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Inspection on 08/02/06 for The Cedars Nursing Home

Also see our care home review for The Cedars Nursing Home for more information

This inspection was carried out on 8th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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.

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

What the care home does well

The registered manager leads a large staff team and ensures that standards are maintained. The staff say they feel well supported and that they work well as a team. The staff are trained in all aspects of their work and the manager is striving to continually improve standards. A visiting Doctor said that the home had high standards of care and the nursing staff were skilled and able to meet peoples needs. The residents said that the staff were `wonderful and caring` and that they were very comfortable in the well maintained and furnished home. The residents were very complimentary about the food and said it was good every day. The food was particularly well presented and there were enough staff in the dining room to ensure everyone received the assistance they required to eat their meals.

What has improved since the last inspection?

The registered manager has complied with the previous requirements from September 2005.

What the care home could do better:

This report does not make any new requirements. As discussed with the matron where there are unavoidable gaps in the information on the care plans, it would help to write a brief explanation, for example, on several care plans the social histories were not completed, it was explained that the relatives had been asked to contribute this information and this had not been forwarded to the home as yet. It is recognised that where this had occurred the residents had been admitted recently.

CARE HOMES FOR OLDER PEOPLE The Cedars Nursing Home Church Walk, South Street Bourne Lincs PE10 9UQ Lead Inspector Kima Sutherland-Dee Unannounced Inspection 8th February 2006 10:30 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 The Cedars Nursing Home DS0000002553.V282534.R01.S.doc Version 5.1 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 DS0000002553.V282534.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Cedars Nursing Home Address Church Walk, South Street Bourne Lincs PE10 9UQ 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) 01778 421555 01778 421622 Cedars Health Care Limited Mrs M H Brewster Care Home 56 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0), of places Physical disability (5), Terminally ill (5) The Cedars Nursing Home DS0000002553.V282534.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st September 2005 Brief Description of the Service: The Cedars Nursing and Residential Home is situated close to the town centre of Bourne, which has a range of shops and facilities. The property was originally the vicarage and stands next to the church in its own landscaped grounds, leading down to a river with paths and seating for residents. The building has been extended over recent years and provides accommodation in twin and single rooms all en-suite, on the ground and first floor. There is a choice of lounges for residents to use. There is a circular driveway with car parking to the front of the property. The home is registered to provide nursing care for up to 56 people including older people, people with dementia, adults with a terminal illness and adults with a physical disability. There are also 5 beds contracted with the Primary Healthcare Trust for intermediate care. The registered providers of The Cedars are closely involved in the day-to-day running of the home. The Cedars Nursing Home DS0000002553.V282534.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 5 hours and consisted of talking to the deputy matron, the residents and staff. A sample of the care records, nursing notes and policies were seen as well accompanying a member of staff for part of a drugs administration round and having lunch with the residents. At the end of the inspection feedback was given to the matron and deputy matron and discussions took place. What the service does well: What has improved since the last inspection? The registered manager has complied with the previous requirements from September 2005. The Cedars Nursing Home DS0000002553.V282534.R01.S.doc Version 5.1 Page 6 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 Cedars Nursing Home DS0000002553.V282534.R01.S.doc Version 5.1 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 The Cedars Nursing Home DS0000002553.V282534.R01.S.doc Version 5.1 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): 3,6 The home fully assesses prospective residents wherever possible and the assessment forms the basis for the care plans. The home meets the needs of people admitted for intermediate care and supports their rehabilitation for their return home. EVIDENCE: A sample of the records showed that when the home supports a resident with a planned admission there are full assessments of their needs in place. This home is contracted for 5 beds with the N.H.S and part of this contract involves taking residents at very short notice, for short term (intermediate care) stays. When this occurs it is not always possible for a pre admission assessment to take place. In these circumstances the staff at the home accept the nursing discharge notes and then carry out their own assessment as soon after admission as possible. The admissions process and the care plans are expanded throughout a persons stay as more information becomes available. The home has 5 dedicated intermediate care beds and these are used for people who are discharged from hospital and require additional support before The Cedars Nursing Home DS0000002553.V282534.R01.S.doc Version 5.1 Page 9 they return home. During discussions with the matron, it was clear that the home is able to rehabilitate most of the residents, through increased independence, good nutrition, and wound healing. The staff liaise with social services regarding the persons return home and although the home work well with other professionals, they are not always satisfied with the arrangements for people leaving the home or on their return to their own homes. The Cedars Nursing Home DS0000002553.V282534.R01.S.doc Version 5.1 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): 7,8,9,10,11 The registered person ensures that the home meets the needs of the residents and that they are treated with dignity and respect. The staff are dedicated to providing a high standard of care for all the residents and particular attention is paid to ensuring that ‘end of life’ care is holistic. EVIDENCE: A sample of the care plans showed that all of a residents needs are identified and that the staff are clear about the care that is required for each person. The few gaps that were seen in social history and medication were explained fully by the deputy matron, and this will be addressed. The staff maintain very detailed daily records of the care that is provided and there is evidence that the resident or their representative had been consulted and involved wherever this was possible. The home is committed to the ‘Gold standards framework’, which is a programme for community palliative care, this commits the home to specialist training and raising standards of care. It is used in conjunction with the ‘The Liverpool Care Pathway’ notes for people who are terminally ill and the staff are trained in implementing these in practice. They ensure that all aspects of The Cedars Nursing Home DS0000002553.V282534.R01.S.doc Version 5.1 Page 11 that resident’s life are addressed and they are enabled to have the palliative care they would wish for. The resident’s were very complimentary about the staff and said ‘ They are really lovely, very kind and patient’ One resident was not complimentary, but later in the conversation said the staff were ‘really good’. It is recognised that the home is registered to accept people with Dementia, and if residents are confused this is noted in their records. The home does have a complaints procedure (see complaints and protection, page 14). The staff were observed talking to the residents in a respectful way. It was clear that the staff had a good knowledge of each person’s needs and that people are supported to maintain their dignity. The inspector observed part of the lunchtime medication administration. This was carried out according to procedure and in a way that acknowledged that each resident had a different understanding of their medication and different abilities in taking their medication. The records were maintained correctly. The home meets the health needs of each resident and these are recorded. Each duty shift consists of trained nurses, carers and student nurses, who are all trained to recognise symptoms and illness and to seek advice form their colleagues. The home has a good relationship with the local G.P’s and health care is sought promptly. Two residents required admission to hospital following G.P visits on the day of the inspection and the deputy matron coordinated these transfers and informed the resident’s families. The Cedars Nursing Home DS0000002553.V282534.R01.S.doc Version 5.1 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): 12,15 The home meets the expectations of the resident through offering them choices about their lifestyle and by providing a programme of activities. The meals are appetising, plentiful and well presented. EVIDENCE: The residents commented that they are given choices and they spend the day as they wish. One resident said that they are encouraged to take part in activities and entertainment and this was ‘a good thing to keep people stimulated’. Residents meetings take place and the minutes showed that action had been taken as a result of people’s comments. The inspector was invited to join the resident for lunch. The meal was balanced, home cooked, and very well presented. The residents said they had a choice and that the food was good every day. Each person’s likes and dislikes are taken into account and special diets can be catered for. There are regular reviews of the menus so that they is variety and flexibility to suit the resident needs. The staff assisted some residents to have their meal and to have enough drinks during the day. The dining room is pleasant although busy. The Cedars Nursing Home DS0000002553.V282534.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The home has an effective complaints policy and the resident were confident that they could raise issues with any of the staff or the matrons. Staff are trained to deal with suspicions of abuse and they are confident to raise these with the management team. EVIDENCE: The home has robust procedures for dealing with complaints and suspicions of abuse and the staff receive training. Discussions took place with the matron and the deputy matron following a meeting at the home in January. This concerned a recent complaint that was detailed in the previous inspection report from September 2005. This complaint was fully investigated and has now been completed. The discussion focused on any learning points from that investigation and the minor amendments to the report that were made. No new complaints had been received. The Cedars Nursing Home DS0000002553.V282534.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,23,26 The home is well maintained, comfortable and clean. EVIDENCE: The home is maintained to a high standard and there are comfortable communal facilities. The bedrooms are well equipped and decorated. Residents can bring in their personal possessions and the bedrooms were personalised. The home employs housekeeping staff who keep the home clean and tidy. The matron ensures that the staff are trained in dealing with clinical waste and preventing cross infection. The Cedars Nursing Home DS0000002553.V282534.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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): 27,30 There are enough, well trained staff to meet the needs of the current residents. EVIDENCE: There are enough trained staff and carers to meet people’s needs, the staff team said they work well together and they offer each other support. One member of the team said ‘ It’s brilliant here, we can give very good care. The managers offer really good support and training. It’s great to know that I have done a good job with a resident even on a busy shift.’ The matron co-ordinates placements for student nurses and they are offered opportunities to learn basic care skills and to observe medical procedures. The training schedule showed that staff take part in a variety of courses, these have recently included, communication, control of symptoms and care of the dying. The Cedars Nursing Home DS0000002553.V282534.R01.S.doc Version 5.1 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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): 31,32,35,36,38 The home has a strong management team, who maintain high standards. The staff are supervised and the welfare of the residents is protected. EVIDENCE: The registered manager (matron) and the deputy matron are supported by the involvement of the providers. The matron ensures that staff are supervised and supported to offer a high standard of care. The staff said that they have regular meetings and that they can always speak to the matron or the deputy matron with ideas or concerns. The home maintains safety through regular maintenance and by assessing the risks for both individual residents and the environment. The matron regularly checks the money that is held for each resident and the records are kept up to date. The Cedars Nursing Home DS0000002553.V282534.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X 3 X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 X X 3 3 X 3 The Cedars Nursing Home DS0000002553.V282534.R01.S.doc Version 5.1 Page 18 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Cedars Nursing Home DS0000002553.V282534.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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