Care Home: Cedar Lodge Residential Home

Similar services:

• Oak Ridge
• Sun Court Nursing Home
• Ashville House
• Bilney Hall
• Hill Barn
• Mabbs Hall Nursing Home
• Henrietta House
• Claremont House

What the care home does well Cedar Lodge completes an assessment of need before residents move in and therefore is able to be confident they can meet peoples needs. We found good information about the home that allows people to know what is on offer. The daily life in this care home has an atmosphere of being relaxed, homely and quite jovial. We spoke to several residents all of whom were happy with their lifestyle and how they spent each day. Residents told us of a recent boat trip on The Broads. They were taken in a limousine to add to the experience of the outing. Residents spoke highly of food. One person told us `Lovely dinners, especially chicken with all the trimmings` another person said `Ample portions - more than enough`. We saw several visitors to the home. We spoke to some of them and they too were satisfied with the care their relative was receiving. One resident told us `the staff are kind to me, they are always kind and helpful. This morning I had a bath.` Cedar Lodge is clean, tidy and reasonably well maintained. What has improved since the last inspection? Cedar Lodge has maintained good ratings on 3 elements of this report. This includes information and about the home and ensuring assessments are completed. The activities for residents and opportunities for socialising are good. The environment is generally well maintained and continues to meet the needs of the people who live here. What the care home could do better: This report does contain requirements, and during feedback and discussions with the owners/manager future developments for the service were discussed. These included the need for all residents to have a care plan in place that would be the basis for the care and support to be delivered. This would ensure that all staff knew what action to take to meet the health, personal and social care needs of this individual. Also improvements are needed in the records kept in relation to medicines received, administered and disposed as more accurate records will ensure there is no mishandling of drugs. The management are keen to learn from there recent experience relating to a safeguarding referral and therefore have welcomed in put and advice from the local Social Services safeguarding team in Bury St Edmunds. Staff need to develop their knowledge and understanding around safeguarding with the manager and staff attending training as well as developing a working link with the local team to use their experience and knowledge when needed. We need to be able to determine if sufficient and appropriate staff are on duty to meet the needs of the residents. Therefore, appropriate records such as an accurate roster must be kept at the home. In addition staff must be competent to do their job and supported by being given appropriate training such as manual handling, first aid and medication training. Finally Cedar Lodge needs to ensure the quality of care provided meets the minimum required and is in the best interests of the residents. Therefore a system of monitoring, reviewing and improving the service provided at this home needs to be introduced. Key inspection report Care homes for older people Name: Address: Cedar Lodge Residential Home Hengrave Road Culford Bury St. Edmunds Suffolk IP28 6DX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Claire Hutton     Date: 1 3 1 1 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 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. 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 Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Cedar Lodge Residential Home Hengrave Road Culford Bury St. Edmunds Suffolk IP28 6DX 01284728744 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Sandra Spendley,Mr Michael Lewis Spendley care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: To include one named person under the age of 65 with a mental disability Date of last inspection Brief description of the care home Cedar Lodge is a residential care home that has provided care and accommodation to older people since 1984. There is currently a condition of registration which allows the home to support and care for one resident under the age of 65 with mental health needs. The home is situated in a rural setting within its own grounds and adjoining woodlands on the outskirts of Culford, which is approximately five miles from Bury St Edmunds. There are no community facilities nearby and the nearest shop is in the village of Ingham. The home is spread over two floors with service users being able to access both floors by a central staircase or lift. There are 23 single bedrooms, eight of which are en-suite and one shared room, which also have en-suite toilet facilities. There is a lounge and a dining room and residents also have the use of a small sun lounge on the first floor. A new conservatory to the front of the house has been built Care Homes for Older People Page 4 of 30 Over 65 25 0 Brief description of the care home and this provides additional communal space for residents to use. The homes office is located to the gardens at the back of the home, in a wooden sun house type construction. Mr and Mrs Spendley became the Registered Providers of Cedar Lodge on the 1st September 2004, although both have been involved in the home for a number of years. Mr Spendleys mother owned the home prior to this date and Mrs Sandra Spendley became the registered manager on the 7th July 2003. The home has a statement of purpose providing information for prospective service users. At this key inspection we were advised that the fees charged by the home, ranged from £362.00 to £410.00 per week. These figures did not include hairdressing, toiletries, holidays, specialist dry cleaning, papers and magazines and activities away from the home. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection, which focused on the core standards relating to care homes for older people. The inspection was unannounced on a weekday, and lasted 8 hours. The inspection was completed by 2 Inspectors from CQC. This report has been written using accumulated evidence gathered before and during the inspection, including information obtained from the Annual Quality Assurance Assessment (AQAA), issued by the Care Quality Commission (CQC) was returned completed by the manager. This self-assessment gives providers the opportunity to inform CQC about their service and how well they are performing. Information collated in the ASR (Annual Service Review). We (CQC) also assessed the outcomes for the people living at the home against the Key Lines of Regulatory Assessment (KLORA). A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and Care Homes for Older People Page 6 of 30 safety. Time was spent talking with people who live in the home and 4 members of staff. The owners/manager of the home was available throughout the day of this inspection and fully contributed to the inspection process. A detailed feedback of our findings were presented at the end of our visit. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: This report does contain requirements, and during feedback and discussions with the owners/manager future developments for the service were discussed. These included the need for all residents to have a care plan in place that would be the basis for the care and support to be delivered. This would ensure that all staff knew what action to take to meet the health, personal and social care needs of this individual. Also improvements are needed in the records kept in relation to medicines received, administered and disposed as more accurate records will ensure there is no mishandling of drugs. The management are keen to learn from there recent experience relating to a safeguarding referral and therefore have welcomed in put and advice from the local Social Services safeguarding team in Bury St Edmunds. Staff need to develop their knowledge and understanding around safeguarding with the manager and staff attending training as well as developing a working link with the local team to use their experience and knowledge when needed. We need to be able to determine if sufficient and appropriate staff are on duty to meet the needs of the residents. Therefore, appropriate records such as an accurate roster must be kept at the home. In addition staff must be competent to do their job and supported by being given appropriate training such as manual handling, first aid and medication training. Care Homes for Older People Page 8 of 30 Finally Cedar Lodge needs to ensure the quality of care provided meets the minimum required and is in the best interests of the residents. Therefore a system of monitoring, reviewing and improving the service provided at this home needs to be introduced. 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. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to relevant information about this home, are able to visit and can expect their needs to be assessed before they move in, thereby receiving an assurance that the home can meet their needs. Evidence: There is information available about this home and it is located in the entrance to the home, and it can be requested from the owners by telephone. We found good information about the home and what is offered in each care plan. The date this had been last reviewed was September 2008. Assessments are completed before people move into the home. We were able to see assessments completed by the home dated before the date of admittance. Therefore the home is able to determine that they can meet a persons needs. The manager told us how important their assessments are as recently they have been requested to take people who have nursing needs. Once the home have completed their assessment Care Homes for Older People Page 11 of 30 Evidence: people are invited to visit the home. The manager told us that most people take up this offer and spend the day with them. Two people told us that their relatives made all the arrangements and found the home for them. People also told us that they visited this home before moving in. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home can expect their care needs to be met by staff in a respectful manner. People cannot always expect their care plans to include detailed information about how they wish to be cared for. Medication is satisfactorily managed. Evidence: We examined a sample of 4 care plans and found that on the whole these were satisfactory documents developed from the assessments completed. These care plans had additional assessments for prevention of falls and participating in activities provided at the home. We found there was good information on matters such as dentures, spectacles, hearing aid management and manicures of individuals. We saw that there was regular review of care plans in place and it was explained that each month the resident is asked about their care and support received and their views recorded as part of the monthly review. We did find that there was information in 2 different plans that was still needed - one being the weight of an individual (this will be a key factor to monitor nutrition and well Care Homes for Older People Page 13 of 30 Evidence: being) and the other a record of what to do in the event of the person dying (individual wishes and preferences should be recorded). We also found in one case some very limited information that was said to form a care plan. Following discussions we learnt that this was the case as the individual resident had previously refused any notes made about them to be kept in their room. However, on conclusion the manager agreed to formulate a care plan that would be the basis for the care and support to be delivered. This would ensure that all staff knew what action to take to meet the health, personal and social care needs of this individual. We found good evidence to health care including services of opticians, Community psychiatric nurses, district nurses and GPs. We found good evidence on diabetes and one resident said the home had supported them a great deal in managing their condition. One resident told us it was my GP who suggested I look around this place. Another resident told us that the GP came when needed. In relation to medication we believe that medication is managed well, but their are improvements needed in recording to ensure no mistakes are made. Examples are the storage of medication for sole use by the District Nurse on their visit. If the home is storing this medication, then they should have a record of it arriving and leaving, thereby ensuring its safe custody. Another example was that we were unable to audit and correctly calculate one persons medication, but the manager was able to calculate these medicines as the amount had increased. To ensure accurate auditing can take place, when a medication increases this should be documented. The final example we have was a front sheet for an individual was out of date, but could have confused staff as it stated a medication and dosage that was no longer in use. We found no out of date medication and we found controlled drugs to be well managed. The storage of medication was satisfactory, but the fridge was running slightly too high a temperature to be totally effective and was found to be defrosting with puddles of water at the bottom of the fridge. Therefore this must be remedied. In relation to privacy and dignity we saw some good practice from staff whereby wishes were respected in relation to privacy and not wanting to eat with other residents (majority of people did eat in the dining room and were encouraged to) Staff were seen to knock on doors before entering and showed respect when addressing individuals. Residents did tell us that they were very satisfied with the care and support they received. Two residents spoke very highly of the care and support from the manager. We did observe that when the GP came to see a resident they were shown into another persons bedroom to use their private space. We were told this was Care Homes for Older People Page 14 of 30 Evidence: because we were there and permission had been sought from the resident. We would recommend that this practice did not occur. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be consulted about activities to ensure they are given the opportunity to participate in social, recreational and religious interests of their choice. People can expect to have a good range of fresh and home cooked food as part of a balanced and varied diet. Evidence: The daily life in this care home has an atmosphere of being relaxed, homely and quite jovial. We spoke to several residents all of whom were happy with their lifestyle and how they spent each day. We saw several visitors to the home. We spoke to some of them and they too were satisfied with the care their relative was receiving. The routine of the day was that residents chose when they got up in the morning. One resident told us the staff are kind to me, they are always kind and helpful. This morning I had a bath. Lunch is served at 1pm and there tends to be an activity each day. Planned activities include a quiz, communion, art/craft, hairdresser and bingo. During our visit we saw that residents liked interacting with the large caged bird, some people had knitting on the go (staff helped with a dropped stitch), cards and music were Care Homes for Older People Page 16 of 30 Evidence: played. Residents told us of a recent boat trip on The Broads. They were taken in a limousine to add to the experience of the outing. Residents spoke highly of food. One person told us Lovely dinners, especially chicken with all the trimmings another person said Ample portions - more than enough. Today was fish and chip with peas and sweetcorn, some people had mash potatoes. Rice pudding was served for dessert. We saw that most people chose to eat in the dining room which was nicely laid out, but a small number chose to eat in their rooms. One resident said that the staff have supported their understanding and knowledge of their diabetes and have led to better management of their food and medication. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect their concerns and complaints to be taken seriously and resolved, however the knowledge, understanding and training of manger and staff with regard safeguarding from abuse does not demonstrate sufficient protection for residents. Evidence: Information about the complaints procedure for this home was displayed in the entrance hall and all residents are given this information. We spoke to residents and asked them if they had concerns about their care who would they tell. All said they would speak to the manager, who was always available to them and they were confident that she would resolve matters to their satisfaction. One person said the manager is always kind to me. The self assessment told us that the home had not received any complaints in the last 12 months. The home had a safeguarding referral in the last 12 months and this was discussed with the manager. The management are keen to learn from this experience and therefore have welcomed in put and advice from the local Social Services safeguarding team in Bury St Edmunds. In relation to policy and procedure the home have not got the most up to date safeguarding policy. The 2004 document was still in use and the most up to date document must be obtained as there have been several developments Care Homes for Older People Page 18 of 30 Evidence: locally that the home needs to be aware of. It was fed back to the manager that the home and staff need to develop their knowledge and understanding around safeguarding with the manager and staff attending training as well as developing a working link with the local team to use their experience and knowledge when needed. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Cedar Lodge is clean, comfortable and generally well maintained and meets the needs of the resident group. Evidence: Cedar Lodge is clean, tidy and reasonably well maintained. We found the shared bedroom accommodation was nicely decorated with a curtain dividing for privacy, and contained personal items. Other peoples rooms were checked, all were personalised neat, tidy with no odours. We did however find an odour (possibly that of urine) in the hallway area on entering the home and around the WC in the annex, which was also detected in the afternoon. The layout of the home and use of additional aids, such as shaft lift, handrails and hoists ensures that the accommodation meets the needs of the current residents. We found that radiator covers are in place to protect people from burns and water restrictors were in place, however we found hot water in bathroom 1 in excess of 43 degree centigrade. The homes records showed this was last tested in 2008. This information that the water was 3 degrees above the recommended temperature was fed back to the owners so that they could ensure the safety devices are adjusted to prevent scalding. It was agreed that before we left a notice would be posted upon this Care Homes for Older People Page 20 of 30 Evidence: bathroom do not use. Until it was made safe and appropriate for staff and residents to use. We were notified after our visit that water temperatures were altered to be within safe limits. We visited the laundry room and found this to be clean and tidy, with suitable equipment to launder soiled linen. The washing machine has sluice cycle and red alginate bags system in use with soiled linen washed separately. These systems ensured that laundry was appropriately laundered and lessened the risk of infection within the home. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will find that there are sufficient staff who are satisfactorily recruited, but could be better trained to meet the needs of the resident group. Evidence: We examined the roster in place to determine if there were sufficient staff on duty. However, upon sharing our findings and concerns with the management of the home, it became clear that the documents were not accurate and the management confirmed that there was always 3 care staff in a morning, 2 in an afternoon and 2 on at night and one person who we believed was employed as a cleaner, but the roster showed working nights, and not suitably trained for that role, was not correct. Therefore it is important that the rosters are a true reflection of what does happen at the care home in order that it can be determined that sufficient and appropriate staff are on duty. Residents spoken with confirmed there were sufficient staff on duty to meet their needs. We looked at the recruitment records of 4 staff and these were generally satisfactory, but we noted in all 4 cases that staff appeared to have started work before their CRB was returned. The management explained that all 4 had been POVA 1st (protection of vulnerable adults) checked and were supervised until the CRB (criminal record bureau) had been returned. The evidence of this was said to be on the computer and the manager agreed to print off the returned POVA 1st document for individuals files. Also Care Homes for Older People Page 22 of 30 Evidence: for one employee there were gaps in their application form around previous employment that appeared not to be explored. A more robust approach would demonstrate that the checks that staff are appropriate to work with vulnerable people had been undertaken. We looked at staff training records and spoke to staff about their training. We believe there are some gaps in the training of staff in particular for Manual handling, medication, first aid and safeguarding people from abuse. The management were aware of these gaps in training and had started to address these matters and told us they had a plan in place. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of development on review of practice at Cedar Lodge is currently not assuring quality of service. Evidence: We completed an Annual Service Review on Cedar Lodge in May 2009. In that document we said The home sent us their AQAA (Annual Quality Assurance Assessment )when we asked for it. The information in the form was not sufficient in detail to make a judgement about the service provided by the home. There were a number of general statements about how the home will improve in the next twelve months. These included To carry along the lines we have been and to improve where ever possible, and To continue on-going training and updating our standards and Continually strive forwards .... When asked to provide evidence to demonstrate the service provided the home often referred to feedback from people who live at and visit the home. Whilst this is obviously very important, we would expect systems and checks to be in place that would identify issues before they had an impact on people living at the home and for these to be described in the AQAA. At this inspection we Care Homes for Older People Page 24 of 30 Evidence: found indicators that confirmed this view and was still the case. The service needs to develop their quality assurance systems such as auditing care plans and have a system of monitoring medications. There are wider elements that need to be considered in how this home develops its quality assurance as we found that the training at the home needed to be improved as was planned in the AQQA and also development of policies and procedures used by the home had not been reviewed since 2007. The policy and procedure for safeguarding adults from abuse was out of date and that of 2004 and this is a key area for training and development within the home currently. The registered manager is suitably qualified and explained that the home had recruited a new deputy with the intention of that person developing to take on management duties. The individual had enrolled on the Leadership and Management in NVQ 4 Award. Supervision of staff was examined. We spoke to staff who said that management was very supportive and available to them when needed. Most staff said they received regular supervision. The records kept did not reflect this was happening consistently. Management of the home confirmed that staff were supervised regualrly, but also said that their record keeping of this should be better. We also said in the Annual Service Review The numerical information contained in the AQAA includes details of incidents about which the home is required to notify us. The number of incidents stated on the form does not correspond with the number of notifications we have received. Therefore at this inspection we went through with the management of the home the information that we require a notification for and gave a copy of the forms to use. In terms of health and safety within the home the AQQA confirmed regular servicing of equipment was up to date. We have commented upon the monitoring of hot water out lets in the environmental section. However, regular monitoring would have highlighted the potential hot water risk sooner. In relation to infection control we saw good practice with hand washing with staff and there was hand gel for visitors upon entry to the home. The staff spoken with had a good knowledge of infection control. The home also had information about matters such as MRSA and Scabies. We looked at records in relation to the home keeping small amounts of resident money. This was appropriate in terms of records being kept that would allow anyone to query and audit the small amount of monies stored. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 All residents in the care 01/03/2010 home must have a care plan in place. In order that care staff are aware of what action to take in relation to health, social and care needs of the individual. 2 18 11 The manager and staff must receive training on safeguarding adults from abuse. This will protect residents. 01/03/2010 3 27 17 Appropriate records must be 01/03/2010 kept at the home. This must include a record of persons working at the home and a record of whether the roster was actually worked. This will allow us to determine if sufficient and appropriate staff are on duty to meet the needs of the residents. Care Homes for Older People Page 27 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 30 18 All care staff must be trained 01/03/2010 and receive update training specific to their role. This includes training in manual handling, safeguarding from abuse, medication and first aid. This will ensure staff are competent to do their job. 5 33 24 Cedar Lodge must develop a 31/03/2010 system of monitoring, reviewing and improving the service provided at this home. This will ensure the quality of care provided meets the minimum required and is in the best interests of the residents. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Accurate records need to be kept in relation to medicines received, administered and disposed of to ensure there is no mishandling of drugs. The home should obtain the most upto date policy and procedure in relation to safeguarding adults from abuse and know the local procedures on reporting and response to allegations of abuse. We recommend that hot water temperature outlets be monitored regularly and adjusted promptly to ensure that residents are not put at risk of scalding. 2 18 3 25 Care Homes for Older People Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 4 26 We recommend that the home be free of offencive odours throughout and systems put in place that will control the spread of infection. Recruitment should be more robust. Gaps in previous employment should be explored. The returned POVA 1st document for individuals should be on file available for inspection. This would demonstrate that the checks that staff are appropriate to work with vulnerable people had been undertaken. 5 29 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!