Care Home: Cedar Court Care Centre

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What the care home does well What has improved since the last inspection? CARE HOMES FOR OLDER PEOPLE Cedar Court Care Centre Portland Avenue Seaham Co Durham SR7 8BT Lead Inspector Nic Shaw Key Unannounced Inspection 4th August 2008 9:00 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 Cedar Court Care Centre DS0000071060.V370347.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. Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedar Court Care Centre Address Portland Avenue Seaham Co Durham SR7 8BT 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) 0191 581 8080 www.europeancare.co.uk European Care (England) Ltd Mrs Coreana Anne Smith Care Home 69 Category(ies) of Dementia (69), Learning disability (4), Old age, registration, with number not falling within any other category (69), of places Physical disability (13) Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 69 Dementia - Code DE, maximum number of places 69 Physical Disability, Code PD, maximum number of places 13 2. Learning Disability, Code LD, maximum number of places 4 The maximum number of service users who can be accommodated is: 69 10th September 2007 Date of last inspection Brief Description of the Service: The sale of Stonelea Developments to European Care took place on September 5th 2007. Cedar Court Care Centre is a purpose built home that opened in April 2005. The home provides 69 residential places within 4 separate living units. The home is registered to provide accommodation to people in need of personal care across a range of different categories including old age, dementia, learning disabilities and physical disabilities. The Care Centre also has a separate day centre. The home is built over two levels and provides single room en-suite accommodation with shared living areas. A passenger lift is available to provide access to the first floor units. Outside of the home are well kept gardens and car parking spaces for visitors and staff. The home is situated in a housing estate in Seaham. Local shops and amenities are close by. Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 5 Fees charged by the home are as follows: Private funded residential beds £442.50 Social Services and private funded dementia beds £455.50 Residential learning disability beds £448.50 Residential physical disability beds £486.50 Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. Before the visit: We looked at: • information we have received since the last full visit on 10th September 2007. • how the service has dealt with any complaints & concerns since the last visit • any changes to how the home is run • the views of people who use the service, relatives, staff and other health care professionals . We did this by sending out surveys. Four residents, seven relatives, four staff and five health care professionals completed these and sent them back to us. The Visit: An unannounced visit was made on 4th August 2008. During the visit we: • talked with people who use the service, relatives and staff • joined residents for a meal and looked at how staff support the people who live here • looked at information about the people who use the service and how well their needs are met • looked at other records which must be kept • checked that staff had the knowledge, skills and training to meet the needs of the people they care for • looked around parts of the building to make sure it was clean, safe and comfortable • checked what improvements had been made since the last visit. We told the manager what we found at the end of the visit. What the service does well: There are good admissions procedures so residents know that Cedar Court Care Centre will be able to meet their needs. Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 7 The staff and manager make sure that residents get to see their doctor or other health care professional, such as the district nurse, quickly if they need to. Residents are treated with dignity and respect. And relatives and friends can visit the home any time they wish. The range of activities are excellent and the food is good. The home is clean and fresh and well looked after. Its good that people with more complex dementia care needs are accommodated on the ground floor as this means they can independently us the spacious garden. Staff training is also good. As well as NVQ level 2 and 3 training in care being provided, most of the staff have had specialist training in the needs of people with dementia. The home is well managed. The manager is qualified and approachable and has worked hard to make sure that residents receive a good service. Residents said • • • • • “I like it here” “foods good” “staff are nice” Ken’s canny” (Ken is the activities co-ordinator). “oh yes, I like it here” Relatives said: • • • • • • • • “well informed” “foods good” “good care” “excellent care” “always informed of forth coming events” “very approachable when worried about my relative” “nothing is too much trouble” “takes care of my mother very well” DS0000071060.V370347.R01.S.doc Version 5.2 Page 8 Cedar Court Care Centre When asked what the service does well staff said: • • • “makes sure the residents are safe, warm, clean, well fed and hopefully happy” “staff training is always up-to-date, communication is always important, the home keeps us abreast of what is happening” “after having worked in a few care homes I think Cedar Court is the best one, because everyone is approachable, the décor, the cooking and activities”. What has improved since the last inspection? What they could do better: Although there is overall good information in the care plans the continued development of these is recommended. This is important to make sure each person receives the support they need in the way that they prefer. We recommend some minor improvements to the medication records, such as two staff counting in loose tablets. This will help to reduce errors happening. It would be good practise for the complaints procedure to be displayed in large print so it is easier to read. Receipts should be kept for all purchases made on behalf of the residents. It is also good practise for two staff to sign the transaction sheet. Such steps will help to protect the residents from potential financial abuse. Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 9 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. Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 10 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 Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 Quality in this outcome area is good. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are provided with the information they need to make an informed choice about where to live. Good assessment processes ensure that potential residents’ needs can be met at Cedar Court Care Centre. EVIDENCE: Information about Cedar Court is on display in the main entrance of the home. This information has been reviewed to reflect the recent change in ownership and can be made available in alternative formats such as CD. A welcome pack has been produced and given to residents. Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 12 All seven residents said in surveys that they had been given enough information about this home, which helped them to decide that it was the right place for them. In the information sent to us before the inspection the manager said “there is considerable emphasis on careful planning to ensure the process of admission is as comfortable as possible”. They do this by always making sure they get a copy of the social work assessment before a person is admitted to the home. In addition to this, wherever possible, the manager meets with prospective residents before their admission to the home. However, as the majority of recent admissions have been in an emergency it has not been possible for this to be arranged. Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 13 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. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of residents, which are met to a good standard, are generally reflected in the care plans, which are written in a person centred. This ensures that continuity of care is provided to everyone in the way that they prefer. Staff care practices preserve the dignity and privacy of residents. And medication policy and administration procedures generally fully protect people. EVIDENCE: In the information sent to us before our visit the manager said “we produce comprehensive service user plans that flow from the needs assessment that identify all health, personal, psychological and social needs” Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 14 The resident’s files we looked at did include a range of risk assessment tools, for example nutritional, falls and pressure ulcer risk assessments. From the assessments the care plan is developed. In some of the records we looked at the care plans had clear aims and provided good step by step guidance to staff on the action they needed to take to meet that person’s needs, whilst at the same time promoting their independence. However, this level of detail was not available in all of the plans we looked at. For example, in one person’s plan it said “staff to observe and encourage to maintain independence with eating, drinking and mobility”, with no further information about how this is to be achieved. In one care plan we looked at a person had been assessed as at high risk of developing a pressure ulcer but no care plan in place to show preventative action which should be taken by staff. There is a different care plan used for people with dementia. This focuses upon a person’s strengths and areas where they need support. This particular care plan is good as it provides information about what a person is able to do, not just their needs. There is now in place a “daily statement of well-being”. Each day care staff use this to write about the care they have provided. A coding system is used to cross-reference to the care plans which have been followed. These records include information about the time a person gets up, what they have eaten that day and anything unusual noted, such as unexplained bruising and what action has been taken as a consequence of this. The manager audits a number of care plans each week to make sure they are kept up-to-date. There are regular visits from GP’s and other health professionals including, district nurses, optician and chiropody services. No one in this home at the time of our visit has a pressure ulcer. The majority of health care professionals who completed surveys said that individual’s health care needs are “always” met by the home. One health care professional said “many of the residents at Cedar court have complex physical and mental health needs. The care staff are not qualified nurses but are a good team who do their best for the residents in their care in my experience”. The majority of resident’s said in surveys that they “always” receive the care and support they need. Senior staff are responsible for ordering and administering medication, which is kept in a secure area of the home. The majority of medication is pre-packaged and dispensed by the chemist in a monitored dosage system (MDS). Senior staff read the instruction on the Medication Administration Record (MAR) and check this against the information on the MDS before they administer Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 15 medication. This was done in a discrete, careful, sensitive way. There were no gaps on the MAR sheets seen and clear records were maintained. We carried out a brief audit of medication in stock. In one instance the medication in stock, which was not in the MDS, did not balance with the records. This was, however, an isolated incident and after a discussion with senior staff and the manager this was attributed to human error. It is recommended that in order to prevent this from happening again two staff count and sign for all medication which is not in the MDS. It is also good practise for two staff to sign the MAR sheet when medication instructions have been handwritten. This again is a way of minimising the risk of information being incorrectly recorded. Staff who give medication said that hey had had training in the safe handling of medication and that the manager does regular audits of this to make sure there have been no medication errors. Staff treated the residents in a dignified, respectful manner. For example, residents were not rushed when staff supported them and their preferred name was used. Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 16 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. We have made this judgement using a range of evidence, including a visit to this service. Residents have opportunities to make choices in daily routines, social and community activities and the range of activities available to people is excellent. This ensures that everyone is able to lead a lifestyle that matches their individual preferences. Residents receive a wholesome diet in pleasant surroundings, which promotes their health and well-being. EVIDENCE: There is an activities co-ordinator and the activities available to people are displayed around the home as well as photographs of activities that have taken place. On the day of the visit people were involved in a slide show, which involved reminiscing about life in Seaham many years ago. Recently the activities co-ordinator and manager have asked residents and relatives about how they could improve activities. As a result of feedback from this further opportunities have been provided for residents to take part in community Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 17 activities. The activities co-ordinator works flexible hours so that this can be accommodated. Recently residents have enjoyed a trip to Mowbary Park and relatives, at their request, are able to take part in such trips. The activities co-ordinator also provides 1:1 activities, such as supporting residents to visit their family members or trips out to the local shop. There is a mobile tuck shop and for one person with dementia, helping the activities co-ordinator with this is an activity they clearly enjoy. Newspapers are delivered daily and some of the residents have been on holiday to Berwick. The activities co-ordinator keeps a record of what activities each resident has taken part in. A life history profile has also been completed with each resident and this information has been used to develop the activities programme. This is good practise when developing activities for people with dementia. All residents have a “programme of personal opportunities” which identifies their individual timetable of interests such as trips outside of the home and family visits, which is excellent. People with more advanced dementia live on the ground floor where opportunities are provided to access the garden independently, which has been developed to provide a safe outdoor space. Priests and Vicars visit the home and the activities co-ordinator holds a weekly “devotional” meeting where the residents choose and sing Hymns. Sometimes opportunities are provided for residents to attend the local Church. Four residents said in surveys that there were “always” activities arranged by the home that they could take part in and two said there were “usually” activities suitable for them. One person said that there were “never” activities they could take part in but this less positive comment was in the minority. Friends and relatives are able to visit their family member at any time. One resident said: • “I get plenty visitors they can come anytime. My son comes in every night at 7.00pm”. Residents commented positively about the quality of meals. There is a choice of main meal and a full English breakfast is available each morning. We had a meal with people who have more complex dementia care needs. The tables were nicely presented with tablecloths and condiments so people could help themselves. Staff offered support to people when this was needed and people were able to eat their meal at their own pace. Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 18 The manager has introduced “protected mealtimes” This is because the manager has looked at research about how best to support people with dementia to eat. This has shown that when people with dementia are not interrupted, receiving the appropriate support they need, they are happier, more relaxed and more likely to eat their meal. The manager told us that menus are changed twice yearly to reflect seasonal changes. Each person’s food likes and dislikes is recorded in their care plan and a record is kept of what each person has eaten each day. Residents said “the foods excellent” “up to know the foods been very nice”. Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 19 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. We have made this judgement using a range of evidence, including a visit to this service. There is a good complaints procedure, which ensures people are listened to and their views acted upon. Good safeguarding procedures ensure that residents are fully protected from abuse. EVIDENCE: The complaints procedure is on display throughout the home. However, this is in small print and was positioned high up on the wall, which might prevent some people from being able to read it. Everyone spoken to said that they knew how to complain and would have no hesitation about doing so if they were unhappy. All of the relatives who responded in surveys said they knew how to make a complaint. One relative said • • “the care home gave me the complaints procedure when my mother first went into care” and “ have not had a lot of concerns but when I have the staff have responded well” DS0000071060.V370347.R01.S.doc Version 5.2 Page 20 Cedar Court Care Centre • “any problem is dealt with immediately”. In the information sent to us before the inspection the manager told us that there have been eleven complaints made since the last inspection. The manager resolved all of these within 28 days. Full records are available of these. The company’s programme manager regularly audits complaints to ensure that the manager has dealt with these appropriately. There is a box in the reception area for residents to make suggestions or comments about the day to day running of the home. All of the staff who responded to surveys said that they knew what to do if a relative or friend came to them with a concern about the home. The home has a safeguarding policy and procedure and all staff have had training in the prevention of abuse. Although the manager has a copy of the local authority’s safeguarding policy and procedure none of the staff, including the manager, have had training about this. There have been two safeguarding referrals made since the last inspection. These demonstrated that the manager has a good understanding of the local authority procedures. The residents we spoke to said they felt safe living in this home. Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 21 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 & 26 Quality in this outcome area is good. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that is well maintained and meets the needs of people who live there. EVIDENCE: A good aspect of this home is that people with more complex needs in relation to their dementia are accommodated on the ground floor. This means that they can independently use the spacious garden and enjoy fresh air and sunlight which is very important, not only in terms of promoting their psychological well-being but also their physical well-being. Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 22 The environment is calm and quiet which is very important in dementia care as excessive noise can be very distressing for some people with dementia and may cause them to become agitated. The home is clean and there were no unpleasant odours. Everyone has their own bedroom and all benefit from an en-suite toilet facility. Those bedrooms seen were personalised. Residents said: • • • • “there is always plenty of hot water” “its always clean and fresh, they are always on with the hoover” “it’s a good hotel” “this is my house” The manager told us that there is a policy on infection control and that 25 staff have completed training in infection control. Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 23 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. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are sufficient. This ensures residents receive person centred care. Staff training is good, including specialist training to meet the diverse needs of the residents. This enables staff to effectively meet the care needs of everyone living in the home. Staff recruitment procedures fully protect the residents. EVIDENCE: On duty when we visited were the manager and deputy manager, two senior care staff, five care assistants and a full time activities co-ordinator. There are currently 56 people living in this home. There was also an administrator, maintenance person, cook, catering assistant, laundress and two domestics on duty. The above staffing levels are suitable. However, one relative commented that there should be more staff. Health care profession also said in surveys: Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 24 • • “extra staff” and “some staff members are excellent but not enough to go around”. Two staff who responded to surveys said that there were always enough staff and three staff said there were usually enough staff to meet the needs of the residents. We asked residents when we visited if they felt there was enough staff and they said • “I think there’s enough, sometimes not if on different breaks”. Another resident said in a survey: • “staff are always there when I need them”. We spoke to the manager about staffing levels. She told us that she always keeps staffing levels under review depending upon the needs of the residents. In the information sent to us before the inspection the manager told us that 26 staff have the NVQ level 2 qualification in care or above whilst a further 26 are working towards this qualification. In addition to this other training provided to staff has included training in palliative care and the impact of the Mental Capacity Act upon residents. The majority of staff have had positive dementia awareness training and all staff are to attend training called “Yesterday, Today, Tomorrow”. This is specialist training to help them understand the needs of people with dementia. There was an evident warmth between the staff and residents and everyone spoke positively about the staff. Residents said: • • • • “no grumbles with staff, they do their best” “they are here to see we are looked after” “they are all good” “the staff are nice” Relatives said: • “I think the staff have the skills and experience” Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 25 • “staff are very friendly” Health care professionals said: • “many of the staff members seem to have knowledge and interest in the condition of their residents beyond what I expect of no qualified staff”. Staff files showed that a job application is completed and two written references and a POVA first check obtained, whilst awaiting the Enhanced Criminal Records Bureau check, prior to a new person working in the home. Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 26 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. We have made this judgement using a range of evidence, including a visit to this service. Overall the home is well-run, in a way that upholds the best interests of the people who live here. And although their health, safety and welfare is protected this is not the case in relation to their financial interests. EVIDENCE: The manager has many years experience as a manager of a care home and is a Registered General Nurse (RGN). She has continued to attend other training such as dementia care mapping, (this is a way of finding out what life is like in the home for people with advanced dementia by observing what’s going on), and “relationship management” to keep her knowledge and skills up-to-date. Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 27 There are regular staff meetings. Staff also said in surveys that they receive regular supervisions and appraisals. There are clear lines of accountability within the home. There is a deputy manager who takes charge in the manager’s absence. Residents’ views are sought via satisfaction surveys. The home also holds regular resident/relative meetings. As already mentioned the manager regularly completes audits including care plan and medication audits. The home’s programme manager also does monthly visits to the home to make sure that good standards are being maintained. After each of these visits the manager is given a report with details of any outstanding issues which she must address. A full health and safety audit is completed every six months. Regular checks of the fire alarms and fire extinguishers are carried out. The manager has identified that some staff have not had a fire drill recently. In order to address this she has carried out a fire drill and agreed to make sure that each staff, as they come on duty, are provided with a fire instruction. Detailed fire risk assessments have been carried out. Staff receive training in statutory health and safety matters, so that they know how to support residents in a safe way. An appropriate record is maintained of accidents. There have been a high number of accidents which have resulted in residents being admitted to hospital. The manager is aware of this and is closely monitoring the occurrence of these to identify any themes or trends for which preventable action could be taken. We looked at a small sample of resident’s personal allowance records. Receipts were not available for some transactions and only one signature was recorded on the transaction sheet. Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 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 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 2 X X 3 Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 29 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 Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 30 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 2 Refer to Standard OP7 OP9 Good Practice Recommendations Care plans should continue to develop to provide staff with clear step by step guidance of what they need to do to meet the residents health and personal care needs. It is recommended that two staff count all loose medication that comes into the home and keep a record of this. Two staff should also sign the MAR sheet when information has been hand written on there, copied from the pharmacist’s label. This will help to reduce the risk of medication errors occurring. The complaints procedure should be available in large print so that it can be easily read. All staff should be provided with training in the local authority’s safeguarding policy and procedure. This is so that they know what to do should they witness or suspect abuse. Receipts should be kept for all transactions made on behalf of residents. Double signatures should also be recorded on the transaction sheet. These steps will help to fully protect the residents. 3 4 OP16 OP18 5 OP35 Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Cedar Court Care Centre DS0000071060.V370347.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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