Care Home: Cedar Lodge Nursing Home

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What the care home does well People are involved in the development and reviews of their care plans which helps ensure health and personal care needs are met in the way the individual prefers.Cedar Lodge Nursing HomeDS0000063476.V376850.R01.S.docVersion 5.2People who were able to speak with us told us they feel safe and well cared for. People who weren`t able to give their views appeared content and comfortable. Observations made during the inspection found staff to be kind and skilled in their approaches with people. People know how to complain and concerns and complaints are listened to and acted upon. Training opportunities for staff are good which ensures people are cared for by a well-trained and committed staff group who work together to improve people`s quality of life. Staff know the importance of ensuring people`s cultural, religious and other diverse needs are met. Staff are recruited and selected in ways that ensure safe, skilled individuals are employed. The manager, Ms Sonia Seymour communicates a clear sense of direction, leadership and ensures the home is safe and run in the way that the people living there want. The home has in place a good quality monitoring system, based on seeking the views of the people living there so they can decide how improvements are made. What has improved since the last inspection? Care plans are kept up to date so that staff know the care and support people need. Staff have improved how they write in people`s medication records, which shows that people receive their medication when they need it. People are consulted about what they like to do which is recorded in their care plans. We also saw that people are provided with opportunity to influence changes and comment on different aspects of the home. What the care home could do better: Records showed the temperature of the medication room had recently become excessive and the room was too hot on the day of the inspection, which could affect the quality of medication. We brought this to the attention of the manager and provider who thought this was likely to be as a result of the veryCedar Lodge Nursing HomeDS0000063476.V376850.R01.S.doc Version 5.2 recent refurbishment of the medication room and assured us this would be addressed quickly. Although some refurbishments of the home have taken place and people are satisfied with their bedrooms, parts of the home still need attention. There is also a lack of choice of communal areas where people can spend their day which has been highlighted at other inspections. We spoke with the owner about this during the inspection who confirmed that it is still their intention to continue with these plans and incorporate within that further refurbishment. This needs to be followed through by the owner and also looking at ways to develop the environment, in accordance with good practice guidance on dementia care, for example through use of pictures, signage, decor. We brought it to the attention of the owner that improvements are needed with how cupboards and other items removed during recent refurbishment are stored outside of the premises, as they are currently stored next to the front of the building. This does not give a good first impression but is also not good fire safety practice. Key inspection report CARE HOMES FOR OLDER PEOPLE Cedar Lodge Nursing Home 58-62 Kingsbury Road Erdington Birmingham B24 8QU Lead Inspector Rosalind Dennis Key Unannounced Inspection 28th July 2009 09:30 DS0000063476.V376850.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedar Lodge Nursing Home Address 58-62 Kingsbury Road Erdington Birmingham B24 8QU 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) 0121 350 3553 0121 384 4811 United Care Ltd Ms Sonia Seymour Care Home 36 Category(ies) of Dementia (36), Old age, not falling within any registration, with number other category (36) of places Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category 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 (OP) 36 Dementia (DE) 36 The maximum number of service users who can be accommodated is: 36 26th August 2008 2. Date of last inspection Brief Description of the Service: Cedar Lodge is a three storey property situated approximately one mile from Erdington, where there are shops and other community facilities. There is a bus stop nearby. The home is near to Gravelly Hill interchange and motorway network and is therefore convenient for those travelling by car. There is ample off road parking at the front of the premises. There is a ramp to the front door and level access to the rear patio and garden. Stairs and a lift provide access to the first floor and second floors. The home has a good range of specialist equipment, such as hoists to assist people who have mobility difficulties. The home has 14 single bedrooms and 10 bedrooms where two people share a room. Some rooms have en-suites. Rooms which do not have an en-suite facility have a wash hand basin in their room. Toilets, bath and shower are near to rooms. The home has one lounge and dining room on the ground floor. People who use the service and their representatives are able to gain information about Cedar Lodge from the Service User Guide. Information on the current fees charged by the home was not included in the Guide, but is supplied on enquiry in a separate document. It was reported that fees range from £605.134 for a shared room, ranging to £683.354 for a single room with en-suite. The reader is advised to contact the service for up to date Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 5 information. Our inspection reports about this service can be obtained from the home or direct from our website at www.cqc.org.uk Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for service is 2 star. This means the people who use this service experience GOOD quality outcomes. This inspection was carried out by one inspector over one day. The home did not know we were going to visit. The focus of inspections we, the Commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection on 26th August 2008. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think it meets the needs of people living there. Three people living in the home were case tracked. This involves establishing individual’s experiences of living in the care home by meeting them, observing the care and support they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. One person was able to tell us about their day to day life at the home and the support they receive from staff. Another person was not able to give us lots of information but was able to indicate they are satisfied with the home. We spoke with other people who were able to indicate that they are satisfied with their care and feel safe. We also spoke with one visitor and looked at feedback given by staff and people’s representatives when they completed surveys sent by the home. We looked around some areas of the home and observed a sample of care, staff and health and safety records. We spoke with five staff on duty and the manager to establish their views of working at the home and if anything needs to be improved. What the service does well: People are involved in the development and reviews of their care plans which helps ensure health and personal care needs are met in the way the individual prefers. Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 7 People who were able to speak with us told us they feel safe and well cared for. People who weren’t able to give their views appeared content and comfortable. Observations made during the inspection found staff to be kind and skilled in their approaches with people. People know how to complain and concerns and complaints are listened to and acted upon. Training opportunities for staff are good which ensures people are cared for by a well-trained and committed staff group who work together to improve peoples quality of life. Staff know the importance of ensuring people’s cultural, religious and other diverse needs are met. Staff are recruited and selected in ways that ensure safe, skilled individuals are employed. The manager, Ms Sonia Seymour communicates a clear sense of direction, leadership and ensures the home is safe and run in the way that the people living there want. The home has in place a good quality monitoring system, based on seeking the views of the people living there so they can decide how improvements are made. What has improved since the last inspection? What they could do better: Records showed the temperature of the medication room had recently become excessive and the room was too hot on the day of the inspection, which could affect the quality of medication. We brought this to the attention of the manager and provider who thought this was likely to be as a result of the very Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 8 recent refurbishment of the medication room and assured us this would be addressed quickly. Although some refurbishments of the home have taken place and people are satisfied with their bedrooms, parts of the home still need attention. There is also a lack of choice of communal areas where people can spend their day which has been highlighted at other inspections. We spoke with the owner about this during the inspection who confirmed that it is still their intention to continue with these plans and incorporate within that further refurbishment. This needs to be followed through by the owner and also looking at ways to develop the environment, in accordance with good practice guidance on dementia care, for example through use of pictures, signage, decor. We brought it to the attention of the owner that improvements are needed with how cupboards and other items removed during recent refurbishment are stored outside of the premises, as they are currently stored next to the front of the building. This does not give a good first impression but is also not good fire safety practice. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 9 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 Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3. Standard 6 is not applicable as Cedar Lodge does not provide the intensive rehabilitation associated with intermediate care. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed before they move in, which means people can be confident their needs will be met by the home. EVIDENCE: We looked at the care records for two people who have moved to Cedar Lodge since the last key inspection, they were unable to tell us their experience so we looked at the processes which were used. The manager had fully assessed their needs by meeting them in hospital before they were admitted and seeking information about their illness and care needs. This helps to ensure that only people whose needs can be met at Cedar Lodge are admitted. Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 11 The information from the initial assessment had been used to draw up care plans with the person and their representative. This helps staff to know how to give care based on the person’s needs and wishes. A document called “my life before you knew me was present on the file’s we saw and had been completed by the manager with details of the persons life before their illness. This is good practice as it helps staff know more about the person and about things which are important to them. The details within this were included within care plans. We looked at the service user guide, which contains a good level of information about the home, so that people know what the service provides. The guide is available in different formats, such as large print and audio-cassette so that people with varying communication needs can access the information. People and their representatives had been provided with terms and conditions for the home, which contained clear information about the fees charged by the home and what is included within the fee. Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive support and care in the way they prefer and need. Their health needs are met and they are protected by the homes policies and practices regarding medication. EVIDENCE: Most of the people living at Cedar Lodge at the time of this inspection were unable to give their views on the home and the care provided, so most of this inspection is based on observation, looking at documentation to show how peoples needs are met and speaking with staff. We observed staff interacting well with people, providing guidance and help when needed. People appeared content and well looked after. We looked at the care files for the people we case tracked which shows people have detailed care plans and risk assessments in place. This means staff have information on how people prefer to have their needs met taking into account Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 13 any risks to them. Care plans had been signed by the person or their representative to provide confirmation that the care plan had been written up and agreed with them. Care plans provide a good amount of detail. For example for two people who need assistance to move, their care plan described the equipment and techniques needed by staff to move them safely. We later saw staff using the equipment safely and as described in the care plan. We observed that, for people assessed as being at risk of developing pressure sores they had specific mattresses on their beds which are designed to reduce the risk of pressure sores occurring and care plans described what staff need to do. We saw that staff followed the plan, assisting people to rest on their beds in the afternoon. A person who currently has a wound, had documentation in their file showing the care needed of this wound to promote healing, including the type of wound dressing and how often it needs to be changed. The wound had been checked and measured on a frequent basis so that staff could determine if the wound was healing. Staff have good monitoring practices in place for a person who has a condition where they need medicine to help control the level of sugar in their blood. We saw the service looks at ways to support people’s religious, spiritual and cultural needs, including their wishes should they die. We observed people whose appearance reflected what was written in their care plan of how they prefer to look and dress. Four people told us they feel they are well looked after at Cedar Lodge. A relative we spoke with confirmed the home keeps them informed of any changes to their relative’s condition. We looked at the medication records for the people we case tracked and saw these records were up to date and properly completed. The manager or other senior member of staff completes audits of medication. Medication is stored in a locked cupboard so that people are not at risk of taking medication they are not prescribed. We saw records showing that staff monitor the temperature of the medication fridge to ensure that medication is stored at the correct temperature. Staff also measure the temperature of the room where medication is stored. The records showed this temperature had recently become excessive and the room was too hot on the day of the inspection, which could affect the quality of stored medicine. We brought this to the attention of the manager and provider who thought this was likely to be as a result of the very recent refurbishment of the medication room and assured us this would be addressed quickly. We saw the home seeks advice and guidance when it needs to from healthcare professionals, such as GP’s, dieticians, speech and language therapists. A GP Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 14 visited during the inspection and gave positive feedback about the home and how staff follow and put into practice any medical advice given. Staff were seen throughout the inspection checking if people were comfortable and needed anything. Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to take part in activities and events which meet their needs and capabilities. People are offered a choice of meals of foods they enjoy and which meet their dietary and cultural needs. EVIDENCE: Each person has an activities record, detailing the activities they have participated in. This shows that a range of activities are provided, on a one-toone basis with staff, such as talking about past events, or group activities, such as Bingo, music and movement or watching a film. An entertainer visited during the inspection and held a “music and movement” session which some people chose to take part in. A notice board shows forthcoming visits by outside entertainers and planned activities for the week. Care plans include guidance to staff on how to meet people’s religious and spiritual needs. The manager told us how representatives from different religious denominations visit people at the home. One person’s care plan Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 16 included guidance to staff on playing CD’s of religious significance to them and staff told us they play these for the person to listen to. We saw written minutes of meetings which take place on a regular basis and provide opportunity for people to make suggestions for improvement. The minutes show that activities, meals and other topics are discussed with action points produced showing how the home will introduce any change. A meeting held in July looked specifically at activities and whether people think there is enough going on. No issues were raised to suggest people wanted more or different activities. A new cook has started at Cedar Lodge who informed us of their plans to review all of the menus. We saw documentation confirming that staff have been given training on cooking for people from different cultures, which should help to ensure the home is able to cater for different tastes. People who were able to give us their views, told us of their satisfaction with the meals and confirmed they are offered a choice of what they want to eat. One person was very clear in their view that meals have improved significantly since the new cook has started. We observed staff using good approaches with people who need help with eating and drinking and staff were observed providing people with regular drinks of what they wanted throughout the day. Cedar Lodge Nursing Home DS0000063476.V376850.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know how to complain and concerns and complaints are listened to and acted upon. Staff know how to safeguard adults from harm and abuse. EVIDENCE: The complaints procedure is displayed on a notice board in the reception and is also available within the service user guide. The procedure provides people with clear information on the process to follow and who to contact if people want to complain. Three people we spoke with told us they are satisfied with the home and would tell the staff if they were not happy with something. They said the staff and manager would act to put things right. Two people who were less able to communicate their views indicated to us through gestures that they do not have any problems with how they are looked after and feel safe. The AQAA from the manager stated that three complaints have been received in the last 12 months, only one of these complaints was in respect of care practices. The manager told us how she intends to respond to a person who raised a concern about an incident which happened just before this inspection. We looked at the processes used by the manager and provider to respond and act on complaints which shows the home deals with complaints effectively. Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 18 We have not received any recent complaints about the home. The training records we looked at and the staff we spoke with demonstrates that all staff working at the home receive training on safeguarding vulnerable adults from the risk of abuse. Staff told us their role in safeguarding people living at the home from the risk of harm and abuse. The staff team have attended awareness training in the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards and we saw leaflets for staff to refer to. The Act governs decision making on behalf of adults, and applies when people lose mental capacity at some point in their lives or where the incapacitating condition has been present since birth. It is important that staff know how to put the Act into every day practice and the procedure to follow when peoples freedom may need to be restricted. The front door to the home is kept locked to help keep people safe. The manager confirmed that staff support people to go out in the community if they want to. Cedar Lodge Nursing Home DS0000063476.V376850.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25, 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a homely environment and are happy with their bedrooms. The home has limited communal areas, which may limit people’s choice of where they want to relax. EVIDENCE: The home has 14 single bedrooms and 10 rooms where two people share the room. We looked at the rooms for the people we case tracked, which were clean and well-maintained. We saw that people are able to bring in items which are important to them, such as photographs, pictures and small items of furniture. People who share a room have a large floor to ceiling curtain between their beds to provide privacy. The manager reported that people are Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 20 able to choose whether they share a room and those who do are happy to do so. Corridors have been re-decorated and new seating has been provided in the lounge area. The manager confirmed that the home involves people in choosing the colour of their bedrooms when their rooms need to be redecorated. A bedroom on the ground floor has been temporarily changed to a room which can be used for meetings. People who do not have an en-suite facility have a wash hand basin in their room. Toilets, bath and shower are near to their rooms, therefore people are provided with a choice of washing and bathing facilities. There is equipment to help people get in and out of baths and the showers do not have a step, so it is easier to access by people who may have mobility difficulties. The home has a procedure and suitable equipment for ensuring commodes are kept clean. We saw the home has equipment to help move people safely such as hoists and staff told us they consider there is enough equipment to meet people’s varying needs. There are several areas of the home which have a fairly steep slope between different floor levels. This did not appear to cause staff difficulty when they were assisting people to move around the home in wheelchairs. There is a ramp at the front of the home, which has had hand rails fitted to assist people when they are entering the home. There is a choice of stairs or passenger lift to the first and second floors. There is level access to a patio and large rear garden, which is fully enclosed. We saw minutes for a residents meeting held in March where people were asked for their views on the home environment. It was noted that all who attended viewed the home is kept clean and tidy and there were no complaints. Comments documented included its lovely it feels like home. Two people told us during the inspection about how the home is always clean and they are pleased with their bedrooms. We saw domestic staff cleaning different parts of the home during the inspection. The manager gave us information on why there was an odour on the second floor and assured us this would be dealt with. The manager told us a new freezer and kitchen equipment has been provided and achieved a rating from the local environmental health officer which indicates a high standard of compliance with food hygiene. We saw that parts of the home need attention including a bathroom, flooring in the dining room which has lifted up in one area and exterior windows needing repainting. The home only has one lounge and dining room on the ground floor. It has been reported at previous inspections that the home was looking to extend to provide additional communal space, this has not progressed. We spoke with the owner about this during the inspection who confirmed that it is their intention to continue with these plans and incorporate within that further refurbishment. This needs to be followed through by the owner and also Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 21 looking at ways to develop the environment, in accordance with good practice guidance on dementia care, for example through use of pictures, signage, decor. We brought it the attention of the owner that improvements need to made with how cupboards and other items removed during recent refurbishment are stored outside of the premises, as they are currently stored next to the front of the building. This does not give a good first impression but is also not good fire safety practice. Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by staff who have the skills and knowledge to meet their needs and who are suitable to work with vulnerable adults EVIDENCE: We spoke with staff, observed them working and discussed staffing levels with the manager which indicated that sufficient skilled care and nursing staff were on duty to meet the needs of people currently living at the home. Three people who live at the home told us there are enough staff to help them. The manager described how staffing levels are reviewed if people have greater needs. Staff described how they do additional shifts to cover for absences, rather than use agency staff, so that people are cared for by staff who know them. In addition to care and nursing staff the home also employs kitchen, domestic, laundry, maintenance and administrative staff to ensure that all aspects of peoples needs are met. The manager has an effective process to show when staff are up to date with training and when training is needed. This demonstrates that regular staff training takes place, which ensures staff have the skills and knowledge to meet the needs of people living at the home. Training which has been provided Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 23 includes training in safe working practices such as fire safety, infection control and food hygiene as well as more specific training including dementia care, life support, communication with people who are dying, equality and diversity and managing conflicts. A nurse we spoke with described the support given to ensure nurses clinical skills are kept up to date. All staff told us they are provided with very good training opportunities and gave us examples of the training they have done since working at the home. We were informed that 68 of care staff have achieved a recognised qualification in care (National Vocation Qualification) at level 2, which should contribute to ensuring the staff team have an effective knowledge of social care. We looked at the process used by the home to recruit two members of staff who had started working at the home recently. All parts of the recruitment process were accurately recorded and demonstrated that required preemployment information, such as references and POVA (Protection of Vulnerable Adults) had been sought prior to the staff working at the home. A full CRB disclosure (Criminal Records Bureau) had been obtained for one of these staff members before they started work. The other staff member started work prior to their full CRB disclosure being obtained. The staff member and the manager confirmed they are working in a supervised capacity until their CRB is obtained. The home’s recruitment process helps to ensure only staff who are suitable to work with vulnerable adults are employed. We saw documents, which demonstrate the home provides new staff with a comprehensive induction, so they know about all aspects of the home and the care people need. Two newly appointed staff confirmed they received an induction which they found very useful and they spoke positively about the support they have received since starting at Cedar Lodge. The manager told us that staff who are new to the caring role are provided with a more in-depth induction. Meetings for staff take place on a regular basis. Minutes are kept of these meetings which show that nursing staff are kept updated with clinical issues and all staff are kept informed of issues such as health and safety and outcomes of audits. Staff told us they have regular supervision meetings with the manager, which enables them to reflect on practice and identify their training and development needs. Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 People using the 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 manager, Ms Sonia Seymour communicates a clear sense of direction, leadership and ensures the home is safe and run in the way that the people living there want. EVIDENCE: The manager has worked at Cedar Lodge for some time. The manager has considerable experience in managing care services and management experience is supplemented by supporting qualifications and an enthusiasm to continually update her skills and knowledge, including nursing and clinical practice. Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 25 The manager describes within the AQAA how she provides a clear sense of direction and leadership in an open and transparent management style and this was apparent throughout the inspection. People and staff told us they think the home is well managed. Staff told us they are encouraged to work as a team to benefit people living at the home and they described the manager as very approachable and an excellent manager. One staff member told us how they look forward to coming to work. We observed the manager speaking with people, ensuring they were comfortable and overseeing practices. Observation of care documentation also shows that the manager oversees wound care and undertakes regular audits of care related practices, to ensure that people are receiving a good standard of care. There are processes in place to monitor quality within the home throughout the year. Regular meetings take place with people who live at the home, covering topics such as their thoughts about visits from external professionals, dealing with complaints, activities, meals and personal care. Action plans are drawn up which say if changes are needed. This ensures people are able to influence how the service is run. We saw that questionnaires are sent out to obtain feedback from staff and from peoples representatives. The information is then brought together into a report for action to be taken if necessary. Five surveys recently completed by relatives showed satisfaction with the service and included comments my relative is always clean and tidy, friendly caring staff, pleasant and polite staff. A representative of the company monitors quality at regular intervals during monthly unannounced visits. We observed the reports produced as a result of these visits which show the visits look at a wide range of matters to ensure the service is operating well and that people are pleased with their care. For the purpose of this inspection the manager had responded to a request by the Commission to complete an annual quality assessment document (AQAA). This is an opportunity for providers to share with us areas they believe they are doing well and where they could improve. The manager provided clear, relevant information of what the home does well, improvements which have occurred and plans for future improvement. We looked at records relating to the management of small amounts of personal monies and the process used by the home appeared robust with receipts kept to show spending and transactions checked by two people, which should ensure peoples money is held safely. Information was provided within the AQAA to confirm servicing and maintenance of equipment is undertaken and policies and procedures are reviewed. We looked at a selection of maintenance and servicing records, all were up to date and demonstrate that systems are in place to ensure the home and equipment is safe. As previously noted the home needs to improve Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 26 how items are stored at the front of the premises. We saw that staff have regular training in health and safety, which ensures they are provided with the knowledge and skills to help people keep safe. For example, staff receive training in the safe use of bed rails, so they know how to keep people, who are assessed as needing bed rails, safe when they are in bed. We saw that a fire drill had recently taken place, so staff should be aware of the procedures to follow in the event of a fire. The home keeps us informed of the occurrence of accidents and incidents and knows when to refer to other agencies. Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 27 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 28 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 2 3 Refer to Standard OP9 OP19 OP20 Good Practice Recommendations Measures must be put in place to reduce the temperature of the medication storage room. This is to ensure medication is stored at the correct temperature. An action plan should be produced and forwarded to the commission, detailing the intentions of the owner to refurbish and develop the home People should be provided with greater choice of where they spend their day and the environment should be enhanced in accordance with good practice guidance on dementia care. . Cedar Lodge Nursing Home DS0000063476.V376850.R01.S.doc Version 5.2 Page 29 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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