Inspection on 06/03/07 for The Cedars Nursing Home

This inspection was carried out on 6th March 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Cedars Nursing Home 03/11/05

The Cedars Nursing Home 12/05/05

The Cedars Nursing Home 04/11/04

The Cedars Nursing Home 06/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cedars Nursing Home, The Cedar Park Road Enfield Redditch Worcestershire B97 6HP Lead Inspector Chris Potter Unannounced Inspection 6th March 2007 12:30 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 DS0000004102.V332923.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 DS0000004102.V332923.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedars Nursing Home, The Address Cedar Park Road Enfield Redditch Worcestershire B97 6HP 01527 63038 01527 63038 thecedars@thecedarsnh.co.uk 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) Mr Robert Delaney Mrs Denise Goldman Care Home 40 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (40), of places Physical disability (4), Physical disability over 65 years of age (40), Terminally ill (4) Cedars Nursing Home, The DS0000004102.V332923.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The category PD is in respect of persons aged 55 - 65 years. The category TI is in respect of persons aged 60 and over. Date of last inspection 3rd November 2005 Brief Description of the Service: The Cedars nursing home is a late Victorian manor house that is located on the outskirts of Redditch town centre. The home is registered to accommodate forty older residents requiring twenty-four hour nursing care. The home is owned by Mr R Delaney who is the sole provider, who visits the home frequently and inputs into the day-to-day management of the home. Mr Delaney employs an administrator who manages the business and financial side of the business. The registered manager is Mrs Goldman who is a first level registered nurse with many years experience in managing care homes. The Cedar’s rates are reviewed annually service users are notified one month in advance. The additional charges to service users are detailed in the service user guide. This is clearly laid out in the terms and conditions. Fees for The Cedars are: £495.00 - £625.00 per week. Cedars Nursing Home, The DS0000004102.V332923.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the Cedars key unannounced inspection for 2006/07. It was undertaken over two part days on the 6th and 7th of March. At the time of the inspection the home was accommodating forty residents. A range of evidence was used to make judgements about this service. This includes: information from the provider, staff records kept in the home, medication records, discussion with people who use the service, discussions with the staff team, discussion with the manager, tour of the premises, previous inspection reports, quality assurance process, Fire Authority reports, Environmental Health Office reports, observation of care experienced by people using the service. Feedback received from residents, and relatives were generally complimentary about the home and the care provision, comments included: “Home is marvellous”. “Cleanliness is very good” “Food is very good” What the service does well: What has improved since the last inspection? Since the last inspection the home has commenced a landscaping project for the grounds allowing easier access for disabled residents. This provides Cedars Nursing Home, The DS0000004102.V332923.R01.S.doc Version 5.2 Page 6 pleasant views from the home and residents appeared pleased with the progress. Care plans have further improved since the last inspection and provide a more personalised picture of the resident. The home has invested in upgrading some area of the home, providing a treatment room and hair washing facilities to assist the hairdresser. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cedars Nursing Home, The DS0000004102.V332923.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 DS0000004102.V332923.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 and 5 (standard 6 is not applicable to this home) Quality in this outcome area is good. Prospective residents and their representatives have the information they needed to choose a home, which will meet their needs. They have their needs assessed and a contract which clearly tells them about the service they will receive. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the home has reviewed and updated their Statement of Purpose and Service User’s Guide. A copy of the Service User’s Guide is provided for any potential resident to assist them with their choice. The Service Users Guide is available in a standard format. Cedars Nursing Home, The DS0000004102.V332923.R01.S.doc Version 5.2 Page 9 Generally it was relatives that chose the home for the residents in The Cedars, residents stated that they were pleased with their choice. Prior to the admission of new residents to The Cedars the manager completes a pre – admission assessment to ensure that the home can fully meet their needs. This takes into account the individual needs, concerns and anxieties of the prospective resident and their families. The care files for two recently admitted residents were reviewed these showed that a pre – admission had been carried out before they were admitted to the home. Residents are provided with a statement of terms and conditions following their admission to the home. It gives information on what service user can expect to receive for the fee they pay and sets out terms and conditions of occupancy. Cedars Nursing Home, The DS0000004102.V332923.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 Quality in this outcome area is good. The nursing and personal care, which a resident receives, is based on their individual needs. The principles of respect, dignity and privacy are put into practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the manager has introduced a new care-planning model, which is more personalised to the residents, care needs. Four care plans were reviewed at the time of the inspection. There is recorded evidence that the nurse’s are trying to involve the resident’s in the development and review of their care plan. The care plans includes the basic information necessary to plan the individuals care and includes appropriate risk assessments. The home has a good range of pressure relieving equipment in use, and use appropriate risk assessments to indicate the need for prevention equipment. At the time of the inspection the home had no residents with skin Cedars Nursing Home, The DS0000004102.V332923.R01.S.doc Version 5.2 Page 11 pressure damage. There is written evidence in the care plan of health care treatment and intervention, and a record of general health care information including weight monitoring, and nutritional information. The manager has worked to make the new system provide a more informed indication of care provided and progress made by individual service users. There was recorded evidence of updating information and changing actions in the care plans. Residents have access to health care services that meet their assessed needs within the home. The manager is currently reviewing chiropody cover for the residents. The home has a medication policy which is accessible to staff, medication records are up to date for each service user and medicines received, administered and disposed of are recorded. Since the last inspection the home reported a medication error, appropriate intervention was taken by the home and all nurses have attended additional training. The manager is looking to change pharmacy supplier given some delay in the medication being dispensed from the pharmacist. All staff spoken to were aware of the residents care needs and how to treat residents with respect and to consider dignity when delivering personal care. Residents and relatives stated they were happy with the way that staff deliver their care and respect their dignity. The home has achieved their Gold Standards Framework in “End of Life” since the last inspection. With the residents consent they record the resident’s wishes for their final days. One resident was very poorly during the inspection and the home had prescriptions available from there General Practitioner should the medication be needed without any delay. The manager stated that if relatives were not present with their poorly relative staff would take turns sitting with them. It is recommended that the home cover with additional staff when they have a poorly resident to ensure that they are accompanied and the rest of the residents care is not being compromised. The manager and staff have received some written compliments from the families of residents who had died at The Cedars, wishing to express their gratitude and thanks. Cedars Nursing Home, The DS0000004102.V332923.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. Residents are able to choose their life style and keep in contact with family and friends. Social, cultural and recreational activities generally meet resident’s expectations. Residents receive a healthy, varied diet according to their assessed requirement and choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home tries to be flexible and attempts to provide a service, which is more individual by using its staff and resources effectively. The residents where possible are consulted on how the home can provide them with a flexible lifestyle. Staff confirmed that this was not always possible with the number of care staff on duty. Residents are given the opportunity to take part in a variety of activities within the home and a record is maintained for each resident who participates. Cedars Nursing Home, The DS0000004102.V332923.R01.S.doc Version 5.2 Page 13 The service attempts to consider the preferences of the majority of its service users but may not always please everyone. Generally the majority of residents and relatives felt that the activities were satisfactory. Comments included “I enjoy the activities very much” “Not many activities” The home has open visiting arrangements and relatives were present during the inspection times both in the lounges and their bedrooms. The food in the home is of good quality, well presented and meets the dietary needs of the residents. The residents are consulted about their likes and dislikes and the cook tries to meet the preferences and suggested dishes when preparing the menu. The cook is able to cater for all special diet requirements. Residents are able to choose to eat in their own room if they wish. Regular drinks and snacks are available throughout the day. The cook maintains appropriate food records, and has a cleaning schedule in place. Residents have a choice of cereals or a cooked breakfast every day. A choice of a cooked lunch is provided at 12.30pm and a varied tea menu at 1700pm. The cook confirmed that all staff have access to the kitchen to do snacks for residents if they request anything. Residents and staff stated that the meals were very good. Cedars Nursing Home, The DS0000004102.V332923.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. Residents have access to a robust, effective complaints procedure, are protected from abuse and have their legal rights protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure that meets the national minimum standards and regulations. The complaints procedure was visible within the home. No complaints have been received since the last inspection in November 2005. The manager is clear when incidents need external input and who to refer the incident to. Links with external agencies are satisfactory and include the CSCI, police and adult protection teams. All staff spoken to were aware of their responsibilities of reporting any concerns and were all-confident to do this. Cedars Nursing Home, The DS0000004102.V332923.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 and 26 Quality in this outcome area is good. The home is well maintained and in good repair to enable residents to live in a safer, better-maintained and comfortable environment, which encourages independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a rolling program for ongoing decoration and maintenance in the home. Since the last inspection the home has completed a training area for staff. Provided a treatment room with hair washing facilities for the hairdresser Cedars Nursing Home, The DS0000004102.V332923.R01.S.doc Version 5.2 Page 16 to use. The grounds are being landscaped to provide easier access for disabled residents to use them when the weather permits. The bedrooms have generally been personalised by the resident to reflect their individual personality. Residents stated that they were happy with their bedrooms and found them very comfortable. Some residents confirmed that they preferred to stay in their bedrooms in preference to using the communal areas of the home. The home has two large lounge areas and a dining room on the ground floor for residents to use if they wish to. There is also a quiet area by the entrance for residents who wish to sit quietly. The home has a chair to assist the residents in bedrooms with steps up to them. All areas of the home were observed to be clean and tidy and the management of odours was commended. Residents and staff complimented the home for its cleaning standards. “Cleanliness is very good”. Some comments about the laundry indicated problems and items of clothing going missing. The home is currently meeting to review this problem, and is to increase the daily hours covered in the laundry. The laundry is very busy given it caters for forty residents both personal and bed linen washing. It is recommended that the home review equipment to assist staff with ironing, currently a domestic iron is used. Cedars Nursing Home, The DS0000004102.V332923.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. Staff in the home are being trained to fill the aims of the home and meet the changing needs of residents. Staffing numbers are below the recommended minimal requirements for some shifts. The recruitment policy by not being adhered to fully can compromise the safety of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents stated that they are satisfied with that the care they receive and that staff meet their needs, but there are some times when no one is available to immediately help them. They all commented on how hard working the staff was and this was evident on the days of the inspection. Staffing rotas indicate that the staffing levels fall below the recommended minimal requirements on weekends and late shifts. It is recommended that this area is reviewed given the high dependency needs of the residents does not change at weekends. Current staffing levels do not take into account any emergencies that could occur. Comments from residents and relatives included “Very short of staff for Cedars Nursing Home, The DS0000004102.V332923.R01.S.doc Version 5.2 Page 18 forty people”. “Mom has to wait at busy periods for the toilet” Staff confirmed that they were busy, and would appreciate an additional carer to help meet the resident’s needs. The home has a good induction programme in place for new staff, examples of which were seen. Plans for supervision to monitor the performance of staff are in place. The manager has not been able to provide a supervision meeting for all staff. The home recognises the importance of training, and has a training plan in place for all staff to complete. The manager is currently completing an undergraduate post registration course in Dementia. The home has a qualified first aider on all shifts. It is recommended that the home provide some specialist training for their staff. Currently two staff are qualified to NVQ level 2 and two staff are NVQ level 3. Staff confirmed that they are looking forward to undertaking an NVQ award. The homes recruitment procedure has not been fully adhered to and this was evidenced from reviewing the last three staff files. The home must ensure that the applicant provides their current or most recent employer for a reference. Any gaps in employment history must be clearly explained. The staff had commenced prior to a clear CRB (criminal records Bureau) check being received and POVA (Protection of Vulnerable Adults) first had not been requested. The manager confirmed that this would be addressed immediately. Cedars Nursing Home, The DS0000004102.V332923.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36 and 38 Quality in this outcome area is good. The management and administration of the home is based on openness and respect, and effective quality assurance systems are being developed by the provider. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for three years and is a first level registered nurse with many years experience in managing care home. All staff confirmed Cedars Nursing Home, The DS0000004102.V332923.R01.S.doc Version 5.2 Page 20 that the manager is both supportive and helpful. The manager demonstrated a good understanding of the residents and their needs. The home is without a deputy manager; it is recommended that this be reviewed to provide clinical support for the manager. The home has a quality audit in place and address’s any issues that may be identified, i.e. the laundry. Generally all the comments made were either good or excellent. The home does not manage any resident’s finances; this is usually managed by their relatives on their behalf. The administrator is well organised with all the health and safety aspects of the home, and all the required records were provided for the inspection. Staff are given training in health and safety. All fire records were checked and up to date at the time of the inspection. Cedars Nursing Home, The DS0000004102.V332923.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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 3 Cedars Nursing Home, The DS0000004102.V332923.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 2 3 Standard OP28 Regulation 18 18 18 Timescale for action The provider should have 50 of 30/01/08 their care staff with an NVQ level 2 award in care. The provider must ensure that 06/03/07 the recruitment procedure is adhered to. The provider must further 30/06/07 develop their supervision program to include all staff, and on a more frequent basis to comply with the NMS. Requirement OP29 OP36 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 OP27 Good Practice Recommendations The provider must ensure that staffing levels are appropriate for the size of the home, and the dependency of the residents. The staffing levels and skill mix should remain the same for the seven days. Given residents needs are continually changing the levels should be reviewed prior to each shift. The provider reviews the management of the laundry to DS0000004102.V332923.R01.S.doc Version 5.2 Page 23 2 OP26 Cedars Nursing Home, The 3 OP30 improve the outcome for the residents. It is recommended that the manager review some specialist training for both the carers and nurses. Cedars Nursing Home, The DS0000004102.V332923.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Cedars Nursing Home, The DS0000004102.V332923.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. 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