Care Home: Cedar House

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What the care home does well Overall the home has shown us that it has improved the way in which it meets the needs of residents. A resident commented, “I like being here and always gets the help as and when I need it.” We saw that the initial assessments of the residents we case tracked provided a detailed description of all their health and personal care needs.Cedar HouseDS0000010650.V378048.R01.S.docVersion 5.2We found that the care plans of all the residents case tracked were detailed and clearly identified how their needs would be met. Care plans were based on initial assessments. We found that residents choices and preferences are recorded in their care plans. We spoke with residents who told us that they are provided with regular activities. A resident said, "There is something to do every day, but it is up to you." People are involved in meaningful daytime activities of their own choice and according to their individual interests and capabilities. The registered manager explained that there is a greater variety of meals being offered to residents. A resident commented that there were, “Good meals always and on time." People are offered a variety of meals that reflect their personal preferences and meet their dietary needs. A resident said, "You can talk to people here if you don`t like something." The complaints record showed actions taken to resolve complaints. The home has an open culture that allows people to express their views, and concerns in a safe and understanding environment. The annual quality assurance assessment highlighted that there had been on going improvements to the home`s environment. We walked round the home and saw that a number of bedrooms had been redecorated, along with the hallway and main staircase. The home has the necessary adaptations to support people to move around safely. The home’s environment is appropriate to the specific needs of residents and promotes their independence. Both residents and relatives commented positively on the management and leadership provided by the registered manager. A resident told us that she felt that the resident manager was, "Excellent." The registered manager has a clear understanding of how to deliver good outcomes for people living at the home. What has improved since the last inspection? There has been an overall improvement in the quality of outcomes for residents. A resident commented that, "Everything is better here." There were seven areas for improvement identified at the last inspection. All of these have been addressed. In most cases the home had sent us information to confirm they had made the improvements we had asked for. Cedar House DS0000010650.V378048.R01.S.doc Version 5.2 The registered manager has updated the statement of purpose it now reflects the current management structure of the home. . The statement of purpose provides an accurate description of how the home is managed. The registered manager has made sure that any changes to resident’s medication is recorded. Residents receive the medication they need to maintain their safety and well-being. All Staff have received training in adult safeguarding from the host local authority. We checked training records which confirmed this training had taken place. People feel safe and well supported by the home, which has their protection and safety as a priority. Training records showed that since the last inspection staff have received training on infection control measures. Liquid soap and paper towels have been made available throughout the home. Effective infection control measures are in place to make sure that residents are safe. The home has shown us that the rota indicates clearly who is in charge of the home in the absence of the registered manager. Residents can be confidence that staff always have the appropriate leadership. We found that the training records confirmed that staff had completed training on equal opportunities and diversity issues. Residents are supported by staff that understand, respect and promote their diversity and equality. What the care home could do better: There is one area for improvement identified in this inspection report. A record of those staff who administers medication should be maintained. This needs to record their names, signatures and initials. Residents should be confident that qualified staff always administers their medicines. Key inspection report CARE HOMES FOR OLDER PEOPLE Cedar House 6 Dryden Road Enfield Middlesex EN1 2PP Lead Inspector Tony Brennan Key Unannounced Inspection 12th October 2009 11:00 DS0000010650.V378048.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Cedar House DS0000010650.V378048.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Cedar House DS0000010650.V378048.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedar House Address 6 Dryden Road Enfield Middlesex EN1 2PP 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) 020 8360 8970 020 8360 3613 gkattan.cedarhouse@blueyounder.co.uk Cedar House Company Limited Mary Ezzat Jennifer Swords Care Home 17 Category(ies) of Dementia - over 65 years of age (8), Mental registration, with number disorder, excluding learning disability or of places dementia (1), Old age, not falling within any other category (16), Physical disability (2) Cedar House DS0000010650.V378048.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC 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: 16) Dementia - Code DE(E) (maximum number of places: 8) Mental disorder, excluding learning disability or demantia - Code MD (maximum number of places: 1) Physical Disability - Code PD (maximum number of places: 2) The maximum number of service users who can be accommodated is: 17 23rd October 2008 2. Date of last inspection Brief Description of the Service: Cedar House is a care home registered to provide residential care for seventeen elderly people of either sex, one of whom may have a mental health disorder. The home is a limited company owned by Dr G. Kattan and Ms Mary Ezzat. The home is located in a quiet residential area in Bush Hill Park about two minutes walk away from a train station. Enfield town centre is one stop by train and cafés, newsagents, restaurants and a post office are within two to three minutes walk from the home. The home has a large garden. The bedrooms are arranged on two floors. There are eleven single rooms and three double rooms. On the ground floor there is a lounge overlooking the garden and the dining room is at the front of the house. A room next to the kitchen is also used as a dining room. The table in this room is used for different purposes at different times. It is sometimes used for games, for writing and for eating. Another lounge is provided in the extension part of the building adjacent to the back garden. A table and chairs are available for service users to sit in the garden if they wish and if the weather permits. The home aims to provide care and support that is tailored to each service user’s needs. The home also seeks to provide supportive dementia care in a homely environment. The fees are between £420 and £450 a week. Copies of this report are available from the Commission’s website. Cedar House DS0000010650.V378048.R01.S.doc Version 5.2 Page 5 This report is available from the CQC web site. Service users or members of the public may also contact the registered provider who will be able to provide them with copies of this report. Cedar House DS0000010650.V378048.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 two star. This means the people who use this service experience good quality outcomes. This unannounced key inspection was undertaken as part of the annual inspection programme. We sought to confirm that the home continues to provide good outcomes for residents. Prior to the inspection the home had completed its Annual Quality Assurance Assessment. The Annual Quality Assurance Assessment provided us with information about the home and how it was seeking to provide the best outcomes for people. We also looked at any other information we had received about the home since the last inspection. This included any information regarding incidents that the home had told us about. The inspection took place over one day. We were assisted by Jenny Swords, the registered manager, with the inspection. Comment cards were received from six of the twelve residents currently living at the home. Also five staff sent in their comment cards. We spoke with four residents and three members of staff. We observed care practice and interaction between staff and people living at the home. We toured the building and examined a number of records relating to the care, health and safety and management of the home. At the end of the inspection feedback was given to the registered manager, and areas for improvement were discussed. We would like to thank the staff that assisted us by answering questions about the running of the home. We would also like to thank the residents who discussed their views of the service they receive. What the service does well: Overall the home has shown us that it has improved the way in which it meets the needs of residents. A resident commented, “I like being here and always gets the help as and when I need it.” We saw that the initial assessments of the residents we case tracked provided a detailed description of all their health and personal care needs. Cedar House DS0000010650.V378048.R01.S.doc Version 5.2 Page 7 We found that the care plans of all the residents case tracked were detailed and clearly identified how their needs would be met. Care plans were based on initial assessments. We found that residents choices and preferences are recorded in their care plans. We spoke with residents who told us that they are provided with regular activities. A resident said, There is something to do every day, but it is up to you. People are involved in meaningful daytime activities of their own choice and according to their individual interests and capabilities. The registered manager explained that there is a greater variety of meals being offered to residents. A resident commented that there were, “Good meals always and on time. People are offered a variety of meals that reflect their personal preferences and meet their dietary needs. A resident said, You can talk to people here if you dont like something. The complaints record showed actions taken to resolve complaints. The home has an open culture that allows people to express their views, and concerns in a safe and understanding environment. The annual quality assurance assessment highlighted that there had been on going improvements to the homes environment. We walked round the home and saw that a number of bedrooms had been redecorated, along with the hallway and main staircase. The home has the necessary adaptations to support people to move around safely. The home’s environment is appropriate to the specific needs of residents and promotes their independence. Both residents and relatives commented positively on the management and leadership provided by the registered manager. A resident told us that she felt that the resident manager was, Excellent. The registered manager has a clear understanding of how to deliver good outcomes for people living at the home. What has improved since the last inspection? There has been an overall improvement in the quality of outcomes for residents. A resident commented that, Everything is better here. There were seven areas for improvement identified at the last inspection. All of these have been addressed. In most cases the home had sent us information to confirm they had made the improvements we had asked for. Cedar House DS0000010650.V378048.R01.S.doc Version 5.2 Page 8 The registered manager has updated the statement of purpose it now reflects the current management structure of the home. . The statement of purpose provides an accurate description of how the home is managed. The registered manager has made sure that any changes to resident’s medication is recorded. Residents receive the medication they need to maintain their safety and well-being. All Staff have received training in adult safeguarding from the host local authority. We checked training records which confirmed this training had taken place. People feel safe and well supported by the home, which has their protection and safety as a priority. Training records showed that since the last inspection staff have received training on infection control measures. Liquid soap and paper towels have been made available throughout the home. Effective infection control measures are in place to make sure that residents are safe. The home has shown us that the rota indicates clearly who is in charge of the home in the absence of the registered manager. Residents can be confidence that staff always have the appropriate leadership. We found that the training records confirmed that staff had completed training on equal opportunities and diversity issues. Residents are supported by staff that understand, respect and promote their diversity and equality. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Cedar House DS0000010650.V378048.R01.S.doc Version 5.2 Page 9 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Cedar House DS0000010650.V378048.R01.S.doc Version 5.3 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 House DS0000010650.V378048.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 13 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are provided with accurate information about the home. People’s needs are assessed prior to admission to the home to make sure they receive the care and support they need. National Minimum Standard number six is not applicable to this service, as the home does not provide intermediate care. EVIDENCE: Cedar House DS0000010650.V378048.R01.S.doc Version 5.3 Page 12 We found that the needs of the residents case tracked were within a range of those specified in the statement of purpose. The statement of purpose identified the skills and staffing resources available to meet the needs of residents. Surveys from residents confirmed that they all had been given sufficient information about the home. This helped the residents to decide if it was the right place for them to live. A relative confirmed that, “They told us everything about the home.” The home provides a statement of purpose that is specific to the home and the resident group that they care for. Since the last key inspection the registered manager has updated the statement of purpose. It now reflects the current management structure of the home. The registered manager had prior to this inspection sent us an updated copy of the statement of purpose. This shows that the home has a number of seniors who provide management support to the registered manager. The statement of purpose provides an accurate description of how the home is managed. A resident commented, “I like being here. I always get help, as and when I need it.” The annual quality assurance assessment stated, “A detailed pre admission assessment takes place, and after this the manager decides if we can fully meet the person’s assessed needs.” Residents case tracked had assessments from both placing authorities, and ones carried out by the home. These identified the individual’s needs for support and care. We saw that the initial assessments of the residents we case tracked provided a detailed description of all their health and personal care needs. The initial assessments also identified their cultural and religious needs. All surveys from residents confirmed that they received the care and support they needed. As part of the assessment information on the needs of people had been obtained from health professionals. This had been used to inform the home’s own assessment. Admissions are not made to the home until a full needs assessment has been undertaken to ensure the best outcomes for people. Initial assessments recorded the involvement of residents and their representatives in identified areas where they needed support. Both relatives and residents told us that they had been actively involved in the initial assessment process. We found that initial assessments reflected the individual’s preferences and how they wish their needs to be met. Detailed initial assessments are carried out with the involvement of people and their representatives to make sure their needs are identified. A resident told us, “Staff knows what to do to help me.” Care staff spoken to were able to explain the individual needs and preferences of the residents case tracked. Training records showed that staff had all the necessary training to meet the needs of residents. We observed the interaction between staff and residents. We found this supported their continued well being. Admissions to the home only take place when staff have the necessary skills to meet the assessed needs of perspective residents. Cedar House DS0000010650.V378048.R01.S.doc Version 5.3 Page 13 Cedar House DS0000010650.V378048.R01.S.doc Version 5.3 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s personal, social and medical care needs are fully planned for. People who use the service are fully protected by safe procedures for handling medication. People’s right to privacy is supported. EVIDENCE: Discussions with the registered manager showed us that there had been improvement in how residents’ needs are being supported. The annual quality assurance assessment highlighted that “Each resident has a person centered care plan which has been put together by the resident and their relative. All surveys from residents confirmed that staff always listen to what residents had Cedar House DS0000010650.V378048.R01.S.doc Version 5.3 Page 15 to say about their needs. We found that the care plans of all the residents case tracked were detailed and clearly identified how their needs would be met. Care plans were based on initial assessments. For example, one of the residents was identified in their initial assessment is having a history of falls. The registered manager has carried out a falls risk assessment. A care plan has been put in place to prevent further falls. There were clearly defined actions highlighted in the care plans to meet the needs of people. We found that residents choices and preferences are recorded in their care plans. The registered manager explained that she had started reflecting residents capacity to make decisions in their care plans. Staff spoken to were aware of these issues. Residents changing capacity to make decisions were reflected in their care plans. The care plans for the residents case tracked were found to reflect their choices and preferences. Residents commented that they had been asked about how they wish to be supported by staff. Staff were observed to interact respectfully and sensitively with residents. Residents said that staff respected their privacy and treated them with respect. Residents we spoke to told us that they felt staff understood their needs. We saw examples where staff members did relate well with people living at the home, for examples speaking to residents in a way that was appropriate given their age. One of the residents told us, “Staff takes time to ask how I want things done.” A key worker system is in place. Care plans were personalised, and referred to the cultural needs of people. This included whether or not they wish to take part in religious services. A resident said, “I have Communion from the church every week.” Residents are involved in the planning of their care that affects their lifestyle and quality of life. Detailed nutritional, tissue viability, falls and manual handling assessments are in place. Residents were being weighed regularly and action taken if their weight changed. All the residents case tracked had nutritional assessments. Each care plan includes a manual handling risk assessment. Equipment had been provided to assist people to mobilise safely and independently. We observed staff assisting a resident to walk. The member of staff did this in a way that maintained the resident’s safety. Management of risk ensures that safety issues are addressed whilst at the same time improving the quality of life for residents. Diary notes showed that appropriate medical attention and advice is sought. All surveys from residents confirmed that the home make sure they get the medical care they need. Diary notes also showed that the resident had access to their General Practitioner and other health professionals when they needed it. A person told us, “The doctor visits regularly.” Where the General Practitioner had recommended specific medical interventions these were followed up. Resident’s health is promoted to ensure their continued well being. Cedar House DS0000010650.V378048.R01.S.doc Version 5.3 Page 16 The records of medicines received, administered and returned to the pharmacist were all complete. We were able to confirm that residents were getting their medication as prescribed by their General Practitioners. We found where the General Practitioner had made changes to residents medication this was signed to confirm the change had been made. We found that the medication for each of the residents case tracked was accurately recorded. Medication records are fully completed, contain the required entries, and are signed by appropriate staff to ensure resident’s safety. Since the last inspection the registered manager has made sure that any changes to residents medication is recorded. We looked at the medication record for a resident who had been prescribed Warfarin. We found that the information on the medication administration record corresponded with that sent to the home by the anticoagulant clinic. Residents receive the medication they need to maintain their safety and well-being. Medicines were stored safely. All medicines are stored at the appropriate temperature. Separate records were maintained for controlled drugs. We checked the records of the three residents who are currently taking controlled medications. We found that these were recorded accurately. Two staff had signed to confirm they have given the medication. The management team monitors staff to make sure that the correct procedures are followed when administering medication. The homes pharmacist had recently carried out an audit of the homes handling of medication. Their report showed that this was being done safely. Regular management checks are carried out to make sure that medication is administered safely to people. We found that there was no list of the staff who are trained to administer medication. The registered manager agreed to make sure that an up-to-date list of the names, signatures and initials of those staff who administer medication was put in place. Residents should be confident that qualified staff always administers their medicines. Training has been provided on the safe administration of medicines. Training records confirmed that this training had taken place. We were able to observe staff administering medication, and confirmed that this was done safely. Staff understands how to administer medication safely. Cedar House DS0000010650.V378048.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are provided with varied activities to meet their needs. People living at the home are supported to maintain contact with relatives and other representatives of their choice. The menu offers a balanced diet to people living at the home. EVIDENCE: We spoke with residents who told us that they are provided with regular activities. Surveys from residents also confirmed that they always have activities. We observed that activities were taking place at various times throughout the day. We saw that people were enjoying playing a game of Cedar House DS0000010650.V378048.R01.S.doc Version 5.3 Page 18 bingo, talking with staff and listening to music. We saw examples of craftwork made by residents. Also there were pictures of activities and outings that have taken place over the last year. A resident said, There is something to do every day, but it is up to you. Residents interests were recorded as part of their care plans. We found that the residents case tracked had their emotional and personal interests recorded in the very person centred way. The home now has a part-time activities organiser. We spoke to the activities organiser who explained that she had been working with the residents and staff to offer more varied activities. The annual quality assurance assessment highlighted that, We offer one-to-one support with activities and at least once a week we take a small group of residents out to visit local garden centres, pubs and parks. People are involved in meaningful daytime activities of their own choice and according to their individual interests and capabilities. Staff spoken to understood the importance of one-to-one contact for residents. We observed that residents appeared to be generally relaxed, with no signs of ill being. Staff listens to what residents have to say. Staff spoke to them in a way they could understand. A relative told us that she had seen activities taking place. We could see from daily notes that residents had regular contact with relatives and friends. Diary notes showed that residents had regular contacts with family, friends and the wider community. One resident told us, “I have regular visits from my family.” Relatives commented that there were no restrictions on visiting the home. A relative commented on this, “They are always welcoming here.” Diary notes showed that residents had regular contacts with family, friends and the wider community. One resident told us, “I have regular visits from my family.” Residents said they could see visitors in private if they wished. The home supports residents to maintain and develop their family and personal relationships. The menu showed that options are offered at each meal. The annual quality assurance assessment highlighted that residents had, Wanted more choice so we introduced a menu of that residents could choose from. The registered manager explained that she would be consulting residents about the variety of meals being offered. An evening Cook has been employed. The registered manager explained that this means that a greater variety of meals can be offered in the evening to residents. All surveys from residents stated that they liked the meals provided by the home. A resident commented that there were, “Good meals always and on time. We spoke with residents who were generally pleased with the quality of the food provided. A resident said, “Food is very good.” Another resident commented positively about the choice of food offered and that staff, “Do ask what you would like to eat.” People are offered a variety of meals that reflect their personal preferences and meet their dietary needs. Cedar House DS0000010650.V378048.R01.S.doc Version 5.3 Page 19 Meals were balanced and nutritious. People’s dietary needs are recorded as part of their care plans (for example if they were diabetic or needed a puree meal). We observed that meals were well presented in a warm and friendly way. We saw that residents were supported to eat. We observed that this was done at the pace of the resident being assisted. People are able to enjoy the food they prefer and like. Cedar House DS0000010650.V378048.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 18. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are confident that their complaints will be listened to, taken seriously and acted upon. The home’s procedures protect people from abuse. EVIDENCE: The annual quality assurance assessment confirmed that a clearly defined complaints policy with agreed timescales for managing complaints was in place for residents to use. It stated that, Our complaints procedure is clear and has been updated.” We saw that the complaints procedure was displayed around the home so that residents and relatives could access it. All surveys from residents confirmed that they knew how to make a formal complaint. Residents told us they had received a copy of the complaints policy. A resident said, You can talk to people here if you dont like something. Cedar House DS0000010650.V378048.R01.S.doc Version 5.3 Page 21 A complaints book is available to record all concerns, allegations and complaints. We found that the complaints book recorded the actions that had been taken to address issues. There had been two complaints since the last key inspection. The complaints record showed actions taken to resolve complaints. The complaints record showed that the home had consulted with relatives and relevant professionals when investigating these complaints. Residents with whom we spoke confirmed that they knew how to make a complaint. The home has an open culture that allows people to express their views, and concerns in a safe and understanding environment. There were policies on handling abuse and protection. Residents said they felt confident that any concerns they raised would be handled sensitively and appropriately. A resident told us, “I can tell staff if I am worried.” There had been no adult protection issues since the last key inspection. All surveys from residents confirmed that they had someone to talk to informally if they were not happy about any aspect of their care. Since the last key inspection the home has made sure that all Staff had received training in adult safeguarding from the host local authority. They had sent us details of this prior to our inspection of the home. We checked training records which confirmed this training had taken place. Staff spoken to could recognise the signs of potential abuse, and explained how they would respond to it. They had confirmed in their surveys that they knew what to do if they had concerns about the home. A resident said “Staff are nice; there is always a happy atmosphere here.” People feel safe and well supported by the home, which has their protection and safety as a priority. Cedar House DS0000010650.V378048.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that provides a safe and homely environment. The home is clean and hygienic. EVIDENCE: The annual quality assurance assessment highlighted that there had been on going improvements to the homes environment. We walked round the home and saw that a number of bedrooms had been redecorated, along with the hallway and main staircase. The registered manager explained that new bed Cedar House DS0000010650.V378048.R01.S.doc Version 5.3 Page 23 linen and some new bedroom furniture had been purchased. We saw that bedrooms had matching bed linen and curtains. Registered manager showed us that there was an ongoing redecoration programme for the home. The annual quality assurance assessment had said that the next phase was to upgrade one of the bathrooms and redecorate a number of the bedrooms. The home has the necessary adaptations to support residents to move around safely. Bathrooms and toilets were fitted with appropriate adaptations to meet the needs of residents. These are accessible to residents who have mobility difficulties. There are dining and sitting areas for the use of residents. The home’s environment is appropriate to the specific needs of residents and promotes their independence. We saw that bedrooms were personalised with items of furniture and pictures belonging to residents. A resident said, “My bedroom is nice.” Another resident told us that; “I’ve got some of my own furniture in my room.” The registered manager explained that she encourages and supports residents to personalise the bedrooms. Residents are encouraged and supported to personalise their bedrooms. We found that a range of appropriate measures is in place to prevent cross infection. The home has detailed policies on the prevention of cross infection. Training records showed that since the last inspection staff have received training on infection control measures. Staff spoken to understood how to work to minimise the possibility of cross infection. Staff confirmed that they had access to disposable gloves and aprons. Liquid soap and paper towels have been made available throughout the home. Effective infection control measures are in place to make sure that residents are safe. Cedar House DS0000010650.V378048.R01.S.doc Version 5.3 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Sufficient staff are always available to meet the needs of people who live at the home. Staff have all the skills to meet the assessed needs of people who live at the home. People who live at the home are protected by the home’s recruitment practices. EVIDENCE: Surveys from residents confirmed that there were always enough staff available to meet their needs. The rota showed that a consistent staffing level was being maintained in the home. A resident commented that, “Staff are always available.” Since the last key inspection the home has shown us that the rota indicates clearly who is in charge of the home in the absence of the registered manager. Residents can be confidence that staff always have the appropriate leadership. We observed that staff were available to provide Cedar House DS0000010650.V378048.R01.S.doc Version 5.3 Page 25 individual care for residents. A resident told us that, “When assistance is needed the staff are there to help. Staff told us in their surveys, and in discussions with them, that the current staffing level allowed them to meet the needs of residents. The staffing level is reviewed regularly to make sure there are sufficient staff to meet the needs of residents. The annual quality assurance assessment highlighted that staff had been on a range of courses. Residents spoken to felt that staff had the necessary skills to meet their needs. A resident said, “Staff knows what to do to help me.” Training records showed that staff had been on a range of courses relating to the needs of residents. There were training certificates available to confirm this. We observed that staff understood how to respond and communicate with residents. Since the last key inspection we found that the training records confirmed they had completed training on equal opportunities and diversity issues. Staff had confirmed in their surveys that they had enough experience and knowledge to meet these needs. Residents are supported by staff who understand, respect and promote their diversity and equality. Staff spoken to were able to explain how they supported people in a person centred way. A resident said, “Staff do a good job.” Staff are supported through training to meet the individual needs of residents. The registered manager was able to show 50 of staff have achieved the National Vocational Qualification in care. Training records we had examined confirmed this. Staff training records showed that staff had done training in the essential areas, such as food hygiene, health and safety, administration of medication and infection control and first aid. We observed that staff demonstrated that they knew how to support and care for people. Training records showed that staff had also completed training in dementia care. Staff spoken to could explain how dementia affected individual residents. The registered manager told us that she was arranging for staff to attend an advanced course on dementia care. The home makes sure that all staff receives relevant training that is focused on delivering improved outcomes for people. We looked at three staff files. These contained all the necessary documentation to ensure that these members of staff were safe to work with residents. Their employment record had been checked. Two references and a POVA first/CRB check had been obtained prior to them starting work at the home. This showed that the home followed a clear recruitment procedure that ensures the safety of residents. The staff group reflect the cultural backgrounds of residents. Residents said they felt that staff could be trusted. Robust recruitment procedures are followed to ensure the safety and well being of residents. Cedar House DS0000010650.V378048.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 34 35 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Appropriate management structures are in place to ensure that people receive the care they need. People who live at the home are consulted about the quality of the service, and encouraged to make suggestions for improvement. People who live at the home have their financial interests protected by the home’s procedures. People who live at the home and staff are protected by the home’s health and safety procedures. EVIDENCE: Cedar House DS0000010650.V378048.R01.S.doc Version 5.3 Page 27 Both residents and relatives commented positively on the management and leadership of the registered manager. A resident told us that she felt that the resident manager was, Excellent. The registered manager has extensive experience of managing a service for older people. The registered manager has maintained and updated her skills regularly. She has a clear understanding of the key principles and focus of the service to make sure that residents at Cedars House receive the care they need. We observed that the registered manager spent time talking to residents. The registered manager has a clear understanding of how to deliver good outcomes for residents. Staff spoke very highly of the registered manager. They said they felt well supported and received clear directions and leadership. A member of staff said, “She is always available to discuss things.” The registered manager and staff work to make sure that the home is running in the best interests of people who live there. We observe this throughout the inspection. Relatives and other professionals provided positive feedback about how the home was managed to makes sure that the needs of residents are met. The home has a system for obtaining the views of the quality of the service it provides. The home makes sure that any areas for improvement are addressed. A survey of the views of people who live at the home, relatives and professionals had been carried out. We found that the findings of this survey had been action to improve the home. Staff meetings take place to make sure that staff are aware of how they should support and care for people. Both residents and staff confirmed that they had ways of sharing their views of the service and making suggestions for its improvement. Resident’s views are sought and provide the bases for improving the quality of the service. The home does not hold money for residents. The home invoices their families or the relevant social service department for any expenditure made on their behalf. A system is in place to ensure receipts are obtained for any expenditure. We examined the records and receipts for resident’s expenditure. We found that these showed clearly how residents money had been spent. People who use the service can have confidence in the home’s procedures for handling their money safely. The home has a consistent record of meeting the relevant health and safety requirements and closely monitors its own practice. Fire drills were taking place and the fire alarm was tested regularly. We found that the fire risk assessment includes an assessment of all the potential fire risks in the home. We questioned staff on the fire safety procedures and found that they understood fire safety issues. All health and safety policies were available. Certificates for gas, legionella and electrical testing were in date. COSHH guidance was in place and chemicals were stored safely. We discussed health and safety issues with staff and they demonstrated their understanding. The home has an effective system for monitoring accidents to ensure the safety of Cedar House DS0000010650.V378048.R01.S.doc Version 5.3 Page 28 people who live and work at the home. The temperatures of the fridges and freezers were recorded and within safe limits. Health and safety checks, procedures and training make sure that residents are safe. Cedar House DS0000010650.V378048.R01.S.doc Version 5.3 Page 29 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 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 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Cedar House DS0000010650.V378048.R01.S.doc Version 5.3 Page 30 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations The registered persons should make sure that an up-todate list of the names, signatures and initials of all those who administer medication is made available. Residents should be confident that qualified staff always administers their medicines. Cedar House DS0000010650.V378048.R01.S.doc Version 5.3 Page 31 Care Quality Commission London Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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