Care Home: Cedars Resource Centre

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What the care home does well The home was clean and there were no unpleasant smells. The food looked very good. The dining rooms were attractively set and the atmosphere in the dining room was good. Residents told us that they had a choice of three options at lunchtime and that their individual needs were catered for. The health care of residents appeared to be excellent. Good health assessments were in place and there is a lot of input from the on-site health professionals. Residents said they were well looked after and several described how their health had improved. One resident said she was so well looked after that she did not want to go home. There is a lot of emphasis on promotion of Independence and the aim is that people regain life skills to help them live independently. Records relating to the maintenance of the building were well organised. Health and safety checks were up to date. Records about accidents occurring in the home were clear. Good efforts are made to seek the views of residents who have used the service. A representative of the residents is invited to attend clinical governance meetings. Quality questionnaires are issued every three months. The results of the most recent one were very positive. Records showed that good checks are made when staff are recruited and that staff are properly trained. This is essential to protect and ensure the welfare of residents. Management of residents medication has not changed since the last inspection and was good. Generally the home seemed to be well managed. The manager showed a commitment to improve and she keeps her own and her staff`s skills updated. Residents told us that they had a very good relationship with staff. We observed staff treating residents well. They were polite and friendly. Residents said the staff were kind and caring without exception. What has improved since the last inspection? Some improvements have been made to the premises and some more are planned. The bathrooms have been updated to provide more pleasant facilities for people to use and some carpets have been replaced. A linen press has been provided for the laundering of sheets as these were found to be crumpled at the last inspection. Window restrictors have been fitted. These are essential to limit the opening width of windows and prevent residents falling out. A programme of social activities has started and basic social care plans introduced. What the care home could do better: We still feel the social life of residents could be better and have recommended that the activities programme continues to develop. Along with this the recording of this needs to improve to demonstrate that the care is person centered and takes account of social, emotional and spiritual need as well as physical. The laundry room has not been resited due to lack of space. Clean and dirty laundry is still in close contact. The manager is exploring options for laundering away from the site to resolve this. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cedars Resource Centre Morwick Road Lynne Estate North Shields Tyne & Wear NE29 8JB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Janet Thompson     Date: 0 2 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Cedars Resource Centre Morwick Road Lynne Estate North Shields Tyne & Wear NE29 8JB 01912006177 01912008905 karen.robinson@northtyneside.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: North Tyneside Council care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Up to 5 service users category PD, Physical Disability, can be accommodated at any time. Date of last inspection Brief description of the care home The Cedars is an intermediate care facility situated in a residential area of North Shields. The facility is divided in to two units, Highgrove and Roseborough. The Roseborough unit accommodates older people who have orthopaedic problems and the Highgrove unit admits older people who have other health care needs. Most people come to The Cedars from hospital and stay for short periods only. Bedrooms are all single accommodation. There are three lounge/dining rooms and a gym/rehabilitation area. A passenger lift is available to take patients to the first floor. Care Homes for Older People Page 4 of 24 Over 65 30 0 Brief description of the care home The intermediate care team are based in the home. They consist of care staff, nurses, physiotherapists, occupational therapists and social workers. Doctors and other professionals regularly visit. There is no charge for the facility other than for some aids and adaptations. The service is jointly managed between Northumbria Healthcare Trust, North Tyneside Primary Care Trust and North Tyneside Council Social Services. The aim of the facility is to return people to their own homes and avoid unnecessary hospital stays. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is three stars. This means the people who use this service experience excellent quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations. This will only happen when it is considered that people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This was an unannounced inspection. The manager was present at the inspection. Before the visit we looked at information we have received since the last inspection Care Homes for Older People Page 6 of 24 visit, including how the service dealt with any complaints or concerns. We also looked at any changes to how the home is run and asked for the managers views of how well they care for people. During the unannounced visit we talked with people who use the service and some of the staff. We looked at the information about people who use the service and how well their needs are met. We looked at other records the home is required to keep and checked that staff had the knowledge, skills and training to meet the needs of the people they care for. We looked around the building to make sure it was clean, comfortable and safe. and we checked what improvements had been made since the last inspection visit. Feedback was given to the manager at the end of the visit. What the care home does well: What has improved since the last inspection? Some improvements have been made to the premises and some more are planned. The bathrooms have been updated to provide more pleasant facilities for people to use and some carpets have been replaced. A linen press has been provided for the laundering of sheets as these were found to be crumpled at the last inspection. Window restrictors have been fitted. These are essential to limit the opening width of windows and prevent residents falling out. A programme of social activities has started and basic social care plans introduced. Care Homes for Older People Page 8 of 24 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 24 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are properly assessed, taking account of their needs and wishes, so that they can be assured this is a suitable home and receive an individual care service. Evidence: The assessment process has not changed since the last inspection. A qualified nurse assesses all residents before they are admitted to the home. The assessment is very comprehensive. Account is taken of reports from all associated health professionals such as occupational therapists, dieticians, speech therapists and physiotherapists. The assessment is used to inform the staff of the initial care needs of the resident and form the basis of the care plan. The aim at The Cedars is to enable people to return home as soon as they are fit to do so. The development of living skills and independence is a high priority. The intermediate care team work as one to ensure that each resident has one package of care that meets both health and social needs. Residents have access to small kitchens Care Homes for Older People Page 11 of 24 Evidence: were they are assisted to carry out ordinary living skills. Assessments of these are done before the resident returns home. We talked to one resident who was going home with a staff member that day, she was visiting her house to see how much equipment she would need and what areas she required further support in. The resident told us that staff had been very supportive and had helped her a lot to get back to fitness. An analysis is kept of all residents admitted and discharged. This showed that the vast majority of residents went home after their stay at The Cedars. This was usually after a period of two to four weeks. Care Homes for Older People Page 12 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal care that is well planned and takes account of their diverse needs. Evidence: Three care plans were examined. Two were case tracked to individuals that the inspector had seen or met. The case files are divided into two separate files. One contains all of the assessments from the nurses, doctors, physiotherapists and occupational therapists. The other file stays in the residents room and contains records of the day to day care delivered. This includes night and day checks and record of baths and showers. The health care needs of residents were well documented. In depth assessments from the appropriate health professionals were in place. The care is prescribed by a nurse or other health expert. The plans are based on residents health problems and in this area provide some excellent information. There are now social care plans for residents. These provide basic information and could be developed to give a better picture of how each person has spent their leisure time in the home. Care Homes for Older People Page 13 of 24 Evidence: Residents health needs were very well planned for and met. Two residents spoken to said they had been helped back to full health very quickly. Residents looked clean and well cared for. The contribution of health experts in the care of people is excellent and the benefits obvious. Staff are trained and competent in health matters. Training is arranged on topics that relate to resident care. A resident told us that she was very impressed by the attention she had recieved. She described the care as excellent and said she had been dismayed to be admitted but now she was not sure if she wanted to go home. Medication arrangements have not changed since the last inspection. Residents wear hospital style identity bracelets. These are checked during the administration of medication. Staff have received training to administer medication. An error with medication recently occured. This was fully investigated and reported. As a result staff now wear red aprons to administer medication which indicate that they are not to be disturbed. Care Homes for Older People Page 14 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to lead a healthy and fulfilling personal lifestyle. This takes account of their wishes and diverse abilities. Evidence: This service is different to the average care home in that residents are only there a short time. During that time they receive physio and occupational therapy aimed at maximising independence and returning home. Following the last inspection of the home some social activities now take place. These are minimal and could be developed further. The record of social activities was not up to date. We have recommended that individual records are made and that the schedule of social opportunities is extended. There are plans to provide televisions in all of the bedrooms to offer more choice for people. Visitors are welcome in the home between 13.30 and 20.00hrs. This is to enable therapies and treatments to be carried out in privacy in the morning. The restrictions to visiting are flexible and different arrangements can be made on request. This is all stated in the service users guides, which are in each bedroom. The medical staff have suggested shorter visiting times as some residents are reluctant to attend treatment sessions if they have visitors. The manager is reluctant to restrict visiting any further Care Homes for Older People Page 15 of 24 Evidence: and we agree with her. We have suggested that any problems arising from conflicting visiting and treatment times are dealt with individually. Residents are given choice within the constraints of timetables for health treatments and the routines of the home. We heard staff offering people choices in where to sit and what to do with their day. The food looked very good. Residents said it was usually good. The dining rooms were attractive. Residents did not look hurried over the meal and there was a lot of social banter. The manager now has control over the catering arrangements. Fresh vegetables are now used and there are always three choices at lunchtime. One resident told us she had never been so well fed. She said that she enjoyed the food which was well cooked. Another resident thought she had put on weight since coming to the home. One resident told us that her appetite was very small and staff had accommodated her wishes for small portions. Care Homes for Older People Page 16 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are protected from harm through thorough policies, procedures and staff training. Evidence: The complaints procedure is in the service user guide. These are available in all rooms. Leaflets produced by the three managing authorities also set out procedures for complaints. Residents spoken to knew how to complain. The manager records all complaints. There were two complaints recorded for 2009. All complaints were taken seriously and resolved to the satisfaction of the complainant. Adult protection procedures are available in the home. All staff have received training in adult protection. There have been no incidents requiring the intervention of the adult protection team. Care Homes for Older People Page 17 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe comfortable home that is generally pleasant and clean. Evidence: The environment meets the needs of the people who use the service. It is comfortable and clean. Some improvements to the premises have taken place and more are planned. The bathrooms have been refitted and now provide appropriate and pleasant places for residents to bathe. New bedding and towels have been ordered. Some carpets have been replaced in bedrooms and hard flooring is in use in some places. This is better for the promotion of hygiene and control of infection. Window restrictors have been fitted to prevent windows opening wide enough for residents to fall out. A linen press has been provided in the laundry to enable better laundering of bed linen. Both laundry rooms are very small. It is impossible to separate clean and dirty linen in this space. Consideration has been given to the provision of a separate laundry room but there does not appear to be enough space. The manager has now sought quotes to seek external laundry arrangements. Residents own laundry is washed at home by their relatives. Care Homes for Older People Page 18 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported and protected through staff numbers, skill and ability. Evidence: There were adequate numbers of staff on duty. The current staffing for the home is: One nurse throughout twenty four hours. Five care staff during the day and one team leader. Three care staff at night. Staff training records were checked. An electronic training log is in place that alerts the manager when refresher training is due. Statutory training is up to date. Staff continue to access a lot of vocational training related to their role. Good use is made of the expertise already on site. Two staff recruitment files were checked. Good recruitment procedures were followed. All files contained evidence of reference checks, background, and identity and criminal records checks. An interview form was used to ensure accountable and consistent interviewing. There was evidence of a good understanding of equality and diversity throughout the recruitment process. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are protected through reflective management taking account of the diverse needs of the service. Evidence: The manager has many years experience in management. She has been assessed by us as fit to run a care home. The manager is keen to run the home well for the residents. She has consulted them through surveys, meetings and an open door approach. Surveys are carried out every three months. We looked at the results of the most recent ones. All comments were positive. A resident representative also attends clinical governance meetings. This has been a resident who has used the service in the past and the manager reported that this input is very valuable. Health and safety checks were up to date. Certificates were in place for the testing of gas, portable electrical appliances, water chlorination, lifts and hoists. All internal safety checks were up to date. These included fire fighting equipment, door closures, ventaxia and hot water. Care Homes for Older People Page 20 of 24 Evidence: There were no obvious trip hazards in the home. Fire exits were clear of obstructions. All rooms containing hazardous fluids were locked. A weekly audit of the health and safety of the building is carried out to identify any potential risks. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 12 The social opportunities for residents are kept under continual review and improvement. Individual records are kept of activities for each resident. 2 26 Continue to pursue separate provision within the laundry for clean and dirty linen. Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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