Care Home: Cedardale Residential Home

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What the care home does well The home provides good information for prospective residents, and this includes an informative guide prepared by the home in regards to understanding dementia. The home has a friendly atmosphere, and staff have caring attitudes, and do not rush residents. There are activities carried out in the mornings and in the afternoons, enabling residents to have a choice about the items they wish to join in with. Food is well prepared; and provides residents with a wholesome and nutritious diet. The home has good staff training programmes in place, so that residents are cared for by competent and knowledgeable staff. What has improved since the last inspection? Requirements given at the last inspection have been met. These included aspects of infection control management and health and safety; and better documentation for care planning. The new building extension has been completed, and this has increased communal space for residents. The gardens have been re-designed since the building work was completed, and these provide space for residents to wander safely. There have been significant improvements with managing care planning, ensuring that staff have clear instructions for how to carry out individualised care for residents. The complaints procedure has been developed into an easy read format for residents. There have been a number of staff changes, including an increased number of care staff on day shifts. This means that there are more staff available to care for the residents. There are also increased staff training programmes in place. What the care home could do better: The complaints procedure was not as clear as it could be for relatives and visitors, and the head of care stated that this would be amended immediately, to ensure that anyone can easily use it. Some forms in the care plans had not been completed for all residents (e.g. property lists), and there is a recommendation for this.Medication management was found to be generally satisfactory, except that not all handwritten entries on Medication Administration Records had been signed by two staff. It is very important that these instructions are carefully checked and countersigned. Care plans did not all show clearly if there had been a discussion with residents (or their representative) about their spiritual and religious needs; and how the home was meeting these needs. The laundry room has had improved infection control measures put into place, but is too small for effective management of the laundry for a home of this size. The providers have already had plans approved for building a new laundry; and as this work is due to be carried out this year, a requirement has not been given. CARE HOMES FOR OLDER PEOPLE Cedardale Residential Home Queens Road Maidstone Kent ME16 0HX Lead Inspector Mrs Susan Hall Unannounced Inspection 4th February 2009 08:45 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 Cedardale Residential Home DS0000059264.V374111.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. Cedardale Residential Home DS0000059264.V374111.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedardale Residential Home Address Queens Road Maidstone Kent ME16 0HX 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) 01622 755338 michaellisis@blueyonder.co.uk MGL Healthcare Ltd Mr Michael Joseph Gaetan Lisis Care Home 29 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Cedardale Residential Home DS0000059264.V374111.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) 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) 2. Dementia (DE). The maximum number of service users to be accommodated is 29. Date of last inspection 2nd July 2008 Brief Description of the Service: Cedardale Residential Care Home was first registered to care for older people in 1989. MGL Healthcare Ltd. took over ownership in April 2004. They have two other care homes for older people with dementia in the South East region. The home is registered to accommodate up to twenty-nine people aged fifty-five and over, who have a diagnosis of dementia. Cedardale is located in a quiet residential area of Maidstone, close to shops, pubs, churches, public transport and other town amenities. Four rooms are available for shared use (for residents who wish to share); and all other rooms are for single use. Most rooms have en-suite toilet facilities, and the rooms in the new extension have en-suite showers as well. The first floor can be accessed by a stair lift. Off road parking is provided at the front of the home. There are secure gardens at the rear of the home. Current fee levels range from £421.00 to £550.00 per week, depending on the individually assessed needs of each resident, and the room in use. Additional charges are made for hairdressing, chiropody, and newspapers. Further information, including a copy of the last inspection report, can be obtained from the registered manager of the home. Cedardale Residential Home DS0000059264.V374111.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home is assessed as having a rating of good, 2 stars. This was a key inspection, which includes reviewing information obtained since the previous key inspection, which was in July 2008. The home was going through a difficult period at that time, which included extensive building work for the new extension. Nine requirements were given, which included some infection control, and health and safety issues. The home was also cooperating with an investigation by the Kent Social Services Safeguarding Adults department. A Random inspection was carried out in November 2008, and this was mainly to assess the progress the home was making with meeting requirements. We noted that the home was making satisfactory progress. This key inspection was carried out by one inspector, and lasted for seven hours. During this time, we (i.e. CSCI) reviewed previous requirements, and found that these were met – except for one in regards to the laundry – which is in the process of being met. We spoke with four residents, six staff and eleven residents, and observed other residents being assisted by care staff. The inspection also included viewing all areas of the home, and reading documentation - such as care plans, medication records, staff recruitment and training files, and health and safety records. During the afternoon, an hour was spent carrying out a specific observational inspection (a Short Observation Framework Inspection or SOFI). This is a time when the inspector chooses a number of residents (unknown to the staff), and makes detailed recordings about their mood, their activities, and how well staff interact with them. It is very helpful for assessing care for residents with dementia, who may not be able to communicate the levels of care they receive. It was a very positive experience, and confirmed previous findings in the day that residents feel well cared for and are contented living in the home. Residents were seen to be well groomed and nicely dressed, and able to sit or walk where they wished, and join in with activities according to choice. Many were happy and smiling, and others looked relaxed reading newspapers, doing jigsaws, or chatting. Relatives comments included the staff look after them very well; and we are very happy with the care given here. What the service does well: Cedardale Residential Home DS0000059264.V374111.R01.S.doc Version 5.2 Page 6 The home provides good information for prospective residents, and this includes an informative guide prepared by the home in regards to understanding dementia. The home has a friendly atmosphere, and staff have caring attitudes, and do not rush residents. There are activities carried out in the mornings and in the afternoons, enabling residents to have a choice about the items they wish to join in with. Food is well prepared; and provides residents with a wholesome and nutritious diet. The home has good staff training programmes in place, so that residents are cared for by competent and knowledgeable staff. What has improved since the last inspection? What they could do better: The complaints procedure was not as clear as it could be for relatives and visitors, and the head of care stated that this would be amended immediately, to ensure that anyone can easily use it. Some forms in the care plans had not been completed for all residents (e.g. property lists), and there is a recommendation for this. Cedardale Residential Home DS0000059264.V374111.R01.S.doc Version 5.2 Page 7 Medication management was found to be generally satisfactory, except that not all handwritten entries on Medication Administration Records had been signed by two staff. It is very important that these instructions are carefully checked and countersigned. Care plans did not all show clearly if there had been a discussion with residents (or their representative) about their spiritual and religious needs; and how the home was meeting these needs. The laundry room has had improved infection control measures put into place, but is too small for effective management of the laundry for a home of this size. The providers have already had plans approved for building a new laundry; and as this work is due to be carried out this year, a requirement has not been given. 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. Cedardale Residential Home DS0000059264.V374111.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 Cedardale Residential Home DS0000059264.V374111.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): 1-5 (standard 6 is not applicable in this home). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides good information for prospective residents and relatives, so that they have sufficient knowledge to make an informed decision. EVIDENCE: The statement of purpose and service users guide has been updated since the last inspection, and contains all required information. It is well set out, and includes photographs of the building. However, these are currently prepared as one document, and it is rather lengthy. The manager and head of care said that they would separate these into two separate documents to provide clarity. The manager or head of care (there are two heads of care who work opposite to each other) carry out a pre-admission assessment for each resident. Two pre-admission assessments were viewed, and these were sufficiently detailed. Cedardale Residential Home DS0000059264.V374111.R01.S.doc Version 5.2 Page 10 Residents and/or relatives are invited to spend time in the home prior to making a decision about admission. This might include staying for the day or half a day, so that they can take part in activities, and have a meal with other residents. Relatives are provided with a dementia care booklet when the resident is admitted, and this gives an overview of what dementia is, how it is managed, and how it develops over time. This is a useful booklet for anyone who has little awareness of dementia; and underpins the understanding for those with existing knowledge. All residents are admitted for a trial period of four weeks, after which a review is held with the resident, next of kin, head of care, key worker and care manager, as appropriate. All residents (or their representatives) are provided with a contract. These contain clear details in regards to the terms and conditions of residency, and are signed by both parties. Contracts do not clearly specify if there is an agreement to share a room, and it is recommended that this is clearly stated in contracts where residents prefer to share. Cedardale Residential Home DS0000059264.V374111.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): 7-11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans have been significantly improved, and demonstrate that residents are treated as individuals, and have their personal and health care needs met by the home. EVIDENCE: Care plans are set out in individual folders, and these are kept locked in the managers office to preserve confidentiality. We viewed three care plans, and found that they have been significantly improved since the last key inspection. They include personal details and a photograph of the resident at the front; a missing persons information sheet in the event of any resident leaving the home unobserved; care plans for all aspects of daily living; risk assessments; and health and medical notes. Care plans are reviewed each month, and are routinely audited by the manager. They have not been signed by the resident or their representative to show their agreement, and it would be good practice to commence this. Cedardale Residential Home DS0000059264.V374111.R01.S.doc Version 5.2 Page 12 Each care plan has a pen portrait of the resident, giving insight into their previous family, occupational, and social life. Additional information is now being included entitled A day in the life of.. which shows residents preferred individual routines (e.g. times of getting up and going to bed); and likes and dislikes in regards to food, activities, and sociability. These forms show if the resident prefers a bath or a shower and if they like TV etc. They are still in the process of being implemented for all residents. There is a space for additional comments where relatives help to complete these forms and one had written that the home has given wonderful care to my mother, and has cared for her brilliantly for over a year. Care plans are typed for ease of reading, and are very detailed. They cover all aspects of care such as mobility, eating and drinking, continence, washing and dressing, activities, maintaining safety, cognition and communication, and social needs. These clearly itemise the needs of the individual person, and the action to take to meet those needs. Each care plan is accompanied by a risk assessment. For example, a care plan for mobility may state that the resident can walk independently, but staff must check that footwear is in good condition. Risk assessments will highlight if the person is unsteady on their feet, uses a walking frame or wheelchair, and if they need escorting if going out into the garden. Washing and bathing care plans show if the person prefers a bath or a shower; what times they like to get up or go to bed; if they can choose their own clothes; and if they can wash or dress independently. Residents are encouraged to continue to do what they can for themselves; for example, if they can dress independently, staff will check afterwards that their clothing is suitable for the type of weather. There are clear instructions about help needed with oral care, and foot care. The home has a key worker system in place, and the key workers responsibilities include ensuring that residents hands and fingernails are kept in good condition, and that they have sufficient toiletries. They liaise with relatives in regards to this. Toiletries are now stored in small locked cupboards in each room to maintain safety. Residents were seen to be well groomed, shaved, clean, and nicely dressed. Care staff have gentle and caring attitudes, and were clearly familiar with the needs of different residents. There was no sense of rushing residents who were struggling to communicate clearly. Residents are registered with the GP of their choice, and there are three practices in the vicinity. Care plans showed that doctors are contacted if staff notice a change in health or mental state; and there is a good rapport with district nurses, community psychiatric nurses, and other health professionals, such as dietician or dentist. A chiropodist visits every six to eight weeks, to provide foot care. Cedardale Residential Home DS0000059264.V374111.R01.S.doc Version 5.2 Page 13 Residents are accompanied by relatives or by a carer, if they have to attend appointments outside the home. Daily records are written at the end of each shift, and these were generally satisfactory. Senior staff showed a good understanding of the Mental Capacity Act 2005, and how this impacts on residents care, in respect of how decisions are taken on residents behalf. A form is included in care plans, which demonstrates if the resident can understand information, retain information, weigh information, and make an informed decision. This training is being delivered to all staff. Medication storage was being improved on the day of the inspection. The medication trolley, and stock medication, has previously been stored in the office, which is quite cramped. A separate locked cupboard was being made in an unused corner of one of the current lounges, and will provide sufficient space for medication storage in the future. There are no hand washing facilities in this cupboard, but there are sufficient hand washing facilities for staff around the home. The cupboard will be fitted with appropriate ventilation, and the storage temperature will be recorded. The manager is also arranging for points to be fitted in different areas of the home where the trolley can be fixed to the wall, in case the staff member giving medication has to leave the trolley in an emergency. There is a controlled drugs (CD) cupboard which meets specifications in the managers office. There is also a drugs fridge in the office, and the temperature is recorded daily. Medication is mostly administered via a monitored dosage system. There are clear details printed alongside each Medication Administration Record (MAR chart) to show when as necessary medication may be given; and this shows good practice. All MAR charts were viewed, and were well completed, except that some handwritten entries had not been checked and counter signed, and there is a recommendation for this. Only senior staff who have had appropriate training administer medication, and staff have competency checks prior to carrying out any administration on their own. The manager or head of care ask about end of life preferences as part of the admission process, so that any specific requests are known immediately. Care staff are trained in caring for residents who are dying, and will keep them as comfortable as possible, and sit with them if they wish. The homes ethos is to enable people to die with dignity, in their own home, and to keep them pain free. Cedardale Residential Home DS0000059264.V374111.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): 12-15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy a range of activities. Food is well managed in the home, and residents benefit from a nutritious diet. EVIDENCE: The home has two part-time activities organisers, and activities are carried out in the mornings and afternoons. The activities organisers use both lounges for group activities – one lounge in the morning, and the other in the afternoon. All residents are invited to join in, and the activities organisers try to speak to and spend time with each resident, each day; either in a group context or on a one to one basis. The activities organiser on duty on the day of the inspection said that staff get to know which residents usually prefer to join in, and they know which specific activities they like to participate in. This was clearly seen by the way in which some residents were being assisted with jigsaws, or board games, and others were happy to join in with group activities. Details are recorded in care plans and in separate records maintained by the activities Cedardale Residential Home DS0000059264.V374111.R01.S.doc Version 5.2 Page 15 organisers. Care staff are also familiar with their preferences; for example, one resident likes to dance, and was dancing with a carer in the afternoon. Another likes to play the piano in the new lounge. The staff have devised a four weekly activities plan, which includes sessions for reminiscence, board games, ball games, music and dance, gentle exercises and a weekly film afternoon (with popcorn and choc ices). The activities programme is displayed in the entrance hall and in other places around the home, and relatives and friends are invited to take part. Since the building extension has been completed, the gardens have been relandscaped, and there are different areas for residents to sit or to walk in good weather. There are plans to provide new garden furniture. Residents are taken out in the homes minibus in groups of four to six; and go to places such as shops, restaurants or pubs for meals out, and to the pantomime and theatre. Some residents are also taken out by family members on a regular basis. Entertainment is provided in-house, and includes events such as buffet meals for relatives to join in with, a Christmas party, an Easter bonnet competition, and a Valentines Day meal. Families and friends are welcomed into the home, and are always offered a drink. The home has a generally friendly and homely atmosphere, and there are residents and relatives meetings approximately every two months. This provides opportunity for ideas to be raised, and for general discussion about how to further improve life in the home. During the inspection we carried out a Short Observational Framework Inspection (SOFI), for one hour, which is a set format for observing the care given to specific residents over a period of time. We followed the care and input given to five residents over one hour, without the home knowing which residents were being observed. The results were extremely positive, with plenty of attention being given to each resident, and good interaction with staff. Residents care plans state if they have religious beliefs, but there was no evidence recorded to show how the home assists them in meeting their spiritual and faith needs. Individual ministers or priests are invited to visit on request. The head of care said that they used to hold a Christian church service in the home (for people who wish to attend), and they are looking at the possibility of arranging this again. Residents (and their families) are encouraged to bring in special items to personalise their rooms, and many had photographs, pictures and specific items they had chosen to bring in. Some have large names/pictures on their bedroom doors, and the manager intends to have these for every resident in the future. Cedardale Residential Home DS0000059264.V374111.R01.S.doc Version 5.2 Page 16 A new kitchen has been fitted since the last key inspection, and this is well designed with stainless steel appliances. We chatted with the main chef, who works out the menus, and adds in items according to residents choices. She spends time with the residents, and knows the food choices which they particularly like. This is very helpful if they are feeling unwell or not eating much, as she can usually find something to tempt them with. She prepares one main meal each day, but as she is aware of specific likes and dislikes, will prepare an alternative for anyone as necessary. She will also provide alternatives such as omelette, soup or sandwiches each day. All meals are home cooked. The chef attempts to ask each person each day what they would like to eat; and the heads of care have been working with her to take photographs of each meal, and to make a menu choice of laminated pictures. This will enable residents to make a choice more easily. The chef prepares a hot dish for tea times, and home made soup is always available. There is a choice of desserts, and home made cakes each day. A designated carer carries out the tea preparation. Residents can have a snack at any time; and cooked breakfasts are available if requested. The kitchen was seen to be clean and well organised. Fridge, freezer, and hot food temperatures are recorded each day; and there are good cleaning schedules in place. Cedardale Residential Home DS0000059264.V374111.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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff understand the importance of enabling residents to communicate any concerns or complaints, and these will be taken seriously. All staff receive training in the protection of vulnerable adults, and this protects the residents from abuse. EVIDENCE: The complaints procedure has been updated since the last key inspection, and has been prepared for residents in an easy read format with accompanying pictures. This procedure is available in each room, and in the service users guide. However, the procedure for relatives or visitors to the home was not so clear, and this was discussed during the day. The head of care said that she would amend the format of it the next day, to make it more straightforward; and to include the address of the local Social Services department, as a reminder that care managers or the Social Services duty officer can assist complainants if required. CSCI details are included and are correct. The procedure is kept on display in the entrance hall where it is easily accessible, and is accompanied by complaints forms. A complaints log is maintained, and there have been no complaints since the last key inspection. No record was being made of minor concerns, and the manager agreed that it would be good practice to commence this, so that clear Cedardale Residential Home DS0000059264.V374111.R01.S.doc Version 5.2 Page 18 evidence can be seen for what action has been taken to address any issues. It will also highlight if there is an ongoing pattern for any concerns. Training records showed that staff are all trained in the recognition and prevention of abuse for vulnerable adults. This training is commenced at induction, and is followed up with additional training. Staff are familiar with the Kent and Medway protocols for Safeguarding Adults. The home has a well prepared staff handbook, and this includes further information about this subject. Each staff member is given a copy of the handbook when they commence employment. Cedardale Residential Home DS0000059264.V374111.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): 19-22 & 24-26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has been enhanced by the completion of a new wing, and this provides more communal space, and a better standard of environment for the residents. Décor and fittings have been carried out to a high standard; and other areas in the home are being refurbished. EVIDENCE: The home comprises an original Tudor style older building, and a new ground floor extension, which was completed last year. This work has been completed to a high standard, and includes spacious bedrooms with en-suite toilet and shower facilities, wide corridors, an additional lounge, and another bathroom. Furniture and fittings are of good quality, and the extension enhances the home. All communal areas and corridors were also refurbished and re-carpeted last year. Cedardale Residential Home DS0000059264.V374111.R01.S.doc Version 5.2 Page 20 Since the extension has been completed, work has commenced to refurbish all other bedrooms, and many of these have been repainted and have new carpets and furniture. The manager said that bedrooms are being refurbished as they become vacant. The older rooms were seen to be homely and comfortable. Residents in existing bedrooms were given the option of moving to rooms in the new extension, and some chose to take up this offer. The home was clean in all areas, and there were no offensive smells. Most rooms are for single use, but there are several shared rooms for people who prefer to share. One of these is quite small, and has a fire exit. Furniture has been moved since the last visit to ensure that the fire exit is not obstructed, and a risk assessment is carried out for any residents staying in this room. Most wardrobes have locks fitted to them but these will only be used if specifically requested, so that residents can have access to their clothes as they wish. The addition of the new extension provides the home with two lounges and a dining room. The manager said that they are going to change the older lounge into a dining area, and vice versa, as the current dining room overlooks the front of the home and residents like to look out of the front window. There are three different garden areas at the rear of the building and these are pleasant and well maintained. There are sufficient toilet facilities, and some of these are near to communal areas. There are two bathrooms with assisted baths, and some rooms have en-suite showers. A stair lift provides access to the first floor, and residents are assessed for their suitability for having a room upstairs. Equipment is obtained as necessary, and this includes the recent purchase of a mobile hoist. All care staff are trained in moving and handling, and in use of the hoist. The providers have purchased individual slings, and individualised handling belts for assisting residents. Other equipment in the home includes grab rails and handrails, commodes and raised toilet seats. All radiators are covered for safety, and hot water outlets accessible to residents are fitted with thermostats. The maintenance man checks hot water temperatures every week. The new extension has under floor heating, so no radiators are needed. Window restrictors have been fitted. The laundry room is small, and is currently difficult for managing laundry. However, the providers have already had plans approved to build a separate laundry, and this is due to be carried out this year. This building work will only cause minimal disruption, and will not affect access to the gardens. A requirement has not been made in regards to the laundry premises, as this is already being attended to. Cedardale Residential Home DS0000059264.V374111.R01.S.doc Version 5.2 Page 21 The laundry has one washing machine and one dryer, and with the increased number of residents, needs additional equipment. There is a designated laundry assistant on duty each weekday, who also carries out the ironing. Care staff assist with laundry at weekends. New waste bins have been purchased since the last key inspection, which have improved the management of infection control. All chemicals are kept in a locked cupboard. It is thought that the existing laundry room will provide an extra storage room for equipment (such as wheelchairs) when the new laundry is built. Cedardale Residential Home DS0000059264.V374111.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are satisfactory, and are being increased in relation to the increased numbers of residents. There are good staff training programmes in place, and this means that residents benefit from being cared for by competent and well-trained staff. EVIDENCE: There have been a number of staff changes since the last inspection, and the manager has also increased the numbers of staff. There are now four care staff on duty throughout the day, as well as the manager and a head of care each day. There were twenty-two residents at the time of the inspection, and the manager said that a fifth carer will be allocated for day shifts when the number of residents rises to twenty-four. Night shifts are covered by two waking care staff, and one sleeping night staff. It is only a short-term measure to have a sleeping-in carer, while the number of residents is increasing. When the number has risen to twenty-four residents, there will be three waking care staff on night duty. Cedardale Residential Home DS0000059264.V374111.R01.S.doc Version 5.2 Page 23 The home has two part time activities assistants, covering four days per week. The providers will have to consider if another activities assistant is needed for the other three days, (when the home is full) or if allocating an additional carer will be necessary. They may also need to consider if the numbers of domestic staff are sufficient. The home currently has only three care staff who have completed NVQ 2 training (or higher), but another seven are in the process of completing training. This will bring the percentage up to 62.5 per cent. As the home is working towards a level above 50 per cent, no requirement or recommendation has been given. Three staff files were viewed to assess recruitment practices, and these were found to be well managed. Application forms asked for a full employment history, but with a chronological order for the last ten years. This was felt to be rather confusing, and it was suggested that the form is re-worded to state that a full employment history should be provided – i.e. from the time of leaving full time education. The application form includes a declaration of any criminal convictions, and a health questionnaire. Two senior staff carry out interviews, and a record is kept of the interview. Two written references are required, and the management check these verbally as well. POVA first and Criminal Record Bureau (CRB) checks are obtained, proof of identity, and confirmation of previous training records. A training manager has been appointed to cover all three homes in the group. She carries out induction training for all staff at one of the other company homes, where there is a training room. All staff now undergo a full weeks induction with her, and complete all mandatory training during this time. New staff then work alongside more experienced staff until they have been assessed as competent to work unsupervised. The homes training matrix confirmed that all mandatory training is being kept up to date. The training manager is a trainer for some subjects (e.g. fire safety, Mental Capacity Act), and she accesses external trainers for other subjects such as moving and handling, health and safety and basic food hygiene. In addition to mandatory training, all staff are trained in dementia care, protection of vulnerable adults, and communication skills. The dementia care training programme consists initially of a one day course; and this is then followed up with a twelve week distance learning course, with a workbook for staff to complete. Other training is booked for subjects such as equality and diversity, and deprivation of liberty. Cedardale Residential Home DS0000059264.V374111.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31-33 & 35–38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager and the heads of care work together to ensure that the home is managed effectively. This means that residents and relatives can be confident that due care and attention is paid to all matters regarding the running of the home. EVIDENCE: The manager is a trained general nurse and mental nurse, and has many years of experience in caring for older people with dementia. He is assisted by two heads of care, who work alongside him on different shifts, so that there is always a head of care on duty in the day times and at weekends. They have established separate areas of responsibility, and work Cedardale Residential Home DS0000059264.V374111.R01.S.doc Version 5.2 Page 25 well together to ensure that all aspects of the life of the home are being managed between them. As well as meeting with the heads of care, there are also regular meetings with the care staff, ensuring that they are aware of their roles, and are up to date with any changes in the home. Minutes from a meeting last year showed that they had discussed key worker responsibilities, such as tidying wardrobes, liaising with relatives, and keeping clear written records. New staff are mentored by senior staff. There are also residents and relatives meetings, which are held approximately every three months. Surveys are sent out from the home every six months, and contain a variety of different topics. The most recent survey includes asking relatives if they find the dementia booklet helpful, (which they are given when the resident is admitted). The home also provides a monthly newsletter, and this is sent out to each next of kin or representative to keep them up to date with news in the home. Monthly (Regulation 26) visits are carried out by the manager from a different company home. The manager has an open door policy, and the manager or a heads of care are available each day to talk with any family members. Small amounts of pocket monies are stored individually for residents, so that any small items can be purchased on their behalf. One of the heads of care maintains these records, and they are audited each month by a company representative. One to one formal staff supervision is currently carried out by the manager, using a set format to discuss items such as issues arising from working practices, training courses, and future training needs. Supervision sessions are carried out every two months, and there is also a yearly appraisal. There are plans to delegate formal supervision to other senior staff as well. Policies and procedures are being reviewed yearly, and any changes are brought to the attention of the staff. Records were generally up to date and well maintained. We examined some maintenance records, including the homes new fire risk assessment, and fire log book. A fire officer has visited the home since the last key inspection, and recommendations have been followed. There are weekly fire alarm tests. Individual dorguard fittings have been applied to bedroom doors where residents prefer the door left open at night. These are devices which shut the door automatically if the fire alarm sounds. The maintenance file confirmed ongoing checks are carried out, such as weekly hot water temperature checks, fire door checks and checks for first aid boxes. There is an ongoing workbook for maintenance needs, and the issues are recorded when the maintenance has been carried out. Cedardale Residential Home DS0000059264.V374111.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 3 3 3 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 2 17 X 18 3 3 3 3 3 X 3 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Cedardale Residential Home DS0000059264.V374111.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 2 Refer to Standard OP2 OP7 Good Practice Recommendations Contracts should include details of the room allocated, especially if the resident chooses to share a room. To ensure that all care plans are brought up to date e.g. all property lists are completed; all forms for a day in the life are completed; and all forms regarding the Mental Capacity Act 2005 are completed. To ensure that all handwritten entries on Medication Administration Records are checked and signed by two appropriately trained staff. To ensure that there is written evidence to show how residents spiritual and religious needs are being met. 3 4 OP9 OP12 Cedardale Residential Home DS0000059264.V374111.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Cedardale Residential Home DS0000059264.V374111.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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