Care Home: Cedarwood House

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What the care home does well People are happy living at the home. They feel staff’ are kind and caring, the food is good and they have nice rooms. A relative felt the home is always welcoming and they are able to visit any time. Professionals spoken with felt the home has improved. One said it’s a ‘happier and brighter’ place. People receive care from a staff team who feel well supported and a good number are qualified. Staff surveyed felt the home ‘provides a friendly, homely environment for service users and a high standard of care. Cedarwood House has a good staff Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 retention so residents know their carers well. There is always something going on so resident are occupied when they wish to be’ and ‘it is a nice place to work people very friendly to me and resident is nice’. They felt the home does well in ‘making the place nice and homely for our residents’. What has improved since the last inspection? There has been ongoing refurbishment and redecoration to the home such as the kitchen, lounge and bedrooms. New furniture has also been purchased. In addition the cleanliness of the home has also improved giving people a nicer environment in which to live. Fire safety tests show equipment is working to ensure people are safe. Signage and pictures are now used to good effect to guide people around the home. People have chosen their own individual toiletries instead of sharing. There are improved opportunities for people to enjoy social activities and the newly implement programme of activities should enhance this further. Improvements have been made to the medication system to ensure people are safe but further are required. Peoples concerns are now recorded to aid a good outcome and ensure action is taken. A review of staff has taken place and the numbers increased at certain times. Recruitment practices have been strengthened to ensure people are protected. Staff’ has received further training to enhance their skills when caring for people. A deputy manager has been appointed to help the smooth running of the home. What the care home could do better: Actions in relation to health and care needs identified must be monitored through care plans to ensure peoples needs are being met if not other action should be taken. The home must ensure practices carried out in the home ensure people are treated with dignity and respect and their right to privacy upheld. Medication systems must be strengthened to protect people. Other areas for improvement are contained in the text of this report. Key inspection report CARE HOMES FOR OLDER PEOPLE Cedarwood House Hastings Road Battle East Sussex TN33 0TG Lead Inspector Mrs Sally Gill Key Unannounced Inspection 8th June 2009 09:30 DS0000069155.V375693.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedarwood House Address Hastings Road Battle East Sussex TN33 0TG 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) 01424 772428 01424 775260 Cedarwood House Ltd Mrs Christine Butcher Care Home 20 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Cedarwood House DS0000069155.V375693.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) Dementia (DE). The maximum number of service users to be accommodated is 20. 2. Date of last inspection 29th July 2008 Brief Description of the Service: Cedarwood House is registered to provide accommodation for up to 20 older people including those suffering from dementia. They admit people with low to medium dependencies. The owners own several residential homes around the country. Mrs Christine Butcher is the registered manager and is in day-to-day control of the home. The premise is a detached property with gardens to the front and rear of the property. The gardens include lawns areas and established borders and shrubs; the rear garden is secure and has a level paved patio area with tables and seating. There are 19 bedrooms on the ground and first floor. All are used as singles although one could be used as a double. Nine bedrooms have ensuite facilities. A passenger lift provides access to the first floor. There are two assisted bathrooms and one assisted shower room. The home has two lounges and a dining room. The home is non-smoking. There is level access to the home. There is car parking for around eight cars. The home is situated down a quiet lane off the Hastings Road. The town of Battle is approximately one mile away with local amenities, shops and a railway station. The staff compliment consists of a manager, senior carers, carers and ancillary staff. Care staff’ work a rota that includes a minimum of two staff on duty Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 5 during the day and two at night. Current fees range from £346.03 to £435.00 per week. Additional charges are made for toiletries, hairdressing, newspapers and chiropody. Previous inspection reports are available from the home or can be viewed and downloaded from www.cqc.org.uk Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1star. This means that the people who use this service experience adequate quality outcomes. The previous inspection took place on 28th July 2008. This inspection was carried out over a period of time and concluded with an unannounced visit to the home between 09.30am and 4.00pm. The manager and staff assisted during the visit. People that live in the home, a relative, visiting professionals and staff’ were spoken with. Observations were made throughout the day. Sixteen people were living at the home on the day of the visit one of which is a staying short term. Surveys were sent to the home for the manager to distribute to residents, staff and health and social care professionals. One was return from a resident and two from staff. All were generally positive. Telephone contact was made with health and social care professionals and the Environmental Health Office. The care of three people was tracked to help gain evidence as to what its like to live at Cedarwood House. Various records were viewed during the inspection and a part tour of the home undertaken. The home sent their annual quality assurance assessment (AQAA) to the Commission within the required timescale. The AQAA is a self-assessment picture of how the manager thinks they are doing against the national minimum standards. What the service does well: People are happy living at the home. They feel staff’ are kind and caring, the food is good and they have nice rooms. A relative felt the home is always welcoming and they are able to visit any time. Professionals spoken with felt the home has improved. One said it’s a ‘happier and brighter’ place. People receive care from a staff team who feel well supported and a good number are qualified. Staff surveyed felt the home ‘provides a friendly, homely environment for service users and a high standard of care. Cedarwood House has a good staff Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 7 retention so residents know their carers well. There is always something going on so resident are occupied when they wish to be’ and ‘it is a nice place to work people very friendly to me and resident is nice’. They felt the home does well in ‘making the place nice and homely for our residents’. What has improved since the last inspection? 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 on page 4. Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 8 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. Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their representatives have the information needed to make an informed choice about moving to this home who has agreed they can meet their needs. EVIDENCE: People have the information they need to make an informed choice about whether this home is right for them. The person surveyed indicated they received sufficient information about the home prior to moving in. A statement of purpose and service user guide is in place. The service user guide has recently been updated with further information and photographs. A copy of the service user guide is sent to individuals prior to admission. Feedback from a social care professional involved in an admission was very positive. They said staff’ was very helpful. Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 11 People are protected by contracts of terms and conditions. One file examined contained a contract which included information about fees and was signed by both the individual and the home. The person surveyed confirmed they have a contract. People’s needs are generally assessed prior to admission. The manager usually visits people in their own environment to assess their needs. The format used for the pre-admission assessment has recently been change so it is now more concise and less repetitive. A set of questions (A personal care handbook) is also given to individuals or their relatives for them to complete about their care needs. Three assessments were examined which contained sufficient information. The manager advised that usually where a person is funded by local authority a copy of their assessment is obtained. However the home had not obtained the assessment for one person case tracked. It is required by legislation that the home must always obtain a copy of the local authority assessment to get a full picture of care needs. A letter is sent following the assessment to confirm whether care needs can be met. People confirmed that they had had the opportunity to visit the home prior to admission. Intermediate care is not provided but short term care can be vacancies allowing. Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that a person receives is based on their care plan. This could be enhanced for individuals with improvements in care planning. The principles of respect, dignity and privacy are not always put into practice. People are still not fully protected by medication procedures. EVIDENCE: People’s health, personal and social care needs are documented in the care plan folder but key information is sometimes lost in the amount of information. The folders of three people were examined. Individuals or their relatives are involved in the developing and reviewing of care folders. The folders contained information relating to all aspects of care and support. Different sections were reviewed monthly with good detail. However information contained in the folders is not always brought forward onto the plan of care meaning staff would have to read all the reviews (eight) to get an up to date picture of the individual. Examples are information about current input by health Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 13 professionals and for what, fluid and turning chart have been put in place, daily checks needed for pressure relieving equipment and a programme of regular toileting. There is also no monitoring of actions identified in the plan of care. For example the checks on pressure relieving equipment and some individual care plans state the person should be toileting ‘regularly’ or ‘3 to 4’ or ‘5 to 6’ times a day. There is no evidence this is achieved and in daily notes made by staff it is clear if people are toileted regularly this is not always successful in ensuring peoples continence. The manager is introducing a new format assessment/care plan which will allow for more detail to be recorded on the care plan. Care plans contain a variety of risk assessment (nutrition, moving and handling, mental health, falls and environment) and all documents are reviewed regularly. Some documents are confusing where they have been updated and it is not clear which is the most up to date information. For example one person had independent, supervised and 1 carer all tick for assistance required in a moving and handling task. People spoken to confirm that they are generally happy with the care and support they receive. The person surveyed indicated they ‘always’ receive the care and support they need. One professional spoken with felt the home are alert to an individuals needs and respond appropriately and quickly. Staff members felt they ‘always’ or ‘usually’ receive up to date information about the needs of people. Stakeholder’s views on whether health care needs are appropriately met are mixed. Feedback from health and social care professionals was very mixed. One said any concerns they have raised with staff are followed through into practice or referred on appropriately. Another said when an individual was not well the ‘staff kept on it to ensure a doctor was called and medication prescribed’. Another said the home is ‘task orientated’ for instance they are not sure ‘people who cannot help themselves receive enough fluids’. A health professional surveyed indicated that peoples health care needs are only ‘sometimes’ monitored, reviewed and met by the care service. One professional felt that when concerns arise they are not always referred directly but staff try to manage which can result in further deterioration. The person surveyed indicated that the home ‘usually’ ensures they get the right medical care. The accident book evidenced that staff are dressing wounds that should treated under the instruction of a GP or district nurse. Medication systems must be improved to fully protect people. The medication system was examined and improvements have been made. These include storage is now more secure; the temperature of storage is check and recorded and a fridge has been purchased to ensure medications are stored at the correct temperature. Handwritten entries on the Medication Administration Record (MAR) charts are now dated and signed although still not witnessed Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 14 which was previously a recommendation for good practice. Medication is logged into the home. Concerns found include one person had run out of a prescription cream so it had not been administered, the code O (other please specify) had been used on the MAR charts but no explanations recorded, in two cases prescriptions state one or two tablets to be given but staff have not recorded which amount was administered. Sachets of medication were stored without a prescription label and the manager advised these were no longer used for whom they were prescribed but kept in case a health professional came in and asked for this to be administered to an individual. Medications must not be used for any person apart from who they are prescribed for; these medications must be returned to the chemist. Records were kept of the quantity of a controlled drug used but this was not witnessed by a second member of staff for the past three days in line with the homes policy. A requirement is made. There have been improvements to ensure people are treated with respect and their right to privacy and dignity enhanced. Although observations highlighted staff do not always following good practice. Signage has been used to clearly identify toilets and bathrooms. People have been involved in making name plates for their bedroom doors and also placemats for the dining tables. Doors have also been painted different colours to help identify what a room is used for. People now have their own individual toiletries. Most notices and cleaning checklists have been removed from display. Peoples privacy and dignity is ‘sometimes’ respected was indicated by one professional survey. Some observations were made which is not good practice. Whilst transferring a person from wheelchair to chair in the lounge two staff spoke about an individual’s incontinence in a derogative way. On the way out of the dining room an individual told a member of staff assisting them they needed the lavatory but the member of staff sat them in the lounge and the person had to repeat her request to someone else a few minutes later when she was assisted. An individual received treatment from a professional in the lounge although the owner did address this when brought to his attention. Results for the homes own quality assurance survey indicated people feel their privacy and dignity is respected and stated that staff knock on their doors before entering. Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make some choices about their lifestyle. People have better opportunities for stimulation through appropriate social, cultural and recreational activities but this should continue to be improved. People enjoy the food and have a varied diet. EVIDENCE: People have improved opportunities for social and recreational activities. Records and discussions confirmed that activities are taking place. These include gardening, reading, quizzes, television, music, knitting, manicures, cooking, and motivation, outside entertainer/singer, ball games and short walks for individuals. The home has developed a programme of activities which was implemented on the day of the visit. This should see three activities taking place each day which will be good practice. People enjoyed listening and singing along to an outside entertainer/singer on the day of the visit. The person surveyed indicated the home ‘usually’ provides activities to take part in. Results from the homes own quality assurance survey indicate that people are Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 16 happy with the activities on offer and could not think of any other interests or hobbies that they would wish to do. People maintain contact with family, friends and the local community. The manager advised that people have the opportunity to receive regular communion from two separate visiting denominations. One person goes out regularly to attend a local club. A garden party is planned for June. A hairdresser visits regularly. A relative was spoken with confirmed they can visit anytime and are made to feel welcome. The results of the homes quality assurance survey indicated that relatives feel they are made very welcome and staff’ are always polite. They are able to spend quality time with their relative during visits and are usually offered a drink. People are able to exercise choice over their lives. People spoken to confirm that they can get up and go to bed as they wish. Results from the homes own quality assurance survey indicated people feel they are able to choose when to have a shower or bath and when to go to bed and get up. The home handles a small number of savings for individuals and others make their own arrangements. Bedrooms visited were individualised by personal possessions such as knick knacks and photographs. Records evidence people were given the choice to vote. People were observed to be offered a choice of drink during afternoon tea and spend time as they chose in company or in their own rooms. In some areas people could be offered more choice particularly in relation food and mealtimes. For example one person spoken with had been given sandwiches the previous tea time on white bread but really preferred brown which was recorded in their care plan. They were still hungry and asked for a pudding and were given a piece of cake. They also said at breakfast they would normally have two eggs not one as given and at lunchtime they were heard saying the meal was not really enough. The inspector advised staff’ of this who offered seconds which was accepted. It is acknowledged that this individual had only just moved into the home and these problems would have become evident. However if staff are proactive in offering choices it would ensure good outcomes for people directly. People are offered a varied diet which generally is enjoyed. Breakfast is generally porridge, cereals or toast. The main meal is served at lunch time. On the day of the visit it was shepherds pie and cabbage followed by rice pudding. Alternatives are available but it is unclear that people are aware they can or would ask for something different. Special diets are catered for. Tea is a light meal, soup or sandwiches. On the day of the visit it was soup or sandwiches. Homemade scones were served during the afternoon with a drink. People confirm the meals are quite good. The person surveyed indicated they liked the meals. Results from the quality assurance survey were positive, people were happy with range of food offered and indicated the quality of meals was rated good. A drink of squash was evident at the lunch table and staff were observed to offer top ups. One person took a very long time to eat their first course although all the puddings were brought out to the Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 17 table at the same time which meant by the time they came to eat their pudding it must have been cold. A board in the dining room should display the menu for today but the main meal was not put up on the day of the visit and when people were asked they did not know what was for lunch. The dining room is enhanced by linen tablecloths and fresh flowers on the tables. Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s complaints are taken seriously and responded to. People are protected from abuse. EVIDENCE: People know who to complain to and feel their concerns will be addressed. A complaints procedure is displayed in the front hall as well as a complaints and compliments folder. The manager advised the home now records concerns as well as formal complaints. Records show the home has received three concerns or complaints. Each was investigated and responded to. The person surveyed indicated that staff ‘always’ listen and act on what they say and they knew how to make a complaint. Results of the homes quality assurance survey indicated people feel staff’ are always available if relatives have any questions or concerns and they feel able to discuss issues with management if they wish. During discussions with a visitor it was found that their relative had lost their reading glasses approximately two weeks ago. The senior on duty was asked about this and explained that a search had taken place but the glasses could not be found but would turn up, staff would keep looking but could not see what else could be done. This was later mentioned to the manager who was not aware the glasses were missing but agreed to take action. The manager needs to be sure staff’ are aware of the procedure for managing any concerns. Staff surveyed indicated they know what to do should someone have a Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 19 concern. The manager advised a residents/relatives meeting had been arranged so people could voice their views but unfortunately only one relative attended. People are protected from abuse. The AQAA indicated that policies and procedures are in place to safeguard people. Further safeguarding training has taken place. Most staff’ have now either attended or are booked to attend a course. Staff’ spoken with was aware of the routes to report suspicions of abuse both inside the home and outside. Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are living in a home which is homely, comfortable, generally clean and benefiting from ongoing refurbishment. EVIDENCE: People live in a home where the environment has been improved. Since the last visit several improvements have been achieved. These include the kitchen has been refurbished with new cooker, fridges and work units. There is also a new food storage room. New toilets frames, some commodes, waste paper and clinical waste bins and shower chairs have been purchased. The bath hoist stand has been repainted. New storage has been found for the hoover and cleaning materials. Linen in the store is no longer stored on the floor. Areas of the home including bedrooms and the lounge have been redecorated. There are plans which have been submitted to the local council Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 21 for a 15 room extension. A full time handy person has been recruited. Rooms are now clearly marked by painting doors different colours and using signage and pictures. People and visitors remarked how these changes have really improved the home. During a part tour of the home some concerns were found. These include the laundry and new staff room refurbishment is currently ongoing. However this has resulted in the laundry being in a state of untidiness, not as clean as it should be and surfaces not readily cleanable. The owner and manager advised this is a temporary situation due to a problem with contracts but should be resolve shortly. The safety of people is a concern when building and decorating work is going on. The door to the work area clearly had a notice on to keep shut but was open for most of the morning. Although when the owner was advised action was taken. A door was also painted on the upstairs landing but there was nothing informing people or keeping them away from the wet paint. Gardens lawns are tidy but borders are still unkempt. When asked what could the home do better one staff member commented ‘try to make it better decorated’. People confirm they are happy with their rooms which are individual and have displays of personal possessions. Apart from the laundry area where refurbishment was ongoing the home was seen to be clean. Some practices need to be looked to ensure good infection control. One visitor commented that there is not always soap or towels available in bedrooms to wash you hands. This is possibly because they have been taken for laundry following use but do need to be replaced directly. One member of staff was observed to walk through the home to outside the kitchen area wearing white disposable glove (used for personal care) opening doors along the way. Another member of staff was observed in the kitchen without an apron and gloves which is contrary to the homes policy. However action was taken when brought to the managers attention. The home had no unpleasant odours present on the day of the visit. The person surveyed indicated the home is ‘always’ clean. Results from the homes annual quality assurance survey indicates that people feel the cleanliness of the home has improved greatly with the appointment of a new housekeeper. Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a staff team which has received further training and a good number are qualified. EVIDENCE: The needs of people recorded in care documents may not always be met by current staffing levels. The manager advised a risk assessment is undertaken periodically to ensure sufficient numbers of staff are on duty. Numbers have increased since the last inspection at certain times. In discussions the owner and manager had different views of what staffing was in place Monday to Friday mornings. It was agreed there are always two carers on duty Monday to Friday 8am to 8pm and in the afternoons this sometimes rises to three carers. Monday to Friday mornings if a third pair of hands is required the manager will assist. On the day of the visit the manager was observed on two occasions to assist with moving and handling where two staff are required and also assisted during lunchtime. A health professional advised that one individual needing two carers to assist requires an hourly toileting programme and other care plans also state various regular toileting programme are required. If this were being monitored it may conclude that staff would not have sufficient time to spend on peoples social needs. Observations concluded certainly on the morning of the visit that staff spent very little time with people Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 23 unless a task was needed. No staff’ was evident spending time in the lounge although the majority of people were sitting in here. Three carers are on duty 8am to 8pm at the weekends. Two staff is on wake night duty 8pm to 8am each night. In addition there is a cook and domestic seven days a week and a handyperson five days a week. One staff member and the manager spoken with felt there are sufficient staff on duty to meet the needs of people. The person surveyed indicated staff are ‘always’ available when needed but commented ‘more staff would help them (the home)’. One staff surveyed felt there are sufficient staff on duty the other did not answer this question. Most interactions observed staff’ were kind, caring and sensitive to peoples needs. People receive care from staff that is qualified. The AQAA indicated that eight staff have obtained a National Vocational Qualification (NVQ) level 2 or above. This is above the recommended 50 for good practice. People are protected by the recruitment procedures. Three newly recruited staff files were examined. These evidenced that all appropriate checks are in place to ensure people are protected. The application form should be checked against new age discrimination legislation. Further staff’ is trained to do their job. Since the last inspection further staff training has taken place in safeguarding, infection control, fire, medication, moving and handling, dementia, palliative care and food hygiene. The manager is aware there are still gaps and has booked most staff on courses to address this. The home has also introduced a new induction programme which is to Skills for Care specification. For two of the files examined staff had completed their induction and the third still had some gaps. Staff surveyed felt their induction covered everything they needed to know and they receive appropriate training. Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home needs to ensure they are proactive in continuing to improve outcomes for people across all areas. EVIDENCE: People live in a home where the manager is qualified and staff’ feel approachable. The manager has undertaken NVQ level 4 in care and also the Registered Manager Award (RMA). She is also a registered nurse. Staff spoke positively of the manager saying she is ‘very supportive’. Professionals had mixed comments about the manager. One said they had access to the manager for discussion. Another felt the manager is not proactive in Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 25 communication when they visit the home but has to be sought out in her office. People benefit from an atmosphere which is relaxed and calm. It is acknowledged the home has worked since the last inspection to improve the home particularly the environment. All visitors at the home spoken with agreed the changes have made a difference but differed on how much. One said the place is ‘brighter and happier’. Another said ‘the home is marginally better but care is not as individualised as it could be it tends to be task orientated’. It is debateable whether people can always receive good outcomes with the manager required to be the third carer each morning to ensure care needs are be met. The home has undertaken an annual quality assurance survey which was sent to people who live in the home and their relatives. A good response was received which was positive in all cases but one. Visits by the provider are undertaken as required by legislation and reports are in place. Discussion with the owner highlighted that the homes monitoring systems are not perhaps robust enough to ensure the home is fully meeting legislation and the National Minimum Standards. It is acknowledged that requirements and recommendations made at the last inspection have been generally met but monitoring system should now be ensuring outcomes for people are continually looked at for improvement. It is evident during the inspection that incidents reportable under legislation are still not always reported. For example following a visit from Environmental Health at the time of building works it was suggested the kitchen was not used but meals on wheels were brought in, the manager advised for a week. This should have been reported. Reporting was raised at the previous inspection however after discussion with the owner he agreed to address this so a requirement is not made at this time. The home returned their AQAA within the required timescale. It gave a reasonable picture of the home. In some section information was more informative than others. In two ‘what we could do better’ sections is was simply stated ‘I feel we do well in this standard’. There is always room for improvement and the home should strive to further improve outcomes for people. People’s financial interests are protected. The home holds savings for some people. Records were checked and appropriate records are maintained. People’s health, welfare and welfare are generally promoted. Accidents are recorded and monitored for trends. Information in the AQAA indicates that the home has serviced equipment appropriately. The fire safety log book was examined as a requirement was made at the last inspection. This showed all tests had been carried out to required frequencies. Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 26 Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 3 X 3 Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 OP8 Regulation 15(2) Requirement The registered person must ensure peoples changing health and personal care needs reflected in their care documents are monitored through their care plans and related records. Timescale for action 08/08/09 2 OP9 13(2) The registered person shall make 15/06/09 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. In particular medicines are the sole property of the person to which they are prescribed Controlled drugs must be handled and administered inline with procedures Records must be clear as to what has been administered including quantity and reasons why medication has not been administered Sufficient stocks of medicines Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 29 must be held to ensure they are administered in line with directions 3 OP10 12(4) The registered person shall make 15/06/09 suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cedarwood House DS0000069155.V375693.R01.S.doc Version 5.2 Page 30 Care Quality Commission South East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. 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