Inspection on 22/01/07 for Two Cedars

This inspection was carried out on 22nd January 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

Two Cedars 23/06/09

Two Cedars 27/06/07

Two Cedars 30/11/05

Two Cedars 25/08/05

Two Cedars 28/02/05

Two Cedars 28/07/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Two Cedars 81 Dunyeats Road Broadstone Poole Dorset BH18 8AF Lead Inspector Trevor Julian Unannounced Inspection 22nd January 2007 1:45 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 Two Cedars DS0000004066.V327262.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. Two Cedars DS0000004066.V327262.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Two Cedars Address 81 Dunyeats Road Broadstone Poole Dorset BH18 8AF 01202 694942 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 John Williams Mrs Jean Lillian Williams Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Two Cedars DS0000004066.V327262.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th November 2005 Brief Description of the Service: Two Cedars is registered as a care home with the Commission for Social Care Inspection and may accommodate up to 17 older people. It is privately owned and managed by Mrs Williams. Two Cedars was built in 1908 and more recently had an extension built which incorporated further bedrooms and sitting area. The extension is in keeping with the style of the original building. It is close to the village of Broadstone, which has shops, a post office, banks and buses into Poole, Wimborne and Bournemouth. The care home is set well back from the road, in large, mature, well kept gardens which are easily accessible to service users. There is a large patio area accessible through French doors from the lounge. There is ample car parking space. The three-storey house provides accommodation for service users on the ground and first floor. The second floor provides office and private accommodation. There are 17 single en-suite rooms, with adequate communal bathing and toilet facilities strategically placed around the house. The lounge and dining room are spacious. Three rooms on the first floor have access to a balcony overlooking the garden. A passenger lift is available between the ground and first floors. The service users have an emergency call system and staff are provided 24 hours a day. In January 2007 the fees were £1800 per calendar month. Additional expenses included hairdressing, newspapers and chiropody. See the following website for further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choos.aspx Two Cedars DS0000004066.V327262.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over two visits 22nd and 24th January 2007. The inspection lasted a total of 5 hours. Before the visit Mrs Williams had provided a pre inspection questionnaire giving details of the home’s staffing structure and brief information about the care needs managed within the home. Residents and visitors were invited to complete comment cards giving their views of the home. Twelve cards were received from the residents; eleven from relatives, one from a GP and two from healthcare professionals. All the responses showed high levels of satisfaction comments included: Admission process was well explained. I am very happy here. I feel very lucky to be in such a lovely home. Tour of the home, including the kitchen, showed that this is the place for me and have never regretted the decision. I wish to say that Jean and all her staff are dedicated people, very helpful and kind. However they feel themselves they always put on a cheerful face. Very happy with the care, food and attention received in the home and the standard of cleanliness. I have complete peace of mind. I am able to visit in the resident’s own room so plenty of privacy. Residents are treated as if an extended family. A very caring staff team and owner. The house is always clean and well presented. Friendly atmosphere. Residents seem happy. Further information was gathered during the visits though discussion with residents, staff and Mrs Williams: a tour of the premises and the examination of records. What the service does well: The home continues to be well run for the benefit of the residents, Mrs Williams has appointed a deputy, they both have the experience and skills to operate the care home. The pre- admission process helps to ensure that the home is able to meet the identified needs of the individual. The care plans were regularly reviewed and updated and the daily records showed how care needs were addressed. The home worked closely with the local GP surgery to address any health needs. Two Cedars DS0000004066.V327262.R01.S.doc Version 5.2 Page 6 The home’s medication system was well organised and generally ensures that medicines are safely handled and stored. Residents felt they were well cared for and treated with dignity and respect. This was also observed during the visits. The home arranges a range of activities in the home and trips out during the warmer months. Residents reported that they encouraged to join in but there was no compulsion. During the visit a large group of residents were playing cards with a member of staff. Most of the residents had newspapers delivered to the home. People in the home were encouraged to follow their spiritual needs; two people attended local churches and Mrs Williams had organised monthly communion in the home. The quality and variety of food was praised, both by the comment cards and residents seen during the visit. Nutritional intake was monitored by the care staff and there were regular weight checks. Residents said they felt confident enough to raise any concerns with Mrs Williams and the staff. The home had systems in place to record and procedures for dealing with complaints and allegations of abuse. Staffing levels were appropriate for the needs of the residents. Training systems were in place to ensure that the staff were adequately skilled. The residents manage their finances independently or with help from family friends or solicitors. The home did not look after any cash for the residents instead any extra costs e.g. newspapers chiropody etc. was invoiced to the person responsible for the residents’ finances. What has improved since the last inspection? Since the last inspection, Mrs Williams had taken steps to address the issues identified. The home has a low turnover of staff, which helps greatly with continuity of care. A check of one new care worker’s file showed that Mrs Williams had ensured that the required clearances and references were obtained before the person started work. The medicines policy had been reviewed and personalised for the home so that procedures were sufficiently detailed for staff to work to. Staff responsible for managing medication had also completed accredited training. Two Cedars DS0000004066.V327262.R01.S.doc Version 5.2 Page 7 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. Two Cedars DS0000004066.V327262.R01.S.doc Version 5.2 Page 8 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 Two Cedars DS0000004066.V327262.R01.S.doc Version 5.2 Page 9 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that the needs of prospective residents are assessed prior to admission to ensure that the home has the equipment and skills needed to meet those needs. EVIDENCE: One person had recently moved into the home. The person had previously stayed in the home for respite care and so had found it very easy to settle into daily life. The records showed that pre-admission assessments had been completed before admission. There was a copy of the contract. Other residents recalled the admission process and said they had been given good levels of information helping them to decide the home was suitable, several recalled visiting the home before admission. Two Cedars DS0000004066.V327262.R01.S.doc Version 5.2 Page 10 The home’s Service Users’ guide was available by the main entrance. It provided information about the services offered. Two Cedars DS0000004066.V327262.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has appropriate systems in place for managing identified care needs. Healthcare needs are met through referrals and close working with community health teams. Medication systems were generally well managed to ensure the safety of the residents. Some action was needed to fully met the standard. The residents felt that the staff and owner treated them with dignity in order to respect their basic rights. Two Cedars DS0000004066.V327262.R01.S.doc Version 5.2 Page 12 EVIDENCE: The care records showed good levels of recording. Care plans were developed from the pre-admission assessments and monthly reviews. Daily reports detailed how those needs were met. The files seen, had been signed by the resident or their representatives to ensure their interests were considered and met. The records showed appropriate referrals for GP and other healthcare appointments. There were nutritional assessments on file and Mrs Williams was due to attend a presentation about an assessment tool. The care plans contained information on social history including religious, spiritual needs. Medication was managed using a monitored dosage system. The supplying chemist carries out audits of the system. Only staff who had completed accredited training and assessed as competent were permitted to administer medication. Since the last inspection, the home had updated the medication policy to reflect the system in use. Staff had access to several medication reference books. The medication records seen were up to date with no errors noted. In the case of handwritten amendments or additions to the medication records, these were not always checked and signed by a second person which could lead to transcriptions errors. There were no controlled medication cupboards however; none of the residents were taking controlled medication. Residents said the staff were supportive and attentive to their needs. None of the residents were able to identify any areas where they needed additional support. The felt the staff were respectful and this observed during both visits. The residents’ bedrooms were fitted with appropriate door locks to enable privacy if needed. Two Cedars DS0000004066.V327262.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to maintain as much independence as their circumstances allow. Activities and excursions are arranged to provide physical and mental stimulation appropriate to the individuals’ needs. The home works with family, friends and the local community to ensure that residents retain involvement in their relationships. The home’s menu provides a varied diet. Meals are appetising and encourage a balanced food intake. EVIDENCE: Residents said that although there were house rules, none were onerous or restrictive and they remained able to exercise choice in the daily lives. They said they were able to get up and go to bed as they pleased. There were Two Cedars DS0000004066.V327262.R01.S.doc Version 5.2 Page 14 photos around the home of activities and excursions including boat- trips in Poole harbour. Two people attend their churches and the home had a monthly communion on the premises. There was also regular entertainment organised in the home. During the visit, a large group of residents met in the dining room to start a card game which they said was a regular feature in the afternoon. Several residents enjoy crosswords from their daily newspapers and they also enjoy playing team scrabble. Residents said their visitors were always made welcome. All the residents seen said the standard and choice of food was very good. They said the menu offered a good variety and the portions were adjusted according to their individual preferences. The comment cards also reflected high levels of satisfaction one person commented. “Excellent nourishing food, well cooked and nicely served.” Two Cedars DS0000004066.V327262.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s systems allowed residents to raise concerns and for staff to respond correctly to allegations or signs of abuse. EVIDENCE: The home had an appropriate complaints procedure which was available to the residents and visitors. It gave contact details for the Commission and the local Social Service department. All the residents were very clear that if they had any concern they would feel confident to raise the issue with the senior staff or owner. One person said that she had raised an issue and it had been dealt with promptly and she had no need to make a formal complaint. Staff were trained in responding to allegations of abuse. In discussion with the staff they were clear on the process and their responsibilities. Two Cedars DS0000004066.V327262.R01.S.doc Version 5.2 Page 16 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, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable and well maintained environment for the benefit of the residents. The home is clean and well presented with staff trained in infection control to help protect the residents from the risk of infection. EVIDENCE: The home was well maintained with problems rectified as they arise. All the rooms were very comfortably furnished and each had been personalised by the occupant using pictures and other mementoes. Two Cedars DS0000004066.V327262.R01.S.doc Version 5.2 Page 17 The home was warm; residents confirmed that the home was always kept at a good temperature. It was noted that the thermostatic radiator valves were connected at the top of the radiator allowing easy access for the resident to set their preferred room temperature. The surface temperature of the radiator was discussed with Mrs Williams, the radiators were said to have a guaranteed low surface temperature of below 43°C, above which scalding can occur. However, the exposed pipework was not similarly controlled; Mrs Williams subsequently advised that the pipework was to be covered. It was recommended that a random sample of surface temperatures was recorded in order to ensure that the control methods remained effective. Hot water was regulated to reduce the risk of scalding and staff record the actual temperature of each bath. Staff were trained in infection control procedures and they had access to protective gloves and aprons; these were seen in use during the visit. Two Cedars DS0000004066.V327262.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staffing levels were appropriate to meet the needs of the residents. The home’s recruitment procedure helps to ensure that new staff are suitable for working in residential care. Staff training ensures that the staff have the skills and training to deliver a high standard of care. EVIDENCE: The home was staffed according to the needs of the residents. The staffing levels were varied over the day to match the level of demand. Residents said that the call bells were answered promptly. The home has a training matrix to ensure that the staff receive the core training and regular updates. The home has seven care staff who had completed NVQ at levels two or three and another five were due to complete NVQ 2 in 2007. Two Cedars DS0000004066.V327262.R01.S.doc Version 5.2 Page 19 The home benefits from having a stable workforce with a very low turnover; most work part time hours. A check of three staff files showed that the required checks and clearances had been obtained before the individual started working at the home. The file of a recent recruit showed that there were no gaps in their employment history. The home has introduced Skills for care induction training for new staff. Two Cedars DS0000004066.V327262.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s management team have the skills and experience to run the home effectively and for the benefit of the residents. The home seeks the views of the residents and relatives to monitor that the home continues to operate as they expect. The home’s procedures protect residents from financial abuse in the home. Staff supervision systems were not fully implemented resulting in staff not being regularly supervised. Systems were in place to aid the safety of residents and staff. Two Cedars DS0000004066.V327262.R01.S.doc Version 5.2 Page 21 EVIDENCE: Mrs Williams has completed NVQ level 4 Management and is also an registered nurse. Her newly appointed deputy is also a registered nurse and was nearing completion of her NVQ level 4. Mrs Williams had operated the home for several years and has experience from working at a senior level in other care settings. Residents said that they could go to staff with any concerns. The home had a process for seeking and recording the views of residents and their relatives including annual surveys, resident and staff meetings. This system needs to be extended to include other visiting healthcare professionals and the results need to be developed into the business development plan. The home does not look after any cash for the residents who either have support from their family or manage themselves. Additional expenditure for hairdressing, newspapers etc. is invoiced monthly. Since the last inspection, Mrs Williams had completed a training programme in staff supervision. Files seen during the visit showed there was a system for staff supervision however it was not fully up to date. Staff receive health and safety training and regular updates. The fire records showed that the fire precautions and procedures were regularly tested and refresher training and drill took place. Specialist lifting equipment was regularly inspected by a contractor. Officers from Dorset Fire and Rescue and environmental health carry out routine inspections of the premises. Two Cedars DS0000004066.V327262.R01.S.doc Version 5.2 Page 22 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 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 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 2 X 3 Two Cedars DS0000004066.V327262.R01.S.doc Version 5.2 Page 23 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. 1. Refer to Standard OP9 Good Practice Recommendations The home should have a Controlled Drugs cupboard for storing CDs and a CD record book for recording receipt, administration and disposal or return of CDs (see information enclosed). Additions and alterations to the medication administration record should be checked by a second person. The quality assurance system should be extended to seek the views of visiting healthcare professionals. The results should be analysed to inform the business development plan. The registered person should ensure that persons working at the home are appropriately supervised. 2 3 OP9 OP33 4 OP36 Two Cedars DS0000004066.V327262.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Two Cedars DS0000004066.V327262.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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!