Care Home: Cedar Court

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What the care home does well We received some positive comments about the home including: ` they look after my wife very well` and `the home provides good care, food and warmth, general needs always catered for`; and `very caring and at all times the patients look clean and tidy` and `the home is friendly and I`m happy and comfortable`. What has improved since the last inspection? There have been a number of improvements since we last inspected this service: Residents` fluid charts are now totalled daily to ensure that they are getting enough to drink. Residents are now able to lock their bedroom doors so that their privacy and security are maintained. `Do not disturb` signs are now placed on residents` bedroom doors to ensure nobody enters when staff are delivering personal care. Staff have a better understanding of adult protection systems and the part they play should the need arise. Residents are given a genuine choice of what they can eat each day and the menu is advertised more explicitly around the home. Notes from interview with prospective employees are now kept to show that they have been recruited fairly and in line with employment legislation. We are now routinely informed of any events affecting the well-being of residents at the home and adult protection issues are reported appropriately What the care home could do better: Pre-admission assessments of people`s needs before they enter the home must be much more detailed to ensure staff have the information and guidance they need to support them well. Staff must be able to demonstrate that they have a good working knowledge of residents` plans so they have the information they need to deliver comprehensive and consistent care. Residents should be given the opportunity to discuss their preferences about end of life issues and to record these to ensure their wishes are known and respected. A record of all medicines received into the home must be kept to ensure there is an accurate record of medication in stock. All staff must receive regular formal supervision so that their working practices can be discussed and so they feel supported. The home`s quality assurance processes need to be developed further to ensure there is an effective and robust way of monitoring the service and care residents receive.The manager needs to undertake further training to ensure he has the appropriate knowledge, skills and qualifications to run a home for older people. Key inspection report Care homes for older people Name: Address: Cedar Court 37 New Road Whittlesey Cambridgeshire PE7 1SU     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janie Buchanan     Date: 1 3 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 23 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: Cedar Court 37 New Road Whittlesey Cambridgeshire PE7 1SU 01733350320 01733205930 cedarcourtcare@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cedar Court Care Limited Name of registered manager (if applicable) Anund Oogorah Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: 1 named female with physical disabilities under 65 years of age (PD) for the duration of her residency only 24 older people (OP) for the duration of condition 1 The 3 places registered for DE(E) will have their mental health nursing care needs met by the community psychiatric service The maximum number of places not to exceed 25 Date of last inspection Brief description of the care home Cedar Court is a single storey purpose-built home that provides personal and nursing care and support for up to 25 people over the age of 65 years. It is owned by Cedar Care Homes for Older People Page 4 of 23 Over 65 3 24 24 0 0 1 1 0 1 2 2 0 0 9 Brief description of the care home Court Care Ltd The building is situated in the market town of Whittlesey and is within reach of shops, pubs and other local amenities. Accommodation comprises 21 single bedrooms, all but two of which have en-suite facilities, and 2 double rooms, which also have en-suite facilities. There are a total of three day/quiet rooms and the home has bathing and toilet facilities, which are provided with aids to enable the needs of the residents to be met. The home has transport available to service users, including two wheelchair accessible vehicles, for visits into the community. Residents have access to a garden and patio area at the front of the building. Weekly fees are £560. Residents pay additionally for newspapers, private chiropody and hairdressing. Basic toiletries are provided. Care Homes for Older People Page 5 of 23 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: For this inspection we, (The Care Quality Commission), visited the home and talked with residents, their visitors, staff and the manager. We undertook a tour of the building, checked medication recording and storage, and viewed a range of documents. We also received completed surveys from residents, their families and staff working at the home. Care Homes for Older People Page 6 of 23 What the care home does well: What has improved since the last inspection? What they could do better: Pre-admission assessments of peoples needs before they enter the home must be much more detailed to ensure staff have the information and guidance they need to support them well. Staff must be able to demonstrate that they have a good working knowledge of residents plans so they have the information they need to deliver comprehensive and consistent care. Residents should be given the opportunity to discuss their preferences about end of life issues and to record these to ensure their wishes are known and respected. A record of all medicines received into the home must be kept to ensure there is an accurate record of medication in stock. All staff must receive regular formal supervision so that their working practices can be discussed and so they feel supported. The homes quality assurance processes need to be developed further to ensure there is an effective and robust way of monitoring the service and care residents receive. Care Homes for Older People Page 7 of 23 The manager needs to undertake further training to ensure he has the appropriate knowledge, skills and qualifications to run a home for older people. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 23 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 23 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need to decide if the home is where they want to live Evidence: There is a statement of purpose and service users guide that give good information about the home and the facilities it offers. These are available in each residents room along with a copy of the latest inspection report. Residents are also issued with a contract which they, or their advocate sign, to show that they understand the terms and conditions of their stay at the home. Residents needs are assessed before they move in and one relative told us that the manager had visited her mother in hospital to assess her needs before she moved in. She also stated that her mothers admission was good and the home had even managed to plan a 90th birthday celebration that very week for her mother. However, the pre-admission assessment form that we viewed for one recently admitted resident Care Homes for Older People Page 10 of 23 Evidence: was very basic and did not provide good detailed information about his needs, or how they were to be met at the home. Care Homes for Older People Page 11 of 23 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are set out in an individual plans of care, however their end of life wishes are not recorded, making it impossible for staff to know and respect them. Evidence: Residents who completed our survey, and whom we talked with, told us that they received the care and support they needed, and that staff treated them respectfully. One commented: the home looks after me on a day to day basis and they do that to a good standard. We checked the care plans for three residents which provided adequate information for staff in how to meet residents needs. We found good evidence that residents and their families had seen their plans and had been consulted about their care. However, information about end of life care in the plans was poor and there was little evidence that residents had been encouraged to express their wishes about what they want to happen when death approaches or the formalities they want observed after their death so that these could be implemented and respected by staff. We continue to receive some concerns about the quality of care planning for residents from a nurse Care Homes for Older People Page 12 of 23 Evidence: specialist who has been visiting the home in the last few months to monitor care practices there. One care assistant openly told us that they had only ever read one persons care plan. This is a serious shortfall as they cannot possibly know how to meet residents needs without reading the important information contained in their plans. Residents health needs are monitored and their Waterlow scores, nutrition risk and mental capacity are regularly assessed. We viewed the plan for one resident who was being treated for pressure sores and found satisfactory turning, fluid and food charts in place, although there were some gaps in important information in his wound management and assessment chart. At our last inspection we made a requirement that fluid charts must be added up daily. We checked the fluid charts for one resident and saw that these were being totalled daily to ensure they were getting enough to drink. We checked a sample of residents medication administration records (MAR). Medication was stored correctly and at the right temperature. However we noted the following shortfalls: the actual amount of variable dose medication given to one resident had not been recorded so it was impossible to tell how much they had actually received, there was no accurate record of the number of Warfarin tablets held in stock for one resident and on several occasions the number of tablets received into the home had not been recorded, making an accurate stock take of the medication impossible . Care Homes for Older People Page 13 of 23 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have access to some activity and entertainment to keep them stimulated. Evidence: The home employs a specific member of staff to organise activities for residents 15 hours a week. However she has not received any training in providing activities for older people and told us she would welcome this for new ideas. There is no planned weekly activity schedule easily available for residents to view, however recent events have included Easter bonnet making, flower arranging, a raffle and she has taken one resident out shopping and another to a coffee shop in Whittlesey. A musical entertainer also visits the home every few months. We observed the activities coordinator spending individual time with residents who dont come out their rooms. One resident told us she had asked the activity coordinator to organise a quiz and this was now being planned. However, one relative wrote on our survey: more activities needed for those more able bodied to keep them occupied and ease the boredom. Lunch on the day we visited consisted of quiche, salad and chips or turkey pie with mashed potatoes. Most residents we spoke to told us the food was good and they enjoyed their meals, however one resident told us she sometimes has to wait till 1.40 PM to get her lunch by which time she is very hungry. Care Homes for Older People Page 14 of 23 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have access to a complaints procedure and staff receive training in how to protect vulnerable adults so they are aware of their local protection systems. Evidence: Each resident has a copy of the complaints procedure in their bedroom giving them details of how to raise concerns. Most residents we talked to felt able to raise concerns, one commenting:I complain to Anand (manager) I can say what I like to him. We checked the homes complaints book and noted that recent complaints concerning the cold temperature of a bedroom and the tea time food had been recorded, and appropriate action taken to resolve the concerns. However one relative told us she felt her concerns werent listened to or acted upon swiftly. For example she has had to request twice now that her mothers hair is not washed the day immediately after she has seen the hairdresser. We spoke to staff about their knowledge of adult protection issues. Their knowledge of the different agencies involved in protecting adults and how to report suspected incidents had improved since we last visited. We also saw evidence that this important topic had been discussed with them as part of their supervision. Action on Elder Abuse contact details are available in the entranceway to the home. The home is still subject to scrutiny from the local safeguarding team due to concerns about poor care planning for residents. Care Homes for Older People Page 15 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a comfortable home, with access to a variety of communal areas. Evidence: The home is purpose built to meet the needs of older people. All but 3 bedrooms have en suite facilities and two have their own shower. There are additional bathrooms and toilets provided throughout the home. There are 2 sitting rooms a dining room and a conservatory giving residents a good choice of communal areas to use. Residents also have access to an attractive courtyard garden. The home was clean and free from strong smells on the day we visited. We checked a number of bedrooms which are noted that residents had been issued with keys so they could lock them to maintain their privacy and security. We also noted that do not disturb signs were now in use so that residents wouldnt be interrupted when receiving personal care Care Homes for Older People Page 16 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are looked after by competent staff, who have been recruited in a way that protects them. Evidence: We received positive comments about the staff including: everyone is so friendly, the carers are helpful, always there when they are needed. Another: staff are so helpful and caring, always joking and talking to mum. However one resident told us: the foreign girls dont understand me, and I dont understand them sometimes. Staffing levels have improved with 5 carers and a nurse now on regularly in the morning to meet residents needs. We noted that all residents had been attended to by 10.30AM on the morning of our visits, a huge improvement since we last visited. We checked training records for 3 staff members which showed us they had received appropriate training relevant to their role. Staff also confirmed that they received training which they found useful. We checked the personnel file for the most recently recruited member of staff which sowed that appropriate references and CRB checks had been obtained before they started working at the home. There was also a record of the interview undertaken with them. Care Homes for Older People Page 17 of 23 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that is adequately managed, although systems to monitor the standard and quality of care received by people living there are lacking. Evidence: The manager of the home is a registered nurse who has experience of both owning and managing homes for older people however he has no formal management qualifications and is yet to do the Leadership and Management in Care Services award: the recognised qualification to be achieved for managing a care home. There have been some improvements in the service since we last visited and one staff member wrote on their survey: I have seen improvements in the home over the last few months including paperwork being filled in thoroughly, staffing levels increased etc. However the homes quality assurance and auditing systems are poor and need to improve so there is an objective way of monitoring the service provided. Most staff we spoke to told us they enjoyed their job and felt supported, however one Care Homes for Older People Page 18 of 23 Evidence: member of staff told us she had never received supervision and didnt feel well supported in her work. We asked to see the supervision file for this member of staff and the manager reported that there wasnt one available despite the member of staff having worked at the home some time. We viewed records in relation to health and safety (including fire, water temperature, portable appliance testing and emergency lighting) which showed us that the home regularly checks its equipment to ensure its effective operation and safety. Care Homes for Older People Page 19 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 20 of 23 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Full and detailed preadmission assessments for prospective residents must be completed before they move into the home. You must do this to ensure that residents needs are known detail so that staff can provide appropriate care. 01/06/2010 2 7 15 All care staff must have a good knowledge of the information set out in residents care plans. You must do this to ensure staff know how to meet residents needs. 01/06/2010 3 9 13 Records made when medication is given to residents must be accurate and complete You must do this to ensure that residents get their medication as prescribed 01/06/2010 Care Homes for Older People Page 21 of 23 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 31 9 The manager must undertake appropriate training for his role. You must do this to ensure he has the skills and knowledge to run a home for older people. 01/10/2010 5 33 24 A robust system for monitoring the quality of care at the home must be implemented. You must do this to ensure that residents receive a quality service which is regularly reviewed. 01/07/2010 6 36 18 Staff must receive formal supervision. You must do this so their working practices can be reviewed and so that they feel supported. 01/06/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 11 Residents need to be given opportunities to discuss their end of life preferences, and have these recorded so their wishes are respected. Staff should receive training in providing suitable activities for older people. 2 12 Care Homes for Older People Page 22 of 23 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 23 of 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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