Care Home: Cedar House

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What the care home does well Residents receive a good assessment process before being admitted into the home. A visitor confirmed when choosing the home they were impressed that they were told no appointment was necessary and they could visit at any time. Staff are able to communicate and understand residents health and personal care needs well. Residents told us,"The weekend food is better. I tell my relative not to take me out on a Sunday as I will miss the Sunday roast. The food is good. They bake you a cake for your birthday." "I read the papers that are delivered, the Mail and the Mercury." A relative commented in a survey. "My mother is very happy in the home and is treated very well. I am very pleased in every respect." Residents needs are met by the numbers and skill mix of staff at the home and tell us they are treated well. The home was found to be homely, clean, safe and comfortable, well maintained and reflected the individuality of the people using the service. Residents told us, "My bedroom is just how I like it." "There are good views over the garden." Residents receive excellent outcomes in particular around the Environment and Daily Life and Social Activities. Residents live in a well managed home and benefit from an open management approach. What has improved since the last inspection? Developments have been made in moving and handling training with two staff now identified to undertake the moving and handling training and teach other carers in the home. This will ensure safe practises for residents around personal care. Risk assessments have been improved for residents and guide staff how to care and support residents. What the care home could do better: Manager should review and update records:- the assessment format, person centred care planning, regular care reviews, and daily record keeping. This has the potential to put residents rights and best interests at risk. Written information about the home:- the statement of purpose, service user guide and complaints procedure should reviewed to ensure they meet current legislation. Quality assurance programmes to be set up, and reflect the aims and outcomes for people living in the home. An internal audit should take place annually. Staff recruitment checks should be improved to ensure staff have the necessary checks before starting work in the home. The same aspect was identified during our last visit. This will safeguard residents and staff from harm. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cedar House 249 Station Road Rothley Leicestershire LE7 7LD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Abel     Date: 0 1 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Cedar House 249 Station Road Rothley Leicestershire LE7 7LD 01162303066 01162375520 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr John Lowe,Mrs Dorothy Lowe,Mr John Lowe (jnr),Mrs Lynda Lowe care home 24 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 24 old age, not falling within any other category Additional conditions: 0 The maximum number of services users who can be accommodated is: 24 The registered provider may provide the following category of service only: Care Home - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home is within the following category: Old Age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Cedar House is situated in a rural setting, on the border of the village of Rothley, and is a short walk from the Great Central Railway station. The home is registered to provide accommodation and care for up to 20 older persons. All of the bedrooms currently provide single en-suite accommodation. The home has one double bedroom, which can be used for partners or other people who wish to share, when it is available. There are a number of lounges and two dining rooms on the ground floor of the home. There is a large secluded and private rear garden, with appropriate seating and cover for people who live in the home to use. There is a large car park to the front Care Homes for Older People Page 4 of 27 Brief description of the care home of the home. There are no shops in the immediate vicinity; the nearest shops are in nearby Rothley village-centre. There is a local bus service to Leicester and Loughborough. The fees charged currently range between 465.00 to £525.00 per week. Extra charges are made for telephone calls and rental, hairdressing, chiropody, newspapers and magazines, and personal washing items. The most current inspection report is held in the reception area. Care Homes for Older People Page 5 of 27 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: two star good 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: This inspection was a Key Inspection that focused on the key standards under the National Minimum Standards and the Care Standards Act 2000 for homes providing care for Older Persons. We spent time planning the areas to focus on before the visit took place. This was based upon information gained from reviewing the homes service history, the last inspection report, the Annual Service Review (ASR), the homes Annual Quality Assurance Assessment (AQAA). The people living at Cedar House prefer to be called residents. The primary method of inspection used was case tracking that involved selecting three people and reviewing Care Homes for Older People Page 6 of 27 the care that they received through inspection of the written information available on their care plans. Discussions took place with residents, relatives, other visitors, staff and the registered manager. Surveys completed by residents, their relatives and supporters and staff were returned to the Inspector after the inspection. Many of the comments have been included in this report. The visits was unannounced and took place on a Wednesday morning and lasted over 4 hours. In addition policies and procedures and records in relation to residents, staff recruitment, complaints and upkeep of the home were viewed. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 27 following this report, you can contact them using the details set out 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 9 of 27 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 10 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive a good assessment process before being admitted into the home. Evidence: The statement of purpose and service guide is available to residents and sets out the range of facilities and services on offer. One visitor confirmed they had received written information when considering the home for a relative. Another visitor confirmed when choosing the home they were impressed that they were told no appointment was necessary and they could visit at any time. It is recommended all the written information service user guide and statement of purpose is updated to ensure it mets the current standards and requirements. The homes needs assessment format was examined for residents case tracked. The format was brief and could be developed further. Religious needs were not included to ensure residents religious needs could be met by the home. Other people attended the Care Homes for Older People Page 11 of 27 Evidence: assessment meetings and should be included in the agreement of the assessment process. This will ensure a prospective resident and their supporters can be sure their needs will be met. Care Homes for Older People Page 12 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are able to communicate with residents and understand and met their health and personal care needs well. Evidence: Only one residents care plan was available out of three care plans sampled. The care plans should be reviewed, to include a photograph of each resident, and agreed by the person using the service. Staff were very knowledgeable about each resident and were observed supporting and encouraging residents. Reviews of residents care takes place regularly. It was agreed with the registered manager the reviews, daily record keeping and weighing routines would be reviewed. This would ensure the residents care plan is updated to reflect charging needs and any current objectives for health and social care are actioned. Residents told us, I dont think you will do any better.The manager and senior are very kind. Its pretty good here. Care Homes for Older People Page 13 of 27 Evidence: Visitors told us, Its excellent here. Nice atmosphere here. I meet other visitors and they say its lovely. The medication area was examined and found to be compliant. Suggestions were given to senior staff around cold storage of medicines. All staff are trained in handling medication and can not handle medicines until they are competent to do so. This protects residents. Care Homes for Older People Page 14 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have good opportunities to develop and maintain important personal and family relationships. Resident enjoy a lifestyle with variety and choice. Meals are well balanced nutritious, and cater for dietary needs. Evidence: Visitors told us,The food smells good. My sister loves her food. Shes diabetic, she is sometimes given an alternative for pudding. There is a yearly summer fete, that is lovely in the garden. The had a carol singers came at Christmas time and a newsletter was given out to tell us about the event. My relative was assorted by a carer to, two family weddings and a funeral. I am so grateful. A group of residents were seen sitting in the garden under sun umbrellas and wearing sun hats. Drinks were brought out to them staff and the registered providers were seen chatting with them. A resident was observed sitting in the quite lounge looking at the garden views and a group of other residents were talking together in the back lounge. Residents told us, The weekend food is better. I tell my relative not to take me out on Care Homes for Older People Page 15 of 27 Evidence: a Sunday as I will miss the Sunday roast. The food is good. They bake you a cake for your birthday. I read the papers that are delivered, the Mail and the Mercury. I went to the residents meeting and made suggestions but dont know what happened to them. The registered manager confirmed another residents meeting is being scheduled and staff will report back to residents progress made. Suggestions were made around meals, activities, and staffing The Inspector sampled the hot lunch of beef stew and jam sponge and custard and found the food to taste delicious, was well balanced and attractively presented. A staff members surveys confirmed, At tea time not so many sandwiches, offer something else. Residents surveys said, I would like to take part in more but cant see or hear very well. It would be nice to have a few more activities. When holy communion take place in the main lounge it is always well attended. Residents received breakfast in bed and can choose from a menu of hot and cold food. Staff support residents to play on a WII game (an electronic interactive game). They can play bowling and golf and other games. One resident enjoys playing draughts with staff. Care Homes for Older People Page 16 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People associated with the home tell us they are satisfied with the service and and feel safe and well supported. Evidence: A complaints procedure is displayed in the home. Two complaints have been received by the home since our last visit and have been dealt with promptly by the registered provider. Some information was held around these issues in care plans and in the homes annual quality assurance assessment, and should also be recorded in the homes complaints record. This may include details of any investigations and any action taken. This confirms residents are listened and improvements are made. Residents tell us, I could complain to Zena the manager if I wanted to. I could talk to Zena, the senior, and carers if I had a problem. Visitors tells us, I could phone and tell the manager if I had a problem. When my sister complained to the manager it was dealt with quickly. Zena just resolved it. Staff are due to have adult protection training and training materials have been obtained by the home to arrange this. This will ensure residents are kept safe from harm. Care Homes for Older People Page 17 of 27 Care Homes for Older People Page 18 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and visitors tell us that are very happy with the environment; it is clean, and comfortable with no odours. Evidence: The home was partly viewed by the Inspector. It was found to be homely, clean, safe and comfortable, well matined and reflected the individuality of the people using the service. The home has reception area with information about the home; inspection reports, social and health care flyers, and information booklets. There is a also Easter raffle display on a table with funds being raised for people at the home. A large number of indoor plants are set around the home and pictures on the walls with good quality furniture and decor. The design and homely decoration benefits the residents. The home is part surrounded by large grassed areas, trees and border plants. All these areas are well maintained. There is garden furniture with tables and chairs. Residents may enjoy teaching the bird table with the frequent bird visitors that is placed in the rear garden. Care Homes for Older People Page 19 of 27 Evidence: Residents tell us, I am very happy here. I like sitting quietly. I like to sit and watch the big rabbits in the evening rushing around the garden there is lots of them. I love to walk around the grounds as well. My bedroom is just how I like it. There are good views over the garden. A visitor told us, When we first visited here we noticed no smells and the dining rooms are pretty. It is like someones home but bigger. The bedrooms are clean, staff are always cleaning. There are no bad smells. Residents surveys told us, A service user was unhappy with the laundry arrangements. This was passed onto the registered manager whom confirmed this had been dealt with. Other surveys said, Standards are very high. Excellent in this respect- the home is clean and fresh. Standards of housekeeping generally very high. Care Homes for Older People Page 20 of 27 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 needs are met by the numbers and skill mix of staff at the home and tell us they are treated well. Evidence: Residents surveys tell us, Very attentive to my needs. Nothing but praise for the staff. I like living here. I have not asked the staff for anything, but think they would listen to me. Staff are generally very attentive. A relative commented in a survey. My mother is very happy in the home and is treated very well. I am very pleased in every respect. Staff recruitment should be improved to ensure checks are in place before staff start working in the home. This will ensure residents are kept safe from harm. Staff reported almost daily meetings and on the job supervision with senior staff. All long serving staff hold National Vocational Qualifications (NVQ) at level 2. Senior have NVQ level 3 & 4. There was plenty of staff available and residents were seen to be unrushed by care staff. Care Homes for Older People Page 21 of 27 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 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 well managed home and benefit from her leadership and open management approach. Evidence: A relative who visited regularly told the Inspector, I am always greeted with a smile and sometimes a cuddle from staff. Another relative told us, I went to see my relatives and saw a staff member pop in who wasnt working, and took her dog around to see all the residents. I thought that was good that she had bothered to do that. Staff surveys told us that care staff felt they gave a good service to residents. Another staff commented,If I have any problems I go to my manager. A staff member told the Inspector I have been here for 3 years and I am well supported by my manager. It is marvellous here for me. The registered manager and staff confirmed passing on from relatives emails and face book messages, to the people living in the home. Residents benefit from the open leadership and management Care Homes for Older People Page 22 of 27 Evidence: approach of the home. Monies were not held for the residents case tracked. Many residents hold their own money and buy in hairdressing services and other items. Record keeping was not up to date in all areas around care planning and staff recruitment. Residents rights and best interests should be safeguarded. See outcome are 2 & 6. There has been a recent residents meeting in March 2009 that was successful and other regular meetings are being organised. There was no evidence of quality assurance and quality monitoring systems. Feed back should be sought from residents and family and friends and supporters. The result of surveys should be published and made available to current and prospective residents. The homes annual quality assurance assessment (AQAA) confirmed healthy and safety checks are up to date. The manager confirmed staff have attended health and safety training, food hygiene, safe handling of medicines and will soon undertaking moving and handling training, and food hygiene and others. The registered manager has undertaken palliative care training. This protects both residents and staff. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 29 19 (1) (b) The provider must make sure 08/04/2009 that no member of staff commences work in the home until the required checks have been carried out. Care Homes for Older People Page 24 of 27 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 7 15 Make the residents care plan 30/04/2009 available to the resident; and keep the plan under review; carry out a consultation with the service user or their representative and revise the residents plan. The resident will be assured care will be delivered in accordance with their care plan. 2 32 24 The registered person shall establish and maintain a system for reviewing at intervals and improving the quality of care provided at the care home. The registered person shall supply to the Commission a report in respect of any review conducted by him and make a copy of the report available to service users. 01/09/2009 Care Homes for Older People Page 25 of 27 The home is run in the best interest of residents. 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 1 Residents and prospective residents should have made available to them the most current statement of the aims and objectives of the home. This will ensure residents have the information they need about the home. The homes needs assessment format should be reviewed to include: the residents religious needs to ensure they are understood and met; People that participate in the assessment process should sign their agreement to the assessmnet. This will ensure residnets know their needs will be met. Regular reviews of the residents plan take place at least once a month, daily record keeping and weighing routines to be reviewed. This would ensure the residents care plan is updated and reflects changing needs and current objectives for their health and social care. 2 3 3 7 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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