Care Home: Cedar House Residential Care Home

What the care home does well The following comments were made by staff either during the inspection or through their surevys:- "I feel that the home does most things well. Full support from the manager and team members" "Cedar House is a lovely home to work in and I enjoy coming to work" "It`s not just a job, we all care" "We welcome relatives and friends to the home" "I feel everyone gives 100%" "Cedar House is a nice place to work. I really enjoy my role here" "It does really well with all the care the residents need". Residents or their relatives said "They really look after you" "Very impressed with the hardworking staff" "They help me to be independent" "They treat you with respect". We observed that the staff and manager know people`s needs and they treat them as individuals. We heard the staff talking about residents` needs in a knowledgeable way. The owner and manager both said that training is important and we saw that staff were given support and opportunities to do national vocational qualifications. What has improved since the last inspection? The home has looked at the activities it provides and tries to make sure there are things for everybody. More variety has been introduced into the menu. Mrs Ransley told us that she feels communication between staff, staff and management and also with external agencies, has improved. What the care home could do better: There are no requirements from this inspection. Mrs Ransley has identified that she wishes to make some improvements to the care plans, to include a specific night care plan. She told us that she will continue to look at activities provided to make sure people have choices that they want. We noted and discussed with Mrs Ransley that the AQAA needs to be completed more fully. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cedar House Residential Care Home 93 Seabrook Road Hythe Kent CT21 5QP     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: Christine Lawrence     Date: 1 2 0 5 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 24 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 24 Information about the care home Name of care home: Address: Cedar House Residential Care Home 93 Seabrook Road Hythe Kent CT21 5QP 01303267065 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 (Hythe) Ltd care home 29 Number of places (if applicable): Under 65 Over 65 29 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 29 The registered person may provide the following category of service only: Care home only (OP) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Cedar House is registered to provide residential care for up to 29 older people. The home is large, a detached property with well maintained gardens to the side and rear. There is sunroom in the rear garden and parking to the front of the home. Cedar House is situated approximately 400 yards from local shops, a post office and a pub. It is a mile from Hythe centre and is on the local bus route. Each bedroom has a private wash-hand basin and call bell, some rooms have ensuite facilities. On the ground floor there are two lounges and a separate dining room. There is also a quiet sitting area on the ground floor. Care Homes for Older People Page 4 of 24 Brief description of the care home The registered provider, Mrs Jacqueline Barham, takes an active role in the running of the home. The registered manager, Mrs Christine Ransley is responsible for the day-today running of the home. The range of fees for this home is between £325 and £530 per week Care Homes for Older People Page 5 of 24 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: The inspection visit was unannounced and started at 10.30 and finished at 15.30. We (the Care Quality Commission, CQC) looked at various records in the home. Information from the previous inspection carried out on 24 May 2007 and the annual service review undertaken in May 2008 was also referred to. We observed the residents who live at the home, noting how they reacted to staff and how relaxed and comfortable they were within the home. A tour of the building was undertaken and this included residents rooms. We made observations of staff interacting with, and supporting residents. We spoke to staff including the manager and staff on duty. We spoke to some of the residents. We spoke to the owner and we sat in on the staff shift handover. We used some information from the Annual Quality Assurance Assessment (AQAA) completed by Mrs Ransley before the inspection. We also receive surveys from Care Homes for Older People Page 6 of 24 residents and staff and information from them is also used in this inspection. 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. 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 8 of 24 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 9 of 24 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 can be confident that the home judges that it can meet their needs because it assesses their needs before they move in. Evidence: We looked at various care plans and assessments for this inspection. This included new people as well as residents who had been at the home for a while. Mrs Ransley, the manager does the assessments, sometimes with the support of other staff. She told us it was important to be sure that someone would be happy in the home as well as ...us being able to meet their needs. The care plans and assessments we saw reflected that other people such as care managers, relatives and friends (where appropriate) would be involved. Care Homes for Older People Page 10 of 24 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. Residents benefit from having an individual plan of care which identifies how their health and care needs are to be met. They are protected by the homes procedures for dealing with medication and they can be confident that they will be treated with respect. Evidence: We looked at four care plans for this inspection. The care plans are based on an assessment of individuals needs and wishes or preferences and they contain information for staff so they know how to provide the necessary support. We saw examples such as bathing and mobilizing noted in guidance and the care plan objectives identify aims, objectives, action, goals and comments. More detailed information is given for some things for some people; these care plans are individual and vary according to what people can do for themselves and what they need help with. The manager told us that she plans on improving the care plans over the coming months and she intends to include a specific night care plan. She also said that new photographs were being done for all residents care plans to ensure they were up to Care Homes for Older People Page 11 of 24 Evidence: date and meaningful. The care plans contain a section to indicate that the resident or their relative have been involved with compiling the care plan. There were risk assessments in place for a variety of things, which varied according to individuals different needs. We saw lots of examples of residents health care needs being identified. This included looking after peoples skin, monitoring their weight, and providing access to healthcare professionals. Each persons care plan contains a record of this eg GP visits, involvement of community nurses, physiotherapists, chiropodists, opticians, specialist nurses such as for advice and support regarding Parkinsons Disease etc. Other specialist health professionals will be contacted as required. The home gets special equipment if needed and we noted examples of people having special mattresses and cushions. We looked at how the home manages medications and noted that the storage and record of administration were properly done. Staff who give out medications have received appropriate training and the manager informed us that she carries out an inhouse audit to ensure that medicines are correctly administered. We observed staff to be polite and respectful in their interactions with residents. If anyone has a particular preference about what name they prefer to be called it is noted in their care plan. We saw staff knock on doors before entering rooms. In our survey/questionnaire for members of staff we ask, are you given up to date information about the needs of the people you support (for example in the support plan)? All four people who completed a survey said that they always were. They also made the following comments Given at handovers, and care plans are updated regularly and any changes documented We are always being updated about the people we care for and look after. We sat in for a shift handover and noted it was detailed and relevant. In our survey/questionnaire for people who live in the home we ask, do you receive the care and support you need? Everyone said that yes they do. Care Homes for Older People Page 12 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their preferences will be identified and responded to and that they will be enabled to maintain contact with friends and family. Residents will be enabled and encouraged to make choices and they will benefit from healthy, well-presented food at a time and place to suit them. Evidence: The AQAA gave us information about some of the activities and diversions provided at Cedar Lodge and we were told about other things through discussions on the day of the visit and through the surveys. This currently includes music for health sessions, hand and foot massages, manicure sessions, film afternoons, bingo, skittles, scrabble and walks out if the weather is fine. A relative said that their relative had enjoyed ...bingo, a party and a musical afternoon... recently. An Activities Folder is maintained providing information about who likes what and who has done various activities. We noted that staff encourage people to do things but respect their decision not to join in. The care plan assessment identifies if anyone wishes to practice their religion and currently this is satisfied by local church representatives visiting fortnightly in a general sense and one person receives communion weekly from her church representative. The care plans identify interests, both past and present, if Care Homes for Older People Page 13 of 24 Evidence: known. There are no restrictions on people visiting and Mrs Ransley demonstrated her awareness of residents need to maintain relationships and memories of past relationships. The manager told us that people are encouraged to be as independent as possible and to make choices and decisions. We saw examples of this within the care plans such as people choosing what time to get up and what time to go to bed, and during the inspection. This included where to eat meals, whether to be with people or on their own and what to eat. The staff served meals individually, asking what people wanted. The manager had told us that in response to some comments from residents changes had been made with regard to meals. One resident told us ...the food has improved lately.... The home makes sure people can be as independent as possible with eating by providing equipment such as plate guards. Residents comments included:- I prefer to stay in my room with my newspaper and television, just going to the dining room for lunch You can make choices and decisions ...the food is plentiful.... Care Homes for Older People Page 14 of 24 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 would be handled objectively and in keeping with the homes appropriate procedures and residents and their representatives can be confident that any concerns will be listened to, taken seriously and responded to. Staff are aware of adult protection issues and there are systems in place which create an atmosphere for protecting residents from abuse. Evidence: The home has a complaints policy and residents and their relatives confirmed both through surveys and on the day of this inspection, that they know how to do this if necessary. One resident said ... Chris (manager) is very approachable.... All three surveys answered yes to the question Do you know how to make a complaint? Staff also ticked yes in answer to the question Do you know what to do if a service user/relative has concerns about the home, adding that ...the complaints procedure is available to all... and ...report to my manager or senior on shift.... The manager notes even small expressions of dissatisfaction, indicating that she takes things seriously. A complaint forwarded to the home by us was handled appropriately. We were informed that staff have either received adult protection training or they were scheduled to do it soon. This was reflected in the training records seen. The manager and owner also recently demonstrated that they are knowledgeable about the safeguarding procedures and work with social services to find solutions. There are Care Homes for Older People Page 15 of 24 Evidence: policies and procedures in place relating to safeguarding people and this includes a policy about the disclosure of abuse and bad practice (whistle blowing). Care Homes for Older People Page 16 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a safe, well-maintained home which is homely, clean, comfortable, pleasant and hygienic. Evidence: We looked round most of the building and saw communal areas, some bedrooms and bathrooms etc. There are lounges and a dining room on the ground floor. There are various garden areas including places to sit. There is an alcove area that the manager told us they sometimes use for serving ice creams through the window when the weather is suitable and people are sitting outside. There is ramped access to parts of the garden. The front of the house is kept neat and welcoming with hanging baskets etc. The handyman does the gardening, cleans windows and shampoos carpets and carries out minor repairs and decorating. The home was clean and fresh on the day of the inspection and the surveys confirmed that this was the usual way the home was. Infection control procedures are in place, with good hand washing facilities. The laundry area is satisfactory. A new role of housekeeper has been created to ensure all aspects relating to cleanliness are monitored. Care Homes for Older People Page 17 of 24 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 sufficient staff who are competent and trained. Residents are supported and protected by the homes recruitment procedures. Evidence: The manager noted in the AQAA that ...we are always monitoring rotas, making sure that staffing levels are enough.... The staff are a mixture of experiences and backgrounds. Twelve people so far have a national vocational qualification (NVQ) in care at level 2 or above and the manager confirmed that this is an ongoing part of the training programme. Two senior staff are both trying for NVQ level 4 but have experienced problems with training providers. Five people are currently doing a distance learning course about dementia, arranged by one of the deputy managers. The cook is undertaking a course relating to nutrition. There is now an area which can be used for staff training. We looked at two staff records and noted that the homes recruitment procedure is thorough and includes application forms, interviews, POVAFirst checks as well as criminal record bureau checks, references, statements of terms and conditions of employment and the provision of a copy of the general social care councils code of practice. Although the induction training is satisfactory we discussed with the manager that including the common induction standards would greatly improve this and she Care Homes for Older People Page 18 of 24 Evidence: agreed to look into this. The surveys completed by residents all ticked always in answer to the question Are the staff available when you need them? Some comments from residents and relatives, either through surveys or talking to us, included the following:- Very impressed with the hardworking staff They are good The girls are very kind and very helpful The following things were either said by members of staff on the day of the inspection or were included as comments in the completed surveys:My manager is very proactive with us and supports us all well Both owner and manager will step in if they need to I think we could do with another person sometimes in the afternoon Manager is always willing to help on the floor if required to do so We keep up to date with training courses I enjoy the training days In the past two years I have had the opportunity to do my NVQ 2 and 3 in social care and have had real support from my manager Care Homes for Older People Page 19 of 24 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 benefit from the home being managed by someone who is competent, experienced and knowledgeable. Residents financial interests are safeguarded and their views are sought. Staff and residents have their health and safety promoted and protected. Evidence: Mrs Christine Ransley is the registered manager. She has her NVQs in level 3 and 4 and has achieved the registered managers award. Her record showed that she undertakes other training to ensure she is up to date with practice eg first aid, manual handling. She informed us that she plans to do some training with regard to the Mental Capacity Act and the Deprivation of Liberty safeguards. Mrs Barham is the owner and she takes an active part in the running of the home. Both she and Mrs Ransley also intend to undertake some IT training. Relatives and residents we spoke to or who completed surveys, commented that they Care Homes for Older People Page 20 of 24 Evidence: were very confident about the service provided; they confirmed that Mrs Ransley was always receptive to their opinions and comments. Staff were also positive about the management. Mrs Ransley said she sends out questionnaires to relatives and residents and takes note of what is said. Recently that has involved some changes with the menu and food provision and also looking at activities on offer. One comment was She (the manager) always make time to listen to me. We discussed with Mrs Ransley the opportunity to use the AQAA each year as a detailed quality monitoring document in which she could reflect the opinions and comments of the people using the service as well as any other interested parties. The content of the AQAA could then be used to effectively inform the homes own quality assurance. Mrs Ransley explained that the home does not get involved with residents finances other than to invoice for fees or to invoice when the home has paid for something on behalf of a resident such as hairdressing. Mrs Barham has the responsibility for this. Receipts are kept and provided to the person paying ie a relative, resident or someone acting on behalf of the resident. We did a spot check on maintenance and service contracts and these were seen to be satisfactory. Staff receive training in regard to health and safety. Care Homes for Older People Page 21 of 24 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 22 of 24 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 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 23 of 24 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. 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. 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