40 hours each week, spending 20 hours on each unit, however activities documented were infrequent and did not meet people’s needs. The acting manager told us that the coordinator was very new and inexperienced; she was hoping to provide some support and training to rectify this. We observed the coordinator carrying out care duties during our visit, they did not organise activities. People told us, “I enjoy the activities especially the bingo but it is not very often, it can get very boring just watching television”. The Cedars Nursing Home DS0000015852.V374074.R01.S.doc Version 5.2 Page 16 The acting manager has informed us following the visit that an activity coordinator from another home is spending two days each week with the new coordinator to give support and training to ensure peoples recreational needs are met. 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”. We observed staff offering people choices and respecting people’s decisions. However some choices were restricted on the clinic due to staff shortages and on occasion’s lack of leadership, this was due to insufficient qualified nurses and the use of agency staff. People received a wholesome, appealing and nutritious diet. We observed a lunchtime meal the food was well presented and choices were available to ensure people’s needs were met. Liquefied food was presented in a manner, which was attractive and appealing. The meal was unhurried and assistance was given sensitively when required. We spoke to the cook who was extremely knowledgeable on people’s needs, in particular in relation to fortified and enriched diet. She had various methods of ensuring people received adequate nutrition. One person told us, “The food is always lovely”. Another person told us, “There is always plenty of choice and if you don’t fancy what’s for diner you ask the cook and she will do you what you want”. We observed that some people who required help had to wait to be given that help, as there was not always staff available. One visitor told us, “people sometimes wait a long time for staff to help them and the food can be cold”. The Cedars Nursing Home DS0000015852.V374074.R01.S.doc Version 5.2 Page 17 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 adequate 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 Cedars home were listened to but not always 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 and told us if they had any complaints they would speak to the staff, as they were always approachable and listened. The acting 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. A number of safeguarding referrals had been received and investigating officers had been appointed. Following their investigations a number of concerns were raised that people’s needs were not being met. The issues were The Cedars Nursing Home DS0000015852.V374074.R01.S.doc Version 5.2 Page 18 only identified on the clinic and the provider has voluntarily suspended admissions to this unit. They have also agreed this will remain in place until the new acting manager has resolved the issues and Doncaster safeguarding are confident practises have improved, to ensure people are protected from risk of harm. The Cedars Nursing Home DS0000015852.V374074.R01.S.doc Version 5.2 Page 19 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 environment continued to be maintained to a high standard. A maintenance and renewal programme was in place all bedrooms, bathrooms, toilets and communal areas were well decorated and maintained to a high standard. The grounds were tidy, safe and attractive and accessible to people. Decorators were in the home at the time of the visit, redecorating various rooms. This ensured people lived in a well maintained home. The standard of cleanliness observed throughout the home was to a high standard. The Cedars Nursing Home DS0000015852.V374074.R01.S.doc Version 5.2 Page 20 People told us the home is always very clean. The Cedars Nursing Home DS0000015852.V374074.R01.S.doc Version 5.2 Page 21 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 poor outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff skill mix did not meet the needs of people and 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: The skill mix of staff on the clinic was not appropriate to meet the needs of the people. There were only two permanent qualified nursing staff, this was not adequate and the providers were relying on agency staff to cover shifts. This had lead to inconsistencies, lack of communication and people’s needs not being identified or met. The care staff were kind and well meaning in their approach to the people living at the home, however they had lacked direction, support and management to be able to understand people’s need and meet those needs. A new acting manager had been appointed and commenced employment on 1st January 2009. She is an experienced manager and had previously managed The Cedars Nursing Home DS0000015852.V374074.R01.S.doc Version 5.2 Page 22 another home in Doncaster owned by the same provider as the cedars. She was therefore knowledgeable in the company’s policies and procedures. A deputy had also been appointed but was awaiting satisfactory clearance before they were able to commence employment. We looked at staff training records these clearly showed what training was required. However staff training was not up to date with most staff still requiring some mandatory training to ensure they were competent to do their jobs, and meet people’s needs. The acting manager had put training in place for staff and some staff had updated some training requirements in the last four weeks. The acting manager had concentrated on moving and handling and fire awareness training. However records we saw showed 10 staff had not attended Protection of vulnerable adults training and another ten staff had not received an update in over a year. A number of staff were also still to attend health and safety, first aid, infection control and food hygiene training to ensure they were appropriately trained to do their jobs and meet people’s needs. One member of staff told us, “Training has been provided since the new manager started”. Another staff member told us, “I have attended some training recently it was really good the trainer was good he made it interesting”. 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. The Cedars Nursing Home DS0000015852.V374074.R01.S.doc Version 5.2 Page 23 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. Health and safety procedures were followed however the home was not always run in the best interests of people. EVIDENCE: The home has been without a registered manager for over two years it has had a succession of acting managers and at present a new acting manager has been appointed she has previously been a registered manager at another home owned by the same providers as the cedars. She has completed her application to become the registered manager and is in the process of The Cedars Nursing Home DS0000015852.V374074.R01.S.doc Version 5.2 Page 24 submitting her Criminal Record Bureau check (CRB) to the Commission for Social Care Inspection. Once this is returned and is satisfactory she can submit her application to the Commission for Social Care Inspection and commence the process to become the registered manager. The Acting manager and regional manager told us that people’s finances were safeguarded with robust procedures in place to ensure this. Quality monitoring systems based on seeking people’s views had not always been carried out. This did not always ensure the home was run in the best interests of the people. Audits had not been carried out as regularly as they were required, therefore problems and issues had not been identified and not all policies and procedures had been followed. The acting manager was working hard to recommence these in order to identify shortfalls so these could be rectified. 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. We saw that most accidents were recorded, however they were not always followed through with implementation of care plans, actions for staff to take identified and risk assessments not put in place this did not ensure that people were protected. The providers have provided support to the acting manager to assist improvement of the service; a manager from another home is spending time each week at the cedars reviewing care plans. The regional manager is spending at least three days each week in the home to ensure improvement targets are met. The operations director is visiting at least once a month to determine improvements are implemented and maintained. The Cedars Nursing Home DS0000015852.V374074.R01.S.doc Version 5.2 Page 25 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 1 8 1 9 1 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 1 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 The Cedars Nursing Home DS0000015852.V374074.R01.S.doc Version 5.2 Page 26 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 12 Requirement People’s health and personal care needs must be identified in Care plans ensuring their needs are met. Revised requirement All medication must be administered as prescribed and recorded and signed for on the medication administration charts. This will make sure that people receive their medications as prescribed. Timescale for action 20/05/09 2. OP9 13(2) 09/03/09 3. OP9 13(2) Revised requirement Handwritten entries and changes 09/03/09 to MAR charts should be accurately recorded and detailed. This makes sure that the correct information is recorded so a person receives their medication as prescribed. Revised requirement All peoples risk assessments must be followed and reviewed to safeguard people. Revised requirement Professional advice must be DS0000015852.V374074.R01.S.doc 4. OP7 13 01/04/09 5. OP8 17 01/04/09 Page 27 The Cedars Nursing Home Version 5.2 6. 7. OP12 OP30 16 18 8. OP33 24 9. 10. OP27 OP31 18 9 11. OP18 13 obtained and followed when risk assessments show people are at risk. People’s social and recreational needs must be identified and met. All mandatory staff training must be updated to ensure staff are able to meet the needs of the people. All quality monitoring must recommence to obtain people’s views and run the home in their interests. An appropriate skill mix of staff must be on duty to ensure people’s needs can be met. The new manager that has been appointed must be registered with the Commission for Social Care Inspection to ensure they are qualified and experienced to run the home. People must be protected from harm by training staff to understand all aspects of abuse and the need to report any incident immediately. 01/04/09 20/05/09 01/04/09 01/04/09 20/05/09 01/04/09 The Cedars Nursing Home DS0000015852.V374074.R01.S.doc Version 5.2 Page 28 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. 2. Refer to Standard OP28 OP9 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. A record of current staff authorised to administer medicines and who understand the medication policy document should be available. This makes it possible to identify who was involved in the event of an administration problem or error. A system should be in place to record all medication received in to the home and medication carried over from the previous month. This helps to confirm that medication is being given as prescribed and when checking stock levels. The supplying pharmacy should be advised of medication no longer in use and asked to provide up to date MAR charts. This makes sure people will only be given medicines that are currently prescribed. The date of opening of all medicines with limited use once opened should be recorded. This includes oral liquids and medication applied to the skin. This reduces the risk of using medication beyond the limited period recommended by each manufacturer. Regular monthly prescriptions should be seen before sending to the pharmacy. This makes sure a check can be made that all the medicines required have been listed and prevents people from being without. Regular checks of controlled drugs storage and records should be made to ensure current regulations are being upheld. People’s own choices for where & how they prefer to receive their medicines should be recorded to enable staff to meet individual needs. 3. OP9 4. OP9 5. OP9 6. OP9 7. 8. OP9 OP9 The Cedars Nursing Home DS0000015852.V374074.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000015852.V374074.R01.S.doc Version 5.2 Page 30 - 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. 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