Inspection on 27/06/07 for Two Cedars

This inspection was carried out on 27th June 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 22/01/07

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 27th June 2007 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 Two Cedars DS0000004066.V343973.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.V343973.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) 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.V343973.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd January 2007 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 June 2007, the fees were £465 per week. Additional expenses included hairdressing 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.V343973.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 27th June 2007 between 10:00 and 16:00. Mrs Williams was on the premises throughout the visit. The purpose of the visit was to monitor compliance with key national minimum standards. Evidence was obtained through a tour of the premises, observation, discussion with Mrs Williams, residents and staff, case tracking and review of some policies. What the service does well: The home has been consistently well run for the benefit of the residents, the management continually put the residents needs at the centre of decision making. The daily lives of the people living in the home are enhanced by the activities and support available. Residents confirmed that there had been pre – admission visits to the home to and that these had been used to assess the suitability of the home to meet the identified needs of the prospective resident. The records also showed that the assessments were completed before placement. The residents said that the home involved GPs and other healthcare professionals as needed. They were involved with the care planning process and were aware that the home maintained care records. Medication was safely managed and the system audited regularly by the supplying chemist chain. There were regular resident meetings to discuss group issues and concerns. The meetings considered ideas for excursions and activities in the home. People said there was plenty to do in the home and that they looked forward to the outings that had been arranged. They enjoyed card games crossword team scrabble; the home also had a visiting library service offering books in a variety of typefaces. Religious and spiritual preferences are considered during the admission process and residents are supported to attend local churches and the holds monthly in-house services. The home offers good variety and choice of food. People commented that they could choose the meal for their birthdays and the home also held themed suppers were residents would be offered menus from around the world. Residents said they were able to express any concerns to the owner or the staff and they were confident that the issue would be sensitively addressed. Two Cedars DS0000004066.V343973.R01.S.doc Version 5.2 Page 6 The premises provided a comfortable and clean environment. The residents rooms had been personalised by the occupants’ and all the residents said that the home was homely. Disposable gloves and aprons were in use to help manage infection control. Staffing levels were good and the training programme helped to ensure that the staff had the required skills. Residents had confidence in the abilities of the staff. Recruitment practice followed the recommended best practice. The owner had the required qualification and had gained managerial experience in several care settings. The home did not manage finances for any person, where people had no cash for additional expenditure e.g. hairdressing, chiropody etc then an invoice is forwarded to the person responsible to the resident’s funding. 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. The summary of this inspection report can be made available in other formats on request. Two Cedars DS0000004066.V343973.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 Two Cedars DS0000004066.V343973.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s admission process helps to ensure that the assessed needs can be met within the service. EVIDENCE: There had been one new admission since the last inspection. The resident said she had visited the home for a morning visit during which time an assessment was completed. The records showed that, for the assessment, additional information had been obtained from the family and the previous care home. Two Cedars DS0000004066.V343973.R01.S.doc Version 5.2 Page 9 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. Care practice in the home ensures that social and health needs are well met. EVIDENCE: Three files were examined. The assessments had been used to develop the initial care plans which had been reviewed regularly with the outcomes recorded. The information contained in the care plan provided sufficient information for the care staff to carry out the care tasks. The files had letters of agreement with the residents to confirm the care plan. The care records showed good support from the local GPs and community nurses. Assessment tools were used to identify those at risk of pressure ulceration and equipment is provided as a precaution. There was evidence that the home had sought the support of the Community Psychiatric Nursing team for one person. Two Cedars DS0000004066.V343973.R01.S.doc Version 5.2 Page 10 During the inspection, the home’s chiropodist was making a follow up visit two residents. She said she made regular visits to the home and all the residents took advantage of the service. She said that she had been calling in to the home for a number of years and had always found the home well run and the staff attentive and helpful. The home uses a monitored dosage system supplied by a national chemist chain. The chemist provide an audit service which had been completed just before this inspection, although the report of the inspection had not been given to Mrs Williams the feedback at the time had been very positive. A check of three residents medication showed the system was well managed and the items safely stored. Temperature sensitive items were stored in a fridge in a lockable container. When these items were opened, the date was marked on the container to ensure it was not used after the expiry date. Where handwritten amendments were made to the medication record sheet the entries were checked by a second person to avoid the risk of transcription errors. The residents said that the staff were kind and supportive. They commented that they never seem to loose their patience and were always helpful when responding to the call bells. Staff were seen to knock bedroom doors before entering and people were asked how they preferred to be addressed. Two Cedars DS0000004066.V343973.R01.S.doc Version 5.2 Page 11 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 excellent. This judgement has been made using available evidence including a visit to this service. The home encourages individual choice to help people to maintain fulfilled lives. EVIDENCE: The day before the visit there had been a residents meeting. This was used to discuss relevant issues in the home this included activities and food. Residents said that they all enjoyed the team scrabble game which takes place once a month in the home. One person said he appreciated the visiting library service and he had a private arrangement with a newsagent for a daily paper. Two of the residents were able to attend local church services with support from church visitors and families. There was also a monthly service held in the home when communion was offered. The garden was enjoyed by the residents in better weather. Several commented that they always enjoyed trips out and were looking forward to a boat trip in Poole Harbour. Two Cedars DS0000004066.V343973.R01.S.doc Version 5.2 Page 12 The day before the inspection, a visitor from the Owl Sanctuary who had brought in a number of birds had entertained the residents and staff. Residents said their families were able to visit them at any time and a number had their own telephones making contact easier. The home arranged postal votes for those wishing to exercise their democratic right. The food was described as very good with variety and choice offered. The home had themed nights with menus from around the world, including Indian, French, and Spanish etc. People were also asked to make requests for their birthday meal. One person said they had really enjoyed a fish and chip supper as part of someone’s celebrations. Two Cedars DS0000004066.V343973.R01.S.doc Version 5.2 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. 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 training and policies ensure that residents are able to raise concerns without risk of recrimination. EVIDENCE: The complaints procedure was displayed in the hallway and was accessible to residents and visitors. People were not necessarily aware of the complaints procedure but they all felt confident that any issues would be addressed appropriately and that they could approach the staff or owner with their problems. There was a complaint register showing complaints received and the outcome. The staff were trained in responding to signs or allegations of abuse and they had access to the home’s policy on adult protection. The staff seen during the visit were very clear about their responsibilities. Two Cedars DS0000004066.V343973.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe and comfortable environment for the benefit of the residents. EVIDENCE: The home continues to be well maintained and comfortably furnished. Work was underway to cover all radiators in the home to remove the risk of burns from hot surfaces. Since the last inspection, the ground floor had been repainted and the ground floor toilet had been adapted to improve access for the residents. A marker had been provided on the edge of the first step of the staircase to indicate a change in level. Two Cedars DS0000004066.V343973.R01.S.doc Version 5.2 Page 15 The home was clean and odour free and the cleaning staff were working hard to maintain high standards. There were aprons and gloves available on both floors to ensure that infection control guidance was followed. Two Cedars DS0000004066.V343973.R01.S.doc Version 5.2 Page 16 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 and training of the staff are appropriate to the needs of the residents. EVIDENCE: The home benefits from a reliable and stable workforce allowing good continuity of care. Many of the staff had worked in the home for several years. The home was appropriately staffed to meet the needs of the residents. People stated that their call bells were answered promptly and there was a regular printout giving response times which confirmed this to be true. The printout was also used to monitor trends and to help identify changing needs. Residents also commented that the staff were always busy. The staff received training in the recommended topics. Most care staff had completed NVQ level 2 in care. Staff described the training as good and there were regular updates. The deputy manager had developed a training programme to identify training courses needed and completed. The home had completed a Skills for Care, the National Training Organisation, audit of staff training and skills. Two Cedars DS0000004066.V343973.R01.S.doc Version 5.2 Page 17 The recruitment process ensured that the required clearances and references had been obtained. New staff had been recruited but were not working as the home was awaiting clearances. The home operated a supervision programme to ensure the staff were up to date with their practice. All staff had received a copy of the General Social Care Council’s Code of Conduct to ensure they were aware of their responsibilities. Two Cedars DS0000004066.V343973.R01.S.doc Version 5.2 Page 18 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 excellent. This judgement has been made using available evidence including a visit to this service. The service is managed to ensure the home is safely run in the best interests of the residents. EVIDENCE: The deputy manager had completed her NVQ level 4 Registered Managers Award and Mrs Williams had achieved the award some time ago. The management team were very active in the home and accessible to the residents daily. It was very clear from the residents that the management and staff sought their views. There were residents’ meetings for general topics including food Two Cedars DS0000004066.V343973.R01.S.doc Version 5.2 Page 19 and activities and as stated previously people were very clear that they could raise concerns with the staff or Mrs Williams. The home did not hold petty cash for the residents. Charges made for additional expenditure including hairdressing and chiropody were invoiced monthly to the person responsible for the residents’ finances. Five people had accounts with a local newsagents and the bills were settled directly. The home carried regular checks and servicing of the fire fighting equipment and fire warning system. All were up to date. There was evidence that staff had received regular training in fire safety and evacuation procedures. The completed accident reports were stored in line with data protection guidance. The deputy manager analysed the reports to monitor trends. Two Cedars DS0000004066.V343973.R01.S.doc Version 5.2 Page 20 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 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 3 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 4 X 3 X 3 X X 3 Two Cedars DS0000004066.V343973.R01.S.doc Version 5.2 Page 21 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 Two Cedars DS0000004066.V343973.R01.S.doc Version 5.2 Page 22 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. 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