Inspection on 05/07/06 for The Cedars Nursing Home

This inspection was carried out on 5th July 2006.

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 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 14/11/08

The Cedars Nursing Home 11/04/08

The Cedars Nursing Home 25/09/07

The Cedars Nursing Home 15/11/05

The Cedars Nursing Home 02/06/05

The Cedars Nursing Home 27/01/05

The Cedars Nursing Home 15/06/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Cedars Nursing Home (The) Northlands Landford Salisbury Wiltshire SP5 2EJ Lead Inspector Karen Mandle Key Unannounced Inspection 5th July 2006 10:00 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 Cedars Nursing Home (The) DS0000015897.V299064.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. Cedars Nursing Home (The) DS0000015897.V299064.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedars Nursing Home (The) Address Northlands Landford Salisbury Wiltshire SP5 2EJ 01794 390284 01794 390068 Telephone number Fax number Email address 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) Alphacare Holdings Limited Mrs Marilyn Bulmer Care Home 31 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (31), of places Physical disability (10) Cedars Nursing Home (The) DS0000015897.V299064.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users who may be accommodated in the home at any one time is 31 No more than 10 service users over the age of 50 years with a physical disability may be admitted at any one time and admission criteria for those between the ages of 50 and 65 must be consistent with the homes’ statement of purpose The minimum staffing levels set out in the Notice of Decision dated 6 November 2003 must be met at all times 15th November 2005 3. Date of last inspection Brief Description of the Service: The Cedars Nursing Home is registered to provide nursing care for 31 older people aged 65 years and older. The home is an older building, situated in rural location on the A36 mid-way between Salisbury and Southampton. Many of the rooms are single, which are well-furnished providing comfortable accommodation. The home has large surrounding grounds and pleasant views of the countryside. The Cedars is owned by, Alphacare Ltd and the Registered Manager is Mrs Marilyn Bulmer who has been in post since autumn 2000. Cedars Nursing Home (The) DS0000015897.V299064.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit for this key inspection took place 5th July 2006 commencing at 9.45am. The Manager Mrs Bulmer was available to assist the inspector. The inspector was able to freely tour the building, visit with many of the service users and observe staff interacting with service users and attending to their care needs. The care of 5 service users was case tracked through the inspection process by reviewing care records, observing the care provided and speaking where possible with the service users gaining their opinion of the service provided by the home. The comments received from the service users were all complimentary of the care provided, stating how supportive and helpful they found the care staff. The providers of the home have plans in place to refurbish parts of the home. The grounds of the home are very well maintained and provide a lovely setting for service users to enjoy time outside. The summer garden party had just taken place, which service users had enjoyed. The home had met all but 1 requirement from the previous inspection. Following this inspection 5 requirements were set and 2 recommendations. The home was providing nursing care for 28 service users at the time of the inspection. The judgments contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: The health care needs of the service users are monitored and GP’s visit the home on a regular basis. The home provides an excellent activities programme with many service users participating in the various activities provided throughout the week. This leads to a feeling of the home having an active and lively atmosphere with service users being stimulated and social needs being met. The service users were complimentary of the standard of food provided. The accommodation is homely with pleasant well-furnished communal areas situated on the ground floor over looking the well-kept grounds of the home. Service users are supported to maintain links with family and friends. The home was clean throughout with infection control measures in place. The home benefits from a stable staff group. The staff had been provided with all mandatory training. Cedars Nursing Home (The) DS0000015897.V299064.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. Cedars Nursing Home (The) DS0000015897.V299064.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 Cedars Nursing Home (The) DS0000015897.V299064.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 An admission procedure is in place and a full pre admission assessment takes place for all prospective service users. The home is not registered to provide intermediate care. Quality in this outcome area is judged to be good. This judgment has been made using the available evidence including a visit to this service. EVIDENCE: All prospective service users are fully assessed by the registered manager prior to admission to The Cedars Nursing Home to ensure that through the assessment process the home is able to meet the nursing care needs and social needs of the service user. Two pre admission assessments were seen which provided information relating to long-term care needs and current health care needs. The manager will support the assessment where possible form care managers and families. A record of the assessment is kept on the service users’ file and used towards implementing a care plan. The home is not registered to provide intermediate care therefore Standard 6 is not applicable to this service. Cedars Nursing Home (The) DS0000015897.V299064.R01.S.doc Version 5.2 Page 9 Cedars Nursing Home (The) DS0000015897.V299064.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 Health care needs of the service users are closely monitored and appropriate action taken when health care needs change. The care records continue to improve with more information recorded providing clearer direction to the care staff as to how the service users care needs will be met, however monthly reviews are not taking place and a recently admitted service user did not have a care plan. The medication procedure is safe apart from the medication administration record format, which is confusing. Quality in this outcome area is judged to be adequate. This judgment has been made using the available evidence including a visit to the service. EVIDENCE: The care records of five service users were reviewed. A general improvement was seen to the standard of documentation within the care records. Shortterm care plans were in place to address any short-term care need identified. More information was recorded daily for each service users, relating to how their day was spent. However not all care plans had been reviewed on a monthly basis ensuring that nursing care needs have been regularly assessed. A service user who had been admitted the previous week did not have a care Cedars Nursing Home (The) DS0000015897.V299064.R01.S.doc Version 5.2 Page 11 plan in place to direct staff on how to meet the service user’s care needs. A pre admission assessment had been completed which should have been used to commence the care plan, followed by assessments of the service users nursing needs on admission to the home. The registered manager informed the inspector that now the home is under new ownership, the care plan format would be changing. All service users are registered with a local GP. A record of GP visits was seen in the care records, where the GP actually documents the reason and outcome of the visit. Health care needs are monitored and action taken when health care needs change. Service users who were able to communicate were complimentary of the care provided and expressed that they felt their health care needs were being meet. The inspector was able to speak with a regular visitor to the home who was happy with all aspects of care being provided for their family member. The medication procedure was assessed, which is generally safe as all medication was stored correctly and the disposal of medication is within current legislation. However the medication administration records works on a 12-week system which appeared to be confusing to some nurses, as some medication had been documented on the records twice which could result in a medication error with the service user being given the same medication twice. Medication had also been given during the morning but not signed for, again it seemed that the nurse was confused with the medication administration record. The dignity of service user is maintained with all care seen being provided behind closed doors. A service user who, due to improved health, was shortly leaving the home reported how the staff had always been respectful towards her during her stay. The Staff were observed and heard interacting with service user in a friendly but respectful manner. Service users confirmed that the staff addressed them by their preferred name. Cedars Nursing Home (The) DS0000015897.V299064.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15 The social care needs of the service users are fully supported by the homes activities programme. Service users are supported to maintain links with family and friends. Service users were complimentary of the food provided, with nutritional needs being met. Quality in this outcome area is judged to be excellent. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The home continues to provide an excellent activities programme, which really caters for the individual social needs and social expectations of the service users. The home had just had a large summer tea party in the grounds, which service users were keen to talk about. Regular art classes take place during the week, which was observed by the inspector during the morning. The service users participating in the art class reported how much they enjoyed the class. The completed artwork is nicely displayed in the dining room. After lunch a sing-a-long was taking place in the communal room. Service users not wishing to take part in the activities were observed spending time in their rooms watching TV, listening to music and reading. Service users are supported by the home to maintain links with family and friends who may visit the home at any reasonable time. Three visits were seen Cedars Nursing Home (The) DS0000015897.V299064.R01.S.doc Version 5.2 Page 13 taking place during the morning of the inspection. Many families had attended the summer tea party the previous day. Service users were complimentary of the food provided which was described as “good home cooking”. A large dining room is provided where many of the service users were observed having their lunch, which also seemed a time when service users socialised with each other. The Staff were observed assisting those service users who required help with their meal on a one-toone basis. The weights of service users are monitored and food supplements given when needed. The kitchen was seen which was cleaned and organised. However there are plans to refurbish the home which will be beneficial to the kitchen, which is now looking tired and well used. Cedars Nursing Home (The) DS0000015897.V299064.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 A complaints policy and procedure are in place and openly displayed. The staff had received training in “abuse awareness” and the manager was fully informed of the local vulnerable adults procedure. Quality in this outcome group is judged to be good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: A complaints policy and procedure is in place, which is clearly displayed in the entrance hall of the home. The complaints procedure is also included in the homes statement of purpose. The manager has a clear understanding how to, conduct a complaints investigation. The home has not recently received any complaints. A regular visitor to the home was asked what action they would take if they had any concerns or complaints regarding the service provided by the home. The visitor reported that they would always speak with the Matron directly who is always helpful and responds quickly to any concern. The staff had received “abuse awareness” training and the manager was fully aware of the local vulnerable adults procedure and how to implement the procedure if an allegation of abuse should occur. All relevant police checks are made for new employees prior to the commencement of employment with the aim of protecting service users as much as possible. Cedars Nursing Home (The) DS0000015897.V299064.R01.S.doc Version 5.2 Page 15 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, 22, 24 and 26 The Cedars provides comfortable accommodation with the majority of the home well maintained. The home is clean throughout and infection control measures in place. The divan beds in use are not suitable for service users requiring nursing care. Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a site visit. EVIDENCE: The Cedars is an older building, which does require continues maintenance. The majority of the building is generally well maintained. However a bedroom window was in a poor state of repair with the window not closing securely and during the inspection, a heavy rain shower took place and water was seen coming through the ceiling in an upstairs corridor, near to an emergency lighting unit. This was reported to the Director of the home following the inspection. A bathroom on the ground floor has been refurbished now providing a wet room with a good showering facility. The communal rooms are spacious and furnished in homely fashion. Cedars Nursing Home (The) DS0000015897.V299064.R01.S.doc Version 5.2 Page 16 The home does provide some profile beds, however divan beds are still in use for service users with nursing needs requiring manual handling aides for transferring from bed to chair. It will be required that the divan beds will be replaced. It also appeared a high percentage of service users had bed rails in place. However the Manager had just completed an audit of the use of bed rails, which confirmed the need for the use of bed rails. Protective bumpers were not in place for all bed rails, ensuring the safety of service users. Many of the bedrooms were visited which vary in shape and size, as this is not a purpose built home. The bedrooms are personalised and homely. A few of the carpets in the bedrooms are stained and need either cleaning or replacing. The bedrooms offer good views of the surrounding countryside. The home was clean throughout with domestic staff employed to carry out cleaning duties. The laundry facility was clean and organised. Infection control measures were in place throughout the home and clinical waste was dealt with appropriately. Cedars Nursing Home (The) DS0000015897.V299064.R01.S.doc Version 5.2 Page 17 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, 28, 29, and 30 The staffing level provided meets the nursing and personal care needs of the service user. The procedures for the recruitment of staff are robust and provide the necessary safeguards to offer protection to the service users. All staff had been provided with mandatory training. Quality in this outcome area is judged to be good. This judgment has been made using available evidence including a site visit. EVIDENCE: The home was operating the staffing levels within the “Staffing Notice”. The Staff on duty at the time of the inspection were: The Manager, 2 qualified nurses, 3 carers, the administrator, domestic assistance, kitchen staff and a handyman. Service users call-bells were observed being answered in a reasonable amount of time, and service users when asked stated their care needs were met by the care staff provided. Four employment files were reviewed. Evidence was provided of appropriate police checks being made. Application forms and employment contracts were in place. Two employment files for staff that had worked at the home for many years did not have references in place; the administrator informed the inspector that when the home was sold in 2000 there were problems obtaining all complete employment files from the previous owners, however the administrator will address this issue. Cedars Nursing Home (The) DS0000015897.V299064.R01.S.doc Version 5.2 Page 18 A training matrix was in place and all staff had received mandatory training. The Manager is keen to support care staff with NVQ training, which many of the care staff had obtained or are in the process of. The home benefits from a stable staff group. Cedars Nursing Home (The) DS0000015897.V299064.R01.S.doc Version 5.2 Page 19 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): 31, 33, 35 and 38 The Registered Manager provides good leadership to the home and fully understands her responsibilities. Quality assurance systems are in place. The financial procedures of the home safeguard the service users. Health and safety issues are addressed providing a safe environment for service users and staff. Quality in this out come area is judged to be good. This judgment has been made using available evidence including a site visit. EVIDENCE: The registered Manager Mrs Bulmer is an experienced manager who fully understands her role as the registered manager of the home. Mrs Bulmer knows the care needs of the service users well and provides leadership to the home. Cedars Nursing Home (The) DS0000015897.V299064.R01.S.doc Version 5.2 Page 20 The home holds personal spending money for service users with systems in place to protect service users. The administrator and Manager make regular audits of the service users personal money, ensuring that service users personal money is safeguarded. A monthly newsletter is produced by the Manager informing service users and families of any changes within the home taking place and up coming events that may be of interest. Service users/relatives surveys take place to ensure that the service provided by the home meets the expectations of the service users and relatives. The home is generally well maintained, apart from two areas, which are identified under Standard 19 of this report. The fire records indicated that all appropriate testing of the fire alarm system was taking place and staff had received fire training. Accidents had been recorded as to how the accident had occurred and what action had been taken by the home following the accident. The Manager audits the accident record monthly to ensure that any reoccurring accidents have been identified and fully risked assessed. Cedars Nursing Home (The) DS0000015897.V299064.R01.S.doc Version 5.2 Page 21 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Cedars Nursing Home (The) DS0000015897.V299064.R01.S.doc Version 5.2 Page 22 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 Requirement The Registered Person will ensure the care plans are reviewed monthly. Progress had been made but not all care plans provided evidence of monthly reviews taking place. 2. 3. 4. OP7 OP9 OP22 15 13 16 A care plan will be commenced at the time of the service user being admitted to the home. An up to date medication reference manual will be provided. The divans beds currently in use for service users with nursing needs will be replaced with an appropriate bed suitable to meeting the care needs of the service users. The bedroom carpets that are stained will be cleaned or replaced. The bedroom window in room 17 will be repaired. 01/08/06 01/08/06 15/09/06 Timescale for action 15/08/06 5. 6 OP24 OP19 23 23 01/09/06 01/08/06 Cedars Nursing Home (The) DS0000015897.V299064.R01.S.doc Version 5.2 Page 23 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 OP7 OP9 Good Practice Recommendations The owners of the home should provide care plan training to all staff prior to introducing a new format. Consideration should be given to providing a clearer record for recording the administration of medication. Cedars Nursing Home (The) DS0000015897.V299064.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cedars Nursing Home (The) DS0000015897.V299064.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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