Care Home: Cedar House Nursing & Residential Home

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What the care home does well Good pre admission assessments are carried out so that the Home can be sure that they are able to meet a residents needs prior to them moving in. The care plans contain good detailed information about the residents needs and how these should be met. The care plans contain information about residents individual preferences and choices. The staff have a good understanding of how to meet the residents needs and were observed to support the residents in a kind and respectful manner. There was lots of laughing and chat between staff and residents on the day of our visit. Residents and a relative told us that the residents receive good care at the Home. Appropriate checks are carried out prior to staff starting work at the Home. Staff then receive effective induction and ongoing training programme which enables them to carry out their roles effectively. The residents spoke highly of the meals provided and the choice that they are offered. One of the comments in a survey states: `the food is excellent, its is fresh and home cooked`. The residents are encouraged to make decisions about their care and about how they live their life at the Home. The medication is managed safely. What has improved since the last inspection? Some areas of the Home have been redecorated, for example, the dining room and some of the bedrooms. A new conservatory has been built and this has lovely views of the garden. The residents enjoy having pet rabbits to look after. What the care home could do better: There have been ongoing problems with the lift and the boilers which the organisation have been addressing. There are still problems with the lift which it is expected will be soon fixed on a permanent basis. There are some bedrooms which are in need of redecoration or new carpets. Some of the windows are also in need of maintenance. The Manager is aware of the need to review the deployment of staff during each shift to ensure that there are always staff available in the conservatory area which is where the majority of residents spend their time during the day. There is a need for increased opportunities for residents to take part in meaningful activities. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cedar House Nursing & Residential Home Church Road Yelverton Norwich Norfolk NR14 7PB     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: Lella Hudson     Date: 0 6 0 7 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 26 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 26 Information about the care home Name of care home: Address: Cedar House Nursing & Residential Home Church Road Yelverton Norwich Norfolk NR14 7PB 01508494207 01508495602 cedars@caringhomes.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Cedar House (Norfolk) Limited care home 26 Number of places (if applicable): Under 65 Over 65 26 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is 26 The registered person may provide the following categories of service only: Care Home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Cedar House is a period residence, with an extension, situated beside the church in the village of Yelverton and is owned and managed by Caring Homes Ltd. It is registered as Cedar House Limited to provide nursing and residential care to older people (not falling into any other category, e.g. with dementia). The main house is on 3 floors served by staircases and a lift. The majority of service user accommodation is on the ground and first floor. The care homes offices and 2 service users rooms are situated on the upper floor. On the first floor the landing area has split-levels and four bedrooms are accessed by a separate wheelchair lift. Care Homes for Older People Page 4 of 26 Brief description of the care home Cedar House stands in pleasant surroundings, having a large garden that is mostly laid to lawn and is surrounded by mature trees. A new conservatory has been built. The location is rural, to the south east of Norwich, and there are no amenities in the immediate area. Access to the nearest shopping and social centre is by private car or by a bus service. . Fees are dependent on the needs of residents. For up to date information about fees please contact the Manager. Care Homes for Older People Page 5 of 26 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 report contains information gathered about the Home since the last Key Inspection in June 2007. It includes information provided by the organisation within the Annual Quality Assurance Assessment (AQAA) that they sent to us as well as information from resident/relatives surveys and also information gathered during an unannounced visit to the Home on 6th July 2009. During our visit to the Home we spoke to the new Manager, the Regional Manager, two members of staff, two residents and a relative. We also looked at records and had a look around the Home. There were 22 residents at the Home at the time of our visit. A new Manager started working at the Home on 1st June 2009 and she has started the Care Homes for Older People Page 6 of 26 process for becoming registered with the Commission. 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 following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 26 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 26 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 26 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. A detailed pre admission assessment is carried out to ensure that the Home are able to meet individual residents needs. Evidence: We looked at the pre admission assessments for four of the residents. These are detailed and contain good information for staff about the needs of the individual resident. The records show that information is gathered from the resident, from their relatives/carers and from any health care professionals as required. Staff who spoke to us said that they feel that the information that they receive prior to a resident moving to the Home is good. Care Homes for Older People Page 11 of 26 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. The personal and health care needs of the residents are met in a respectful and kind manner. Medication is managed safely. Evidence: We looked at two of the care plans in detail. The organisation has recently introduced a new format for care plans and the information has been transfered onto these new formats. The care plans that we saw contained very detailed information about the residents needs and how these should be met. They also contain information about the residents individual choices about how they receive their care. For example, one of the assessment forms asks residents about their choice of gender of staff who will be providing care. It asks questions about other choices such as preferred times for getting up and going to bed, for arrangements at night and other important issues. We did see one example of a care plan which would benefit from further detail. This Care Homes for Older People Page 12 of 26 Evidence: was with regard to a resident who shows aggressive behaviour towards staff on occasion. The care plans contain good details such as reminders that a resident likes to have moisturiser put on and another care plan which reminds staff about the importance of using verbal and non verbal forms of communication. We spoke to two residents who both said that they like living at the Home and feel that they are treated well. We spoke to a relative who spoke highly of the care provided to their relative. They said that they are kept informed when their relative is unwell and that the staff communicate with them well. The resident surveys were mostly completed by relatives and they are mixed with regards to views about whether residents get the care that they need. Views are mixed between always and usually. Records show that residents are referred to health care professionals as required. The Home is a nursing home and so there are always qualified nurses on duty but discussions with them show that they refer to specialists, such as skin integrity nurse, when they need to. The majority of the residents spend their time in the large conservatory which looks out onto the garden. The surveys that were returned to us indicate that there are times when there are no staff available in this area. There are currently no call bells in the conservatory but the Regional Manager said that they are due to be fitted the week after our visit. The new Manager is reviewing the way in which staff spend their time and is aware of the need to ensure that there are always staff available in the conservatory area to ensure that residents needs can be met quickly. Staff who we spoke to have a good understanding of the residents needs and said that they feel that the care plans contain good information about individuals needs. Staff said that there is always a nurse on duty so that if they have any concerns they are able to get advice quickly. The management of the Home responds positively to comments/concerns raised about care. We spoke to a relative who told us that when they raised a concern about their relatives care it was addressed immediately and has never arisen again. We could see from records that the deputy manager has recently reviewed the times at which residents get up to ensure that this is at the time of their choosing. The majority of bathroom and toilet doors have locks on although we did see at least Care Homes for Older People Page 13 of 26 Evidence: one that was missing which does compromise residents privacy. We observed staff supporting residents in a kind and respectful way. They were mindful of residents dignity when assisting them with mobility aids. We looked at the medication system in use. Medication is stored appropriately and we could see that regular audits are carried out by the deputy manager. Only the qualified nurses administer medication and there is always a nurse on duty. We looked at the guidance available for the use of PRN (as required) medication and could see that risk assessments are carried out for these. These assess whether the resident is able to make their own choice about needing PRN medication and instructs staff to ask the resident where this is possible. The guidance for one resident would benefit from being more detailed to ensure that all staff are clear about when to administer PRN. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents dietary needs are met and residents enjoy their meals. Residents are not offered enough opportunities to take part in meaningful activities. Evidence: The Activities organiser currently only works for ten hours a week. There are photographs around the Home of recent activities which have included a Falconry Day at the Home, parties, growing fruit and vegetables. Residents told us that they really enjoy taking part in activities and that they wished that there were more things taking place. The Manager told us about plans to develop an activity room and reminiscence areas. There are pet rabbits in the garden which the residents help to look after. The responses within the surveys that we received stated that there are sometimes activities taking place with one survey stating usually. Several additional comments were made about the lack of activities and stimulation taking place for the residents. Staff said that they have more time in the afternoon to spend with individual residents and we did observe this taking place on the day of our visit. However, there is a need to increase the opportunities for residents to take part in meaningful activities. Care Homes for Older People Page 15 of 26 Evidence: We spoke to two relatives and they told us that they are always made to feel welcome in the Home and that staff keep them informed about issues relating to their relative. One of the residents said that they are very happy with the care provided to their relative. Meetings take place for residents and relatives and we saw the minutes of these. Residents told us that they enjoy their meals. One resident said that we always get nice food and can have as much as we like. Another resident said that the chef is brilliant. We spoke to the chef and he has a good understanding of the residents dietary needs as well as their individual likes and dislikes. The menus show that residents are offered a choice. We observed staff assisting residents at lunchtime and this was done in a respectful way. Residents are able to make a choice about where they have their meals, some stay in their rooms, some had lunch in the conservatory and some in the dining room. The care plans contain information about residents dietary needs and individual choices and preferences. A nutritional assessment is carried out when residents move to the Home and this is regularly reviewed and updated as required. Discussions with staff show that they have a good understanding of residents nutritional needs and how these should be met. Care Homes for Older People Page 16 of 26 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. Complaints are taken seriously and action is taken to address any issues that arise. Procedures and staff training are in place to provide protection to residents from abuse. Evidence: We looked at the complaints record and could see that there has been one complaint made about the care since the last Inspection. We spoke to the person concerned and they were satisfied with the way in which their complaint had been dealt with and said that the situation had not occurred again. The responses within the surveys all state that they are aware of who to speak to if unhappy about something. The relatives and residents are able to raise issues at the relatives/residents meetings as well as the opportunity to use the formal complaints procedure if they feel the need to. The Commission has not received any complaints about the Home. Staff who spoke to us said that they have received training about Safeguarding. They were all aware of the Whistle blowing procedure and said that they felt confident in raising any issues with the Manager. Care Homes for Older People Page 17 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home provides comfortable and homely acommodation for the residents however there are some areas that are in need of redecoration and upgrading. Evidence: We were shown around the Home and saw all of the communal areas and the majority of the bedrooms. The quality of the accommodation is varied with some rooms having been recently decorated and others in need of decoration. There are also some rooms in need of new carpets and some in need of new curtains. Some rooms have windows that are in need of attention due to small cracks in the glass or broken sash cords. The Manager said that the water temperatures are regulated and that the radiators are all covered to prevent burns and scalds. Since the last Inspection the dining room has been decorated and the construction of a large airy conservatory has been completed. There is decking outside the conservatory and seating for residents to use in good weather. At the time of our visit the gardens looked attractive and a sunflower competition was taking place. The Home has had ongoing problems with the lift. The Commission has been kept informed when the lift has been out of action and of the action being taken by the Care Homes for Older People Page 18 of 26 Evidence: organisation to ensure that it is mended satisfactorarily. The Manager told us during our visit that there are still problems with the lift but the company come out immediately to deal with them so that the lift is not out of action for more than a couple of hours at a time. They are waiting for a part to arrive which should then sort the problem out permanently. There have also been some problems with the boiler and hot water which the Commission have been notified of but the Manager said that these are fine at the moment. We were told that call bells are due to be fitted in the conservatory shortly the week following our visit. We noted that some areas of the Home were in need of cleaning, there were cobwebs in some bedrooms behind the curtain areas. There were also unpleasant odours in some bedrooms. The communal areas of the Home were clean and there were no unpleasant odours. Care Homes for Older People Page 19 of 26 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. The staffing levels are adequate to meet the needs of the residents living at the Home at the time of our visit. Staff receive appropriate training and support to carry out their roles effectively. Recruitment procedures ensure that appropriate checks are carried out prior to staff starting work at the Home. Evidence: The views within the residents/relatives surveys about the staffing levels were mixed with additional comments made about the fact that there are often times when there are no staff available in the conservatory. The Manager is aware of this and is going to look at the deployment of staff to ensure that there is someone available in the areas where the majority of residents spend their time. At the time of our visit residents told us that they felt that there were enough staff on duty. Staff told us that they feel that the staffing levels are adequate to meet the current residents needs. There were 22 residents living at the Home on the day of our visit. The current staffing levels are for there to be a qualified nurse on duty plus four carers during the morning, one qualified nurse and three carers during the afternoon and one qualified nurse and two carers over night. In addition to this there are catering and domestic staff on duty every day. Care Homes for Older People Page 20 of 26 Evidence: The Manager is aware of the need to monitor the staffing levels to ensure that they are adequate to meet the residents needs, particular if these change. We saw the training records for staff and also spoke to the staff about the training that they receive. They said that they feel that they receive relevant training to enable them to carry out their roles. All staff receive mandatory training which is provided through a mix of external trainers, the organisations own training manager and through e-learning (through the use of a computer). Currently the training records are not including the additional training that staff attend such as sessions provided by the nurses and the Manager said that she will update the training matrix. The nurses receive additional training to ensure that they are kept up to date with current nursing procedures and policy. We looked at a selection of staff files and can see that appropriate checks are carried out prior to staff starting work at the Home. Staff confirmed that they were asked to complete a Criminal Records Bureau check and to provide names of referees prior to starting work. The staff whom we observed during our visit were kind and respectful towards the residents. They respected their privacy through knocking on doors prior to entering. There was a lot of laughing and chat taking place in the conservatory between staff and residents. Care Homes for Older People Page 21 of 26 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. There has been two changes of Manager within the last year but there is now a permanent Manager who is providing good day to day management of the Home. The health and safety needs of the residents and staff are protected by measures put in place by the Home. The Home has an ongoing quality assurance system which involves the residents in reviewing the quality of the service provided. Evidence: The Homes manager left in 2008 and there was an acting manager for a few months. A new Manager, Sarah Taylor, was appointed in June 2009 and so had only been at the Home for approximately a month at the time of our visit. The Manager is a qualified nurse and has previous relevant experience although this is her first role as a Homes Manager. Ms Taylor has started the process of applying to the Commission to become the registered Manager. Care Homes for Older People Page 22 of 26 Evidence: Staff, residents and a relative spoke highly of the new Manager and said that she had made a point of getting to know everyone as soon as she started work at the Home. Staff said that she is approachable and supportive. The Managers hours are not counted as part of the staffing ratio. The Home also has a deputy manager who does work most of her hours as part of the nursing team. The deputy is responsible for overseeing the medication system and does have other management responsibilities. It may be necessary for the organisation to enable her to have additional management hours to ensure that she can carry out these responsibilities without trying to provide nursing support to the residents at the same time. The organisation has a Regional Manager who was present during our visit to the Home. The Regional Manager has been providing additional support to the Home whilst there have been changes to the management and continues to provide induction and support to the new Manager. Discussions with staff and a look at records show that staff have regular supervision. These include 1:1 sessions as well as staff meetings. Records are kept of meetings. Staff said that they feel well supported and that there is always someone that they can speak to if they are not sure of something. There is a management on call system in place so that the nurses also have someone to refer to if they need advice. We looked at a selection of health and safety records. We could see that regular maintenance and servicing takes place of equipment including the lift, hoists and fire safety equipment. The Manager confirmed that the Gas Safety check was carried out two weeks previously but that they have not yet received the certificate. The Regional Manager also said that an external fire safety company are due shortly to review and update the fire risk assessment. Risk assessments are carried out for the building in general and also for individual residents. Risks are considered and clear plans put in place to manage them. The organisation has an internal quality assurance department who oversee the regular audits that the Manager is expected to carry out. The organisation also use questionnaires to obtain the views of relatives and residents. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 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 19 23 It is required that 30/11/2009 redecoration and recarpeting takes place in those areas in need of it To ensure that residents live in homely, comfortable, well maintained accommodation 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 Care Homes for Older People Page 25 of 26 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). 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