Care Home: Cedar Lawn

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What the care home does well Information is in place to tell new people about the home, to help them to make an informed choice to move in or not. Before people move in they are encouraged to visit the home and stay for a short time before making a final decision to stay there. Care plans are in place containing satisfactory levels of information to enable staff to meet people`s needs. The people at the home are involved in reviewing their care plans to make sure they are kept informed and so that they retain some control over their lives. People are supported to gain access to health professionals and the home has good links with the community nursing service so that people receive support from nurses where necessary. The people at the home speak very highly of the staff and of the support provided them. When speaking about the staff, one person said, "you really can`t beat them" and another commented, "everything about the place is nice, everyone is lovely and friendly". Another said," it`s a lovely place to be, I am very happy here". Everyone looked very comfortable and at ease with staff and there was a friendly atmosphere in the home. The home employs an activities co-ordinator who consults with the people at the home and arranges an excellent range of activities for people to take part in. Regular church services also take place at the home providing opportunities for people to take part in church worship. People are consulted over the menus and are able to choose an alternative meal if they wish to do so. The food is well cooked and special diets are catered for, where necessary. Most people were observed to enjoy a good chat with friends at lunchtime. The food hygiene inspector has recently visited and awarded the kitchen a gold award for food safety, demonstrating good safe hygiene standards. Suitable complaints procedures are in place at the home should people wish to raise any issues. There have been no complaints at the home since the last inspection. The home is clean, fresh and well furnished. Overall the home provides good access for wheelchair users and specialist equipment is available for people with disabilities to support independence and safe care practices. The home provides a variety of staff in different roles to make sure that people`s needs are met and the home runs well, including care staff, housekeepers, cooks, a handyman, activities co-ordinator and managerial staff. Staff are being provided with access to appropriate training courses to equip them to carry out their work roles effectively. The home is well managed and has good systems in place for seeking people`s views about the service they receive. Suitable arrangements are in place for maintaining equipment in good working order and ensuring a safe place for people to live and work in. What has improved since the last inspection? People`s needs are being assessed properly before they move in and this process continues once they are in the home, so that people can have confidence that their needs will be met. Risks are identified and addressed in care plans, in order that staff have the information they need to support people in a safe manner. Staff are properly recruited to the home. This includes taking up Criminal Record Bureau checks and references to ensure that they are suitable to work at the home. Good work has taken place to decorate the communal areas and to provide replacement carpets and furniture to make the home nicer for the people living there. CARE HOMES FOR OLDER PEOPLE Cedar Lawn Cedar Close Stratford On Avon Warwickshire CV37 6UP Lead Inspector Kevin Ward Unannounced Inspection 10th July 2008 08:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedar Lawn Address Cedar Close Stratford On Avon Warwickshire CV37 6UP 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) 01789 205882 01789 292752 home.str@mha.org.uk www.mha.org.uk Methodist Homes for the Aged Manager post vacant Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd August 2006 Brief Description of the Service: Cedar Lawn is a residential care home for older people managed by Methodist Homes. The home is registered for 34 older people requiring personal care and accommodation. The home is close to the town centre of Stratford Upon Avon and the facilities offered within the town. Buses run regularly nearby. The organisation has almost 50 care homes throughout England and Wales. Cedar Lawn was originally a large private dwelling, which has subsequently been converted and extended to provide residential accommodation suitable for older people. The main lounge and dining area are centrally located on the ground floor, however service users may also use the reception area or a sitting room on the first floor. In addition the home has a small quiet/prayer room on the first floor. All facilities, with the exception of five bedrooms, can be reached without the need to negotiate steps. Car parking is available at the front and side of the home. Extensive gardens are to the side of the home. Fees at the time of the inspection visit are in the range of £510-608 per week. The fees do not include newspapers, toiletries, chiropody or hairdressing. Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that people who use the service experience good outcomes. This was a key inspection. A key inspection addresses the essential aspects of operating a care home. This type of inspection seeks to establish evidence of continued safety and positive outcomes for the people using the service. The inspection focused on assessing the main Key Standards. As part of the inspection process the inspector reviewed information about the home that is held on file by us, such as notifications of accidents, allegations and incidents. The manager completed and returned an annual quality assurance questionnaire on time, containing helpful information about the home in time for the inspection. Questionnaires were completed and returned by 4 people that live at the home three health professionals and 6 relatives, enabling them to give their views of the service. The inspection included seeing everyone living at the home and case tracking the needs of three people. This involves looking at people’s care plans and records and checking how needs are met in practice. Other people’s files were also looked at, in part, to verify the healthcare support being provided at the home. Discussions were held with three staff on duty as well as the assistant manager a senior care assistant, a cook, a handyman and a community nurse. A number of records, such as care plans, complaints records, staff training certificates and fire safety records were also sampled for information as part of this inspection. What the service does well: Information is in place to tell new people about the home, to help them to make an informed choice to move in or not. Before people move in they are encouraged to visit the home and stay for a short time before making a final decision to stay there. Care plans are in place containing satisfactory levels of information to enable staff to meet people’s needs. The people at the home are involved in reviewing their care plans to make sure they are kept informed and so that they retain some control over their lives. Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 6 People are supported to gain access to health professionals and the home has good links with the community nursing service so that people receive support from nurses where necessary. The people at the home speak very highly of the staff and of the support provided them. When speaking about the staff, one person said, “you really can’t beat them” and another commented, “everything about the place is nice, everyone is lovely and friendly”. Another said,” it’s a lovely place to be, I am very happy here”. Everyone looked very comfortable and at ease with staff and there was a friendly atmosphere in the home. The home employs an activities co-ordinator who consults with the people at the home and arranges an excellent range of activities for people to take part in. Regular church services also take place at the home providing opportunities for people to take part in church worship. People are consulted over the menus and are able to choose an alternative meal if they wish to do so. The food is well cooked and special diets are catered for, where necessary. Most people were observed to enjoy a good chat with friends at lunchtime. The food hygiene inspector has recently visited and awarded the kitchen a gold award for food safety, demonstrating good safe hygiene standards. Suitable complaints procedures are in place at the home should people wish to raise any issues. There have been no complaints at the home since the last inspection. The home is clean, fresh and well furnished. Overall the home provides good access for wheelchair users and specialist equipment is available for people with disabilities to support independence and safe care practices. The home provides a variety of staff in different roles to make sure that people’s needs are met and the home runs well, including care staff, housekeepers, cooks, a handyman, activities co-ordinator and managerial staff. Staff are being provided with access to appropriate training courses to equip them to carry out their work roles effectively. The home is well managed and has good systems in place for seeking people’s views about the service they receive. Suitable arrangements are in place for maintaining equipment in good working order and ensuring a safe place for people to live and work in. What has improved since the last inspection? People‘s needs are being assessed properly before they move in and this process continues once they are in the home, so that people can have confidence that their needs will be met. Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 7 Risks are identified and addressed in care plans, in order that staff have the information they need to support people in a safe manner. Staff are properly recruited to the home. This includes taking up Criminal Record Bureau checks and references to ensure that they are suitable to work at the home. Good work has taken place to decorate the communal areas and to provide replacement carpets and furniture to make the home nicer for the people living there. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 8 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 Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable admission procedures are in place so that people are reassured that their needs can be met before they move into the home on a permanent basis. People’s rights are underpinned by proper information and contracts. EVIDENCE: Three people files were checked. Each file contained a copy of a pre admission, domiciliary assessment and an assessment summary carried out upon admission to the home. Several people at the home confirmed that their needs had been assessed with their involvement or that of relatives, as part of the admission process. Similarly they confirmed that they / their relatives had visited the home before moving in or had been admitted for a temporary stay to see if they liked the home before confirming their move to the home. A senior carer explained that a service user information pack, containing essential information about the home is passed to people as part of the admission process. The admission pack was seen to contain up to date information, including the current fees charged. Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 10 A Statement of Purpose was also seen at the home, providing a detailed account of the home’s aims and objectives. Current contracts were see on four people’s files. In three cases the contracts had been signed by people / their relatives and the manager. A senior care worker explained that the home has informed the person’s relative of the need to sign and endorse the contract. Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living at the home are provided with the support they need to meet their personal care and health needs. EVIDENCE: Three people’s care plans were checked. A good range of care plans and risk assessments were in place for all three people, reflecting their assessed needs, recorded in the assessment summaries. Personal histories were also on file. This information is important as it helps staff to recognise people’s past experiences, interests and achievements prior to moving to the home. Satisfactory records were in place to demonstrate that a person with pressure area care needs was having their needs monitored and addressed. This included a waterlow risk assessment score, turning charts, skin photographs, records of care given and nurse’s visits. A community nurse commented positively about the care at the home and the prompt actions of staff to bring any concerns to the attention of the nursing service. Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 12 The needs of a person with diabetes are appropriately reflected in their care plan and staff demonstrated a good awareness of the support requirements and dietary needs of the person concerned. Entries in people’s health notes indicate they are being provided with access to health professionals, such as GP, chiropodist and community nurses, where necessary. Another person’s are plan had been updated to take account of a recent admission and catheterisation. The advice in the care plan talks in general terms about giving help to change the catheter bag and comments by staff indicate that they were aware of the support they are meant to provide. A senior care worker explained that the person concerned has been trained to manage their own care in this regard to retain their independence. An assistant manager explained that there is normally a more detailed catheter care protocol in the person’s room that has been written with their involvement but this was not available as the person concerned had gone out for the day, with the protocol. The assistant manager agreed to arrange for a protocol to be agreed and signed by a continence nurse specialist. This is necessary to ensure that all the information is correct and includes relevant information to reduce the potential for infections. New care plans have been introduced that are written in the first person. Two people at the home confirmed that they have been involved in writing their care plans / review records. Two staff confirmed that they involve people in monthly reviews and ask them to sign the records, evidence of which was seen on people’s files. A visiting relative also indicated that communication with the home is good and that they are kept well informed of relevant issues. In a survey returned to us, a relative states, “There is always a friendly atmosphere. The manager knows all the residents by name and staff are treated almost like friends because of the way they behave to the residents”. Like the care plans, the daily care records are also written in the first person. This can be problematic as it infers the record is being written from the perspective of the person concerned, or with their involvement when this is not the case. For example an instance of a person exhibiting inappropriate behaviour had been recorded as though the person concerned had written it themselves when clearly they had neither done so nor seen or signed the records. One relative has raised concerns that there have been occasions that a person at the home has had to miss out on a bath, due to short staffing. A senior care worker explained that bathing frequency is agreed with people as part of the admission process (verification of this was seen on people’s records). The senior care worker explained that a person at the home had required additional baths, due to personal care requirements and that the care plan had been changed to include a daily bath instead of two baths a week. The senior care worker said that similar arrangements could be agreed for other people where necessary. Since the site visit the manager has agreed to review people’s Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 13 satisfaction with the bathing arrangements to check they are happy that their needs continue to be met appropriately. All except one person was seen for their comments. The people at the home commented very positively about the care provided them by the staff and indicated it is rare to have to wait more than a few minutes for staff attention. Several people confirmed that they have satisfactory access to the alarm call bell system and indicated that staff are always very prompt to respond if it is used. Some people at the home have been provided with alarm call pedants to wear so that they can trigger assistance if necessary. One person said, “the staff are marvellous, you couldn’t beat them” and another said “the staff are 101 .” Everyone confirmed that their privacy is respected by staff and that that personal care support is carried out privately behind closed doors. People’s end of life wishes are recorded in their care plans and a high regard is placed on enabling relatives to be involved in supporting people through their last days. Cedar Lawn has now got a relatives room, where relatives can stay during such times of need and so that they remain close to theirn relation during their final days. Some people at the home are enabled to hold and administer their own medication where they wish to so. This is underpinned by a risk assessment designed to clarify that people clearly understand why the medication is necessary and when they should take it. An assistant manager explained that she reviews the risk assessments each month with people to check that it remains apparopriate for them to continue to hold their own medication. Evidence of this was seen in the medication records. The asssitant manager explained that only that only staff that have been trained and assessed as competent to do so give out medication. This verified by certificates and information on two staff files. Most of the medication is provided in blister packs set up by the chemist. The number and type of tablets received in the home is recorded on the medication record. The assistant manager explained that a non blister packed medications, such as paracetamol are checked each weekend so that they can be properly accounted for. This was verified in the medication records. A senior care worker, giving out medication in the morning, demonstrated a good understanding of safe medication procedures. There are currently no protocols on file for giving PRN (as required) medications. This information is important as it ensures that staff are aware of the circumstances under which PRN medications should be given and when other measures should be followed, to ensure that medication is only ever given when necessary. Information leaflets were seen on file containing information about people’s medication so that side effects may be identified and bought to the attention of the GP if necessary. Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People are provided with an excellent range of social and religious activities in keeping with their wishes and are provided with meals they enjoy. EVIDENCE: Comments by people at the home confirmed that they are encouraged to remain involved in the life of the home and are provided with opportunities to engage in a very good range of activities. Examples of activities arranged at the home include: exercises, carpet bowls, story telling, quizzes, croquet, “netball”, craft, making elderflower champagne, flower arranging, reminiscence sessions, pet therapy, reflexology hand massage. The activities are pre planned and arranged by an activities co-coordinator so that people know what’s on offer. People at the home confirmed that they are regularly given ideas for activities and asked what they would like to do so they can contribute their ideas. The activities programme has now been extended to include some activities at the weekends, which is a positive development for people. The home now has a computer suite in a quiet room for people to use. The coordinator explained that arrangements have been made for a college tutor to attend the home to help people to develop their computer skills. The activities Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 15 co-ordinator explained that when people are poorly and confined to their bed, dedicated time is set aside to sit and talk with them to counter isolation. Evidence of this was seen on file. Several people at the home confirmed that they are supported to go on outings and get out to the shops with staff support. One person summed it up, saying, “everyday there is so much to do; no one is overlooked”. Good work has taken place to devise detailed life histories for some people and this work is ongoing. This includes details of people’s past experiences, achievements and people and things that are important to them. This is a valuable exercise so that people’s life experiences, prior to entering the home, are remembered and shared and not forgotten. On the morning of the site visit some people took part in musical worship and exercises and two people went out with relatives. A Methodist service is provided at the home every fortnight and a prayer group is held every month for people who wish to attend. None of the current people at the home are from non-Christian backgrounds that would require different provision. A senior care worker explained that one person is supported by their family to attend worship at a Christian Science church, in keeping with their wishes, which have been recorded on file. Surveys returned by relatives indicate that the home communicates well with them and keeps them informed and updated on developments in people’s care needs. Two relatives spoken with during the site visit also confirmed that they are made to feel welcome at the home and offered a drink. Several people, who were asked, confirmed that they have lockable cupboards in their rooms, to keep their belongings secure if they wish to do so. Several people at the home confirmed that residents meetings are held to consult with them over everyday plans and events in the home and periodic relatives meetings are held to encourage their involvement. The people at the home confirmed that they have been consulted over the menus and are happy with the food at the home. Two people commented that there have been changes in the cooking staff which they are getting used to, as the previous cook had been excellent, although they indicated the cooking was still of good quality. The cook demonstrated a good awareness of individual preferences and dietary needs, including a person with diabetes. Diabetic marmalades and jams were available and the cook explained that she took appropriate measures to ensure that a low sugar diet was provided. In the morning some people were seen to help themselves to breakfast cereals and fruit and other less independent people received assistance from staff. In addition to the main mealtime option there is a list of alternative food that Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 16 people are able to choose from if they wish. Several people confirmed that hot drinks, such as tea and coffee are provided during the morning and afternoon and people are offered a bedtime drink, e.g. horlicks, during the evening. The place settings at the dining tables looked attractive and there is enough space for everyone to sit down together at mealtimes. A healthy buzz of conversation was noticed at lunchtime, making for a pleasant stimulating atmosphere. The people at the home were observed to enjoy an attractively presented, well cooked and wholesome casserole meal at lunchtime. A member of staff was seen to sit with three people to provide them with support / encouragement to eat their meals. The member of staff concerned was seen to offer unhurried and caring assistance in a friendly manner, although this meant sharing her time between the three people. One person that also requires support to eat was out with relatives at lunchtime; otherwise four people in all would have required assistance from the member of staff. There was a delay of several minutes between the time that the meals were bought out and the time the people concerned were offered support to eat, as meals were being brought out to people on other tables. The manager agreed to review this area of practice to ensure that people requiring support receive their meal whist it is still hot. The home has demonstrated good food hygiene practices, having been awarded a gold award for food safety, following a recent inspection of the kitchen by the food hygiene inspector. Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are provided with access to suitable procedures and training to enable them to respond appropriately to any concerns they may hold, so that people are properly protected from harm. EVIDENCE: There have been no complaints to us since the last inspection. A senior care worker explained that there have also been no complaints to the home during the same period of time. This was verified in the compliments and complaints log, which contained several compliments about the service and no complaints. The people at the home confirmed that they knew how to complain and felt they could raise concerns with the manager if necessary. A complaints procedure is available on the notice board in the main entrance to the home for visitors to refer to. There have been no complaints to us about the home since the last inspection. The manager reports that there have been no complaints directly to the home either. The manager confirmed that systems are in place for recording and tracking complaints should this be necessary in the future. The home’s complaints procedure is available in the Statement of Purpose and service user guide and an information pack is kept in the main hallway including the complaints procedure. Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 18 A Prevention of adult abuse policy is available in the home and leaflets on the subject are available in he hallway of the home. Three staff confirmed that they had been provided with safeguarding against abuse training and demonstrated a good knowledge of the organisation’s adult abuse policy, including recognising signs of abuse and how to report any concerns. They were also aware how they might raise any concerns regarding the running of the home should this be necessary. There have been no reported suspicions of abuse at the home since the last inspection that have required referral to Social Services. Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Cedar Lawn provides a clean attractive, comfortable, environment that is equipped to meet people’s needs and encourage their independence. EVIDENCE: The home has 34 bedrooms 27 of which have ensuite rooms. The seven rooms without an ensuite have a private toilet and sink. There are five bathrooms one of which is fitted with a toilet and sink, three communal toilets downstairs and one upstairs. The home has good disability access throughout, including, specialist baths and shower, handrails, grab rails. Extra equipment has been provided where necessary for people’s induividual requirments, e.g. airflow mattresses, raised toilet seats, variable height beds. Consideration has been given to the use of colour and fabrics which do not confuse and clear signage which highlights important areas such as toilet Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 20 facilities. There are two kitchenetees avaiolable for the people at the home and their relatives to make hot drinks should they wish to do so. Since the last inspection the communal areas have been re-decorated, new carpets have been laid and some new furniture has been purchased. Similarly a senior care worker explained that a number of bedrooms have also been redecorated and improved. New energy efficient movement activated lighting has also been purchased. All areas of the home were well lit, making it safer for people with visual impairments to get around. 8 people’s bedrooms were viewed. In all cases the rooms were clean, well decorated, comfortably furnished and well aired. People’s bedrooms were seen to contain items of personal furniture that they have been encouraged to bring with them to make their bedrooms more homely and to their liking. The lavatory and washing facilities within the home are cleaned to a high standard. Bathrooms had been adapted and toilets are located close to communal areas for the benefit of the service users. Sluices are located separately from the toilets and are clean and tidy. The gardens are attractive and well maintained and have seats for people to sit out and relax if they wish to do so. An assistant manager explained that a person at the home enjoys tending the garden. A gardener has recently started at the home one day a week to help tend the plants and maintain the garden in a tidy condition. The handyman at the home cuts the lawns. Laundry facilities were inspected and found to be well organised clean and hygienic. Foul laundry is held separately in red bags and washed at appropriate hot water temperatures to ensure it is thoroughly clean and to control the risk of infection. A suitable clinical waste contract is in place for the safe removal of continence products Staff confirmed that they have ready access to disposable gloves and aprons and are used when carrying out personal care tasks or when handling soiled linen. Hand washing arrangements and paper towels were seen to be available in the toilets to encourage good hygiene practices. Two staff spoken to confirmed that they had received Hygiene and infection control training. Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable procedures are in place for recruiting and training staff so that the people at the home benefit from a suitable staff team equipped to meet their needs. EVIDENCE: A senior care worker explained that there are typically three or four care staff on duty in addition to an activities co-ordinator, housekeepers, cooks and a handy man. This was verified in discussions with staff and sampling recent staff rotas. In addition to the manager the home also employs two assistant managers and two senior care workers to provide sufficient management and shift leadership at the home. Everyone at the home spoke very positively about the care and support provided by staff and confirmed that they are treated with kindness and respect. Similarly people confirmed that they usually find staff to be very prompt to respond to requests for assistance and that it is rare they have to wait for support. During the site there were four staff on duty though one staff member spent some time in the kitchen at lunchtime helping the assistant cook, as the cook was off sick. This was sufficient to meet the needs of the people at the home, notwithstanding a short delay (previously mentioned) in providing staff support to people requiring assistance to eat at lunchtime, which the manager has agreed to remedy in future. Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 22 The files of four new staff employed during the last year, were checked. The records provided evidence confirm that staff are subject to Criminal Record Bureau checks and reference checks, prior to starting work at the home. Supervision records were also seen, as evidence that staff are being provided with planned supervision to support their work and professional development. Two staff verified this. Similarly staff confirmed that they had been provided with an induction and a copy of one staff members induction programme was sampled. Two staff confirmed that they are being provided with a satisfactory range of training courses to enable them to provide safe care practices, as well courses designed to equip them for their caring role, such as National Vocational Qualifications (NVQ’s). Staff training records were sampled, summarising the training provided to staff. Examples include first aid, food hygiene, moving and handling, fire, control of substances hazardous to health, safeguarding against abuse and epilepsy. Some staff have undertaken other care courses, such as dementia training and yesterday, today and tomorrow (a course designed to help staff to support people to plan their funeral arrangements sensitively). In the Annual Quality Assurance document returned by the manager, as part of this inspection, he reports, that the ratio of NVQ qualified care staff is currently 47.8 , with the remaining 52.2 completing the qualification. All new staff that are recruited to Cedar Lawn are asked to complete an NVQ in Care within 6 months of their start date. This indicates a positive commitment to ensuring that everyone is properly trained and equipped for their role. The housekeeping staff have also completed NVQ’s in housekeeping. A senior care worker explained that some staff have received pressure area care training and diabetes training in the past and pass on these skills to new staff but there has been no recent training on these subjects. Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable arrangements are in place for ensuring a quality service and seeking the views of people at the home to inform the management and development of the home. Good systems are in place for maintaining a safe living environment for people. EVIDENCE: Since the last inspection the home has employed a new manager who has yet to apply to be registered with us. The home has a number of good quality assurance measures in place. The manager completed an annual quality assurance questionnaire and returned it prior to the inspection. The document was completed in a comprehensive fashion and demonstrates that there are systems in place for monitoring and improving the work of the home. Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 24 In the annual quality assurance assessment, the manager reports that meetings are held with people at the home and their relatives. This was verified several people living there as well as staff. A senior care worker said he believed that notes are not currently kept of these meetings. Our report of the previous inspection visit was pinned up on the notice board in the main reception, providing visitors to the home with the opportunity to read it. In the annual quality assurance assessment the manager reports that this involves yearly auditing including a 6 monthly internal audit involving residents and junior staff, annual resident satisfaction survey, annual staff survey. This was verified by an assistant manager and a senior care worker. A copy of a six monthly audit was also sampled and confirmed that people are consulted to check they are happy with the care provided at the home. A senior manager visits the home regularly each month to check that the home that the home is running well and to identify any shortfalls that require action. The reports of these visits indicate that they include seeing the people at the home and staff as well as checking relevant records. Monthly medication audits are also carried by an assistant manager, to check that the medication is being properly managed (recent records were seen). A daily shift handover record was seen containing essential information for staff to pass on to new staff arriving on duty to support good communication and continuity of care. In the annual quality assurance assessment, the manager reports that the home does not generally handle residents money or finances, preferring they remain independent or a family member attorney assists them. However detailed systems are in place to control and record all transactions. The home has a safe for residents use and all rooms have a lockable facility. A senior care worker and an assistant manager explained a robust procedure for recording people’s expenditure where necessary. Several people at the home confirmed that they have lockable storage facilities available to them. In the annual quality assurance assessment the manager reports that all the essential equipment checks have been carried out. The home’s handyman explained that he has responsibility for equipment testing and maintenance checks. A number of records were sampled during the visit to verify this information. Entries in the fire safety log demonstrate that fire alarms and lights are being tested at the correct frequency and that periodic fire drills are being carried out at the home. Records are in place to confirm that the fire safety equipment is being maintained by a suitably qualified contractor to ensure it is in good working order. Certificates and records were seen, providing evidence that gas and electrical equipment has been checked to ensure it remains safe to use. Maintenance records were seen to demonstrate that hot water is being monitored to protect people from being scalded and hoists and lifting equipment are being properly maintained. Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 25 In the annual quality assurance assessment the manager reports that the organisation’s Health and Safety Adviser ensures polices are up-to-date and monitors compliance and the Services Manager carries out quarterly compliance checks at Cedar Lawn. Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 26 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 3 x x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 x x x x x x 4 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 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x 3 x 3 x x 3 Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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 OP7 Good Practice Recommendations Review the practice of writing the care records in the first person as this suggests that the service users and not the staff have written the records, when in fact this is clearly the staffs perspective. Arrangements should be made for a catheter care protocol to be written up and signed by the nurse to ensure that staff have clear and accurate procedures to follow, to ensure that they carry out their support role effectively. Protocols should be devised containing advice as to the circumstances under which PRN (as required) medication should be given to ensure that medication is only given as appropriate. Mealtime practices should be reviewed to ensure that people requiring support to eat, receive assistance in a timely manner, to ensure that they are served their meal whilst it is still hot. Pressure area care and diabetes awareness training should DS0000004214.V368064.R01.S.doc Version 5.2 Page 28 2 OP8 3 OP9 4 OP15 5 OP30 Cedar Lawn 6 OP31 be provided to new staff at the home to ensure they have the skills necessary to support safe care practices. The manager is recommended to promptly apply to be registered with us so that their fitness for the role may be verified. Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cedar Lawn DS0000004214.V368064.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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