Care Home: Cedar Court Nursing Home

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What the care home does well Several people using the service made positive comments regarding the support and care provided to them. These comments included, " it`s very nice here, the meals are good and the staff are lovely" Staff spoken with confirmed that staff training was good and confirmed the manager was supportive to them in their duties. Detailed pre admission assessments were undertaken that assessed the needs of individuals, before admission to the service was agreed. This ensured the service was confident that each individuals needs could be met, before an agreement regarding admission was made. The care practices and records seen demonstrated that people were supported appropriately to ensure their needs were met. What has improved since the last inspection? Both requirements left at the last inspection have been met. The service continues to refurbish and redecorate the home through its ongoing refurbishment plan Improvements have been made to the level of activities provided and an activities coordinator was employed for 30 hours a week. People spoken with stated that activities were provided and confirmed they were enjoyed. CARE HOMES FOR OLDER PEOPLE Cedar Court Nursing Home Bretby Park Bretby Derby DE15 0QX Lead Inspector Angela Kennedy Unannounced Inspection 7th August 2008 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 Cedar Court Nursing Home DS0000002105.V369976.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 Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedar Court Nursing Home Address Bretby Park Bretby Derby DE15 0QX 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) 01283 211412 01283 552220 www.cedarcourtcare.co.uk Your Health Ltd Mrs Marie June Pickering Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (3) of places Cedar Court Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 3 places for PD aged 50 years and over included in the total above. Date of last inspection 8th August 2007 Brief Description of the Service: Cedar Court care home has two units. This is the smaller unit and provides nursing and personal care for up to 30 persons aged 65 years and over, including up to 3 places for persons aged 50 years and over with a physical disability. Cedar Court is situated in a rural location near to Bretby village. Your Health Limited owns the home. The home is a two-story building; adapted for use as a care home. Residents have access to all parts of the home including a large enclosed, well-kept garden. The fees for residency at Cedar Court are as per social service rates, although private rates are applicable to people who are self-funding. At the time of this inspection the private amount to pay for self-funding was £410.00 a week. Items not included in this fee were: Toiletries Specific newspapers/ magazines (the company purchases a daily and evening newspaper for everyone’s use) Opticians (not including eye tests) Chiropody Dentist (for privately funded individuals) Activities/ outings Paid for through fund raising and donations to the home. Further information regarding the fees can be obtained by contacting the registered manager at Cedar Court. Cedar Court Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key inspection was unannounced and took place over approximately seven hours. Key inspections take into account a wide range of information and commence before the site visit by examining previous reports and information such as any reported incidents. The site visit is used to see how the service is performing in practice and to meet with the people using the service. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people using the service and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. An Annual Quality Assurance Assessment (AQAA) had been completed by the service. This is a self-assessment for providers that is a legal requirement. This assessment gives the provider an opportunity to let us know about their service and how well they think they are performing. The information provided in the AQAA is reflected within this report. At this inspection visit two people were case tracked. Case tracking is a method used to track the care of individuals from the assessments undertaken before they are admitted to a service through to the care and support they receive on a daily basis. This includes looking at care plans and other documents relating to that persons care, talking to staff regarding the care they provide and if possible talking to the individual. Both of the people case tracked were spoken with and were to some degree able to discuss their opinion of the service and support provided to them. The comments received from them and others living at the home are included within this report. There were no visitors available to speak with on the day of this inspection visit and therefore the opinions of relatives and friends are not included in this report. Several members of the staff team were spoken with on the day of the inspection visit. The comments from discussions held are reflected within this report. The manager and administrator were not on duty on the day of this inspection visit, therefore the nurse in charge assisted the inspector by providing most of the requested information and documents. However there were some Cedar Court Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 6 documents/ records that were not accessible to the nurse in charge and therefore not all of the records requested were seen at this visit. What the service does well: 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. Cedar Court Nursing Home DS0000002105.V369976.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 Cedar Court Nursing Home DS0000002105.V369976.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): 3,5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The suitability of the home for each individual was determined by a needs assessment before admission was agreed. This ensured each persons needs could be met. EVIDENCE: The home was able to support the people because an accurate assessment of needs had been undertaken before admission. This enabled the home to determine that they were able to meet each person’s needs before admission was agreed. Both of the people case tracked had detailed needs assessment in place. As stated in the pre-inspection self-assessment information these had been undertaken prior to admission either by meeting individual’s in hospital or at home. This assessment covered all areas of health, personal and social care need, including any faith and cultural needs. Both of the needs assessments seen had been signed and dated by the manager of the home. Cedar Court Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 9 Assessments were also in place that had been undertaken by other professional bodies such as Local Authority (social services) assessment and the Primary Care Team (PCT). Information from the needs assessments undertaken by the home and other professional bodies was used to develop care plans. Some of the people living at the home were able to confirm that they or someone close to them had been given the opportunity to look around the home before they made a decision about moving in. one person said that they used to come to the home for respite and then decided they would like to stay. Cedar Court Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, personal and social care needs of individuals was met and their dignity maintained. People were supported to take their medicines in a safe way. EVIDENCE: Peoples health, personal and social care needs were met. Plans of care and risk assessments were in place for the two people case tracked. These plans demonstrated that the individual or their representative had been involved in the development of their care plan. Care plans had been signed and dated by all relevant parties, such as the individual or their representative and the manager of the home. The information within the care plans was detailed and provided staff with relevant information about how each person would like to be cared for, their day time and night time routines and the support they required in maintaining these routines. The information provided was broken down within each area of care/ support to instruct staff on the exact support required to ensure that people were enabled to maintain their independence and the skills they Cedar Court Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 11 already had. This promoted independence and enabled people to maintain as much control over their lives as possible. One person spoken with said, “ I’m very satisfied with the care, the staff are lovely” The care plans seen had been reviewed and updated each month as required. This ensured any changing needs could be identified and the appropriate action put in place to address these changes. Records were also in place of individual’s social history. This information enabled the staff team to get to know each person better and the support they needed. It looked in more detail at each person’s family and life history, including their working years, their interests, hobbies and their preferences regarding meals and beverages. The risk assessments seen for the two people case tracked were detailed and assessed all areas of risk identified and the actions that were required to minimise each risk, whilst retaining individual’s independence as much as possible. This demonstrates that the home supports people in a safe way. Risk assessments seen included mobility and risk of falls, skin integrity, pressure areas and pressure sore prevention, maintaining a safe environment, nutrition, pain and pain relief. As stated in the pre-inspection self-assessment information health care needs were clearly addressed and this was demonstrated in the records seen of the people case tracked. Everyone had access to healthcare such as G.P services, chiropodist, dentist and optician. Records seen also demonstrated that specialist healthcare was provided as required such as community psychiatric input and physiotherapy. Records demonstrated that people’s health/ medical needs were addressed on a daily basis to ensure their health was maintained. The records seen included diabetic monitoring charts and as stated above assessments regarding nutritional requirements and nutrional intake, skin integrity and monthly recordings of weight. This enabled any concerns in health to be identified promptly ensuring that the required actions could be taken to address any health care concerns. People spoken with confirmed that their health care needs were met, one person confirmed, “ if you need to see the doctor you can do”. People were supported to take their medication safely. The policies and procedures in place regarding medication were detailed and provided the nursing team with accurate and up to date information on medication ordering, storage, administration - including self administration, recording and disposal. The medication records of the two people case tracked were looked at and no errors were noted in the signing of medication administered. Records had been Cedar Court Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 12 completed accurately. Medications were stored correctly and all records seen were clear and accurate. It was noted that prescribed medications that had been handwritten on medication administration records had not been countersigned. This is a good practice measure to ensure any handwritten instructions are checked by a second person to reduce the risk of errors. The controlled drugs were seen and were stored and recorded correctly. The records of one controlled drug stored were examined and this medication was counted and corresponded with the records held. It was noted that no pill counters was available for counting medication such as controlled drugs, which would ensure medication could be counted hygienically and easily. Staff observed during the inspection demonstrated a caring and friendly approach. People were being supported in a respectful and dignified way. Comments from people living at the home included, “the staff are lovely, they’re very thoughtful” and “ the staff have a laugh and a joke with us but they do treat us well”. Cedar Court Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home supports people to participate and benefit from social gatherings and activities. People are supported to maintain relationships with family and friends and be as independent as they can. EVIDENCE: An activities coordinator was employed and this person was on duty on the day of this inspection visit. They confirmed that they were employed for 30 hours a week to co ordinate activities. In addition to this they also worked as a member of the care team and confirmed that this did not impact on their role as an activities coordinator. The activities coordinator discussed the activities provided this included a variety of indoor games such as soft ball games, card and quiz games and musical entertainment like karaoke. Outdoor activities such as hook a duck and planting tomatoes in the greenhouse was also provided for those who wished to participate. The activities coordinator stated that external entertainers were used at the home but not often as they were expensive and the activities coordinator stated they preferred to spend this money on providing their own Cedar Court Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 14 entertainment for the people living at the home, such as taking some of the people living at the home to the over 50’s day in the local community and organising shopping trips out on a 1:1 basis. Discussions took place regarding 1:1 activities within the home for people who spent a lot or all of their time in their rooms, either because this was their choice or due to health care reasons. The activities coordinator said that she spent time with individuals in their rooms either reading to them, providing nail care such as nail manicures and polish or just sitting chatting, which she said that most people seemed to prefer. The home also provided seasonal events to encourage social get- together’s and raise money for activities and amenities, such as summer fetes, bonfire nights and Easter bingo’s. Some of the people spoken with were able to confirm that there were activities that they were able to join in with and they confirmed these were enjoyed. Comments included, “ there’s activities to do if you want to join in, I like to sit in the garden when the weather is good”. The activities coordinator confirmed that several people enjoyed spending time in the garden and taking afternoon tea there. Information within the pre-inspection self-assessment stated that it was easier to get some people to interact and join in with activities than others and the service was presently looking at how they could encourage participation to enable everyone to benefit in activities and social events at some level. People spoken with confirmed that they were able to choose what they did during the day and decide if they preferred to spend time alone or with others. As stated earlier in this report the care plans seen demonstrated that individuals were encouraged and supported to make the most of their abilities. Cedar Court employs a hairstylist therefore there were no additional charges for anyone who wished to use this service. People spoken with confirmed this and stated that they were happy with the services provided by the hairstylist. It was confirmed by the activities coordinator that church services were held at Cedar Court. These were provided by two different religious denominations on a monthly basis for anyone who wished to participate. Unfortunately no visitors were seen on the day of this inspection, however people spoken with confirmed that their friends and family were always made welcome when visiting them. The pre-inspection self-assessment information stated that visiting was open and that visitors were encouraged to participate in the entertainment provided and were invited to partake in the meals provided. Cedar Court Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 15 The meal choices for the day were on display in the reception area of Cedar Court. The menus were seen and demonstrated that a good variety of meals was available with alternatives offered at each mealtime. Cooked breakfasts were available each day and vegetarian options provided. Special diets were catered for as required. People spoken with said they enjoyed the meals and confirmed that there were alternatives available if they did not want the choices on the menu. Comments regarding the meals included, “ the food is very good and its always well presented”. Care staff were observed with the teatime trolley handing out sandwiches and cakes. It was noted that small plates or saucers were used. These small plates/saucers were used to accommodate four sandwiches and a cake and it was clear that these plates/saucers did not enable the food to be presented attractively and they were not adequate for this amount of food. Staff spoken with stated that these plates/saucers were the only ones available apart from large dinner plates. To maintain safe food hygiene practices, consideration should also be given to the use of a lid on the large milk jug that was seen on the tea trolley, staff spoken with said that there were no lids available for these jugs. Cedar Court Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 16 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. Concerns are looked into and actions are taken to put thing right. The practices and policies in place safeguards people from abuse and neglect. EVIDENCE: As stated in the pre-inspection self-assessment information the service had received two complaints since the last inspection. The records seen demonstrated that one complaint had been addressed in full and copies of letters seen demonstrated that the person making the complaint was happy with the actions taken and the outcome of the complaint. The second complaint had been recently made and the records showed that at the time of this inspection this complaint was being addressed. All correspondence relating to these complaints was stored securely. The complaints procedure has now been amended to inform people that complaints can be referred to the Commission for Social Care Inspection at any stage. However it was noted within the policy folder that the previous complaints policy seen at the last inspection was still in place. This policy needs to be removed to ensure staff are aware of the correct policy and procedure that should be followed. People spoken with said they did not have any complaints about the service and support they received but confirmed that if they did they would speak with Cedar Court Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 17 the manager or their family. They indicated that they were confident that any concerns they had would be addressed. Since the last inspection the policy on Safeguarding Adults has been updated and is in line with Local Authority procedure and policy. A copy of the multi partnership policy was in place that is used by Derbyshire and Derby City Local Authority, the Police, The crown prosecution service, the probation service and NHS Trusts and Foundations. This ensures that if any concerns regarding abuse are observed or disclosed the staff at the home know the correct procedure to follow to safeguard the people in their care. It was noted that the copy of the multi partnership policy stated that it was to be reviewed in February 2008, therefore the service should confirm with the local authority if a reviewed version of this policy is available to them. Staff spoken with had a good understanding of the safeguarding adults policy and were able to confirm that they had undertaken this training. The preinspection self-assessment information, records of staff training and certificates seen confirmed that staff were kept up to date with this training. No safeguarding adults referrals or investigations have been undertaken regarding anyone living at the home since the last inspection. Cedar Court Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 18 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. This judgement has been made using available evidence including a visit to this service. People live in an environment that is safe and good standards of hygiene are maintained. EVIDENCE: A tour of the building was undertaken. The bathrooms and shower rooms seen provided adequate space and the appropriate equipment to ensure that people could be supported in a safe way when providing personal care. The laundry room was seen and two members of staff spoken with. They confirmed that two members of staff were on duty each day to undertake the laundering of individuals clothing both within the nursing unit and the dementia unit and the laundering of all other items used within the nursing and dementia unit. It was noted that an iron and roller were available but staff commented that a press for ironing would greatly assist them with their workload. Cedar Court Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 19 In general the comments received regarding the laundry service provided were positive. One complaint had recently been made relating to the laundry service and records demonstrated that this was being addressed. As stated in the pre-inspection self-assessment information new lounge chairs had been purchased and these were seen on the day of the inspection visit. Redecoration and refurbishment had also taken in place in other areas including bedrooms, corridors, staircases and bathrooms. It was stated in the pre-inspection self-assessment information that all thermostats on radiators have been replaced and the home has implemented no smoking regulations this included; a smokers lounge for people living at the home that smoked, care plans, signage regarding smoking areas and non smoking areas, an outside designated area for staff that smoke, staff risk assessments, and ventilation. Air fresheners were fitted within the main lounge area. People spoken with confirmed that they were happy with the general maintenance and standard of cleanliness maintained at the home. Cedar Court Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. People’s needs are met by staff that receive the relevant training and support from their manager but shortfalls in the recruitment practices do not ensure that people using the service are safeguarded. EVIDENCE: From looking at the rotas and discussions with staff it was confirmed that five staff were on duty throughout the day, one of these being a qualified nurse. At night three staff were on duty, one of these being a qualified nurse. Staff spoken with felt that the staffing levels were not always sufficient to effectively support the people using the service. An example given was in the mornings when one member of the care team assisted individual’s with their breakfast, leaving only three care staff to support people with their personal care routines. They stated that an additional member of staff to support people at breakfast time would increase the support available to individuals in the mornings with their personal care. During the inspection visit time was spent sitting with individuals in the main lounge and it was noted that there were occasions when care staff were called away to support individuals. The nurse on duty did supervise the lounge area during this time. Due to the high level of support required for the majority of people, there should be sufficient staff at all times to ensure people are supervised and supported appropriately. Cedar Court Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 21 The people that were able to express their opinions indicated that there was enough staff on duty to meet their needs and support them. They were full of praise for the staff and the comments made included, “the staff are lovely, they have a laugh and a joke with us” and “ the staff are very good, they work hard”. Two staff files were looked at to assess the recruitment practices undertaken at the home. Certain checks and records that are required by law to be in place before a person commences employment were assessed within these two staff files. It was found that in general the correct recruitment records and checks were in place. The pre-inspection self-assessment information stated that the employment application forms now included a request for a ‘complete’ employment history. However both staff application forms seen did not requested a full employment history and the reasons for any gaps in employment to be recorded. The application forms only requested the last 10 years employment be recorded. One person had commenced employment in February 2008 and this person’s employment history did not provide the full dates for all previous employment or provide a written record of the reasons for gaps in their employment history. The other staff file seen did provide a full employment history. Although this application form did not record the reason for a four-month gap in employment. Staff spoken with confirmed that the training they received was good. Comments included, “ I can’t fault the training, its very good”. The training records seen demonstrated that the staff received the relevant training and support from the manager. Training records and certificates showed that mandatory training was updated as required and training specific to individuals needs was also undertaken, such as eating disorders, diabetic study days, dementia care, sleep disorders and palliative care and link nurses in tissue viability, infection control and continence. Also included were records to demonstrate that over half of the care staff team had achieved a National vocational Qualification (NVQ) in care at level 2 or above. The pre-inspection self-assessment information stated that a further three staff were working towards this qualification. From observations on the day of this inspection staff demonstrated that practices such as moving and handling were undertaken correctly, this ensured individuals and staff safety was maintained. Records were also seen within the staff files looked at to demonstrate that staff received a thorough induction when they commenced employment, with the appropriate levels of support given, to ensure they were competent and safe to support the people using the service. Cedar Court Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 22 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): 31,35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have confidence that the home is led and managed appropriately. The environment is safe for people and staff because the appropriate health and safety checks are carried out. EVIDENCE: The manager has been in post for many years and has the relevant training and qualifications required to manage the service. Information in the pre inspection self assessment stated that since the last inspection visit the manager has undertaken training on the Mental Capacity Act and obtained the Mental Capacity Act guidelines. It was stated within the pre inspection self-assessment that members of the staff team would be accessing this training within the next twelve months. Staff spoken with and were complimentary regarding the manager’s skills and ability in running the service. Comments included, “ the manager is very good, Cedar Court Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 23 she’s very approachable” and “ we all work really well together as a team and the manager is always around if we need her”. Minutes of regular staff meetings and staff supervision records demonstrated that staff were kept up to date with any changes to the service and were supported appropriately by the manager. People living at the home also commented on the manager, comments included, “ she’s a very nice woman, very friendly” and “ she’s lovely, always has a chat with me”. The pre inspection self-assessment stated that annual quality assurance questionnaires were sent out to the people using the service or their relatives and these were audited and a copy was available in the reception. It also said that questionnaires were also sent out to G.P.’s on an annual basis and the audited results were available in the managers office, However copies of these audited results could not be located on the day of this inspection visit and will therefore be looked at during the next inspection visit. Information within the pre inspection self-assessment stated that as a result of last year’s quality assurance questionnaires, improvements have been made to the décor of the home and areas such as staff training. The monies held for the two people case tracked was not looked at on this occasion as the records and balances held were not accessible on the day of this inspection visit as the manager and homes administrator were not on duty. These records will be looked at during the next inspection visit. The nurse in charge did confirm that a small float of money was available for anyone requesting any monies and discussed the procedure that would be followed in recording any financial transactions in the managers and administrators absence. This procedure ensured that the correct records would be undertaken to ensure individual’s finances were safeguarded. Some of the safe working practices at Cedar Court were assessed and found to be satisfactory, and included: the fire alarm certificate test and emergency lighting test and the fire risk assessment. Certificates were in place to demonstrate that hoists, electrical equipment and gas safety tests were carried out as required and water temperatures and water sterilisation was undertaken as required. Accident records were completed, however it was noted that these accident forms did not provide space for staff to record if any treatment was required and what that treatment was, and if the accident or incident had led to a reassessment of the person or environment and the outcome of any re assessment. Summary sheets were provided but very little information regarding the outcome of accidents/incidents was recorded. This means that Cedar Court Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 24 the service is unable to maintain a clear audit of the accidents/ incidents that occur in order to identify and minimise any risks. Cedar Court Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 25 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 3 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 3 Cedar Court Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 26 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. 1. Standard OP29 Regulation 19 (1) (b) Requirement A full employment history, together with a satisfactory written explanation of any gaps in employment must be in place for any member of staff employed at the home. Timescale for action 07/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations Medication Administration records that contain hand written medication administration instructions should be checked and countersigned by a second member of staff that is competent in medication practices. A pill counter should be in place to count controlled drugs. The crockery used at the teatime meal should be of adequate size for the meal provided and ensure the teatime meals are presented attractively. The jugs containing milk should be covered for food hygiene purposes. The old complaints policy should be removed from the policy folder to avoid confusion and ensure the correct DS0000002105.V369976.R01.S.doc Version 5.2 Page 27 2. 3. 4. 5. OP9 OP15 OP15 OP16 Cedar Court Nursing Home 6. 7. 8. 9. OP26 OP26 OP27 OP35 10. OP38 procedure is followed. Consideration should be given to the use of an ironing press to assist housekeeping staff in their duties. The staffing levels in the laundry should be reassessed to ensure the workload is acceptable for the staffing levels in place. Care staffing levels should be assessed in accordance with the support needs of the people using the service. Two signatures should be obtained on all residents’ financial transaction records. Unable to assess at this visit therefore this recommendation will remain in place and be assessed at next inspection visit. Accident / incident records should record any treatment or intervention required and the outcome of that treatment and intervention. They should also record if a re assessment of the individual or environment has been undertaken and the outcome of any risk and the actions taken to minimise that risk. Cedar Court Nursing Home DS0000002105.V369976.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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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