Care Home: The Cedars

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What the care home does well Service users needs are assessed before moving to the home to make sure the staff team have the necessary skills and facilities to meet these needs. Each person has a written plan of care which is specific to their individual needs. The care plan is regularly reviewed to ensure staff are aware of each individual`s current needs. There are effective ways of ensuring staff have up to date knowledge of each individual. People are treated with respect and their dignity is maintained. Service users have access to the full range of medical support available in the community, which helps to maintain their health and well being. The provision of food is good. Service users were able to voice complaints and were kept safe at the home. The service provides a pleasant, homely environment which is well maintained, clean and hygienic. We spoke to one service user during our visit. They were very positive about the care provided. Staff who we spoke to were also positive about the service they offered, the way they worked as a team and the support they received from the manager. The manager takes a very personal and active interest in meeting the needs of all people living at The Cedars. What has improved since the last inspection? The two requirements identified at the previous inspection had been addressed. What the care home could do better: Staff recruitment procedures were not followed with sufficient rigour. This does not mean that any staff are unsuitable, but that insufficient information was obtained for the manager to be able to demonstrate that a "reasonable" decision had been made to appoint specific staff. Some administrative processes around the recording and updating of care plans could be improved. This would minimise the potential for there to be a misunderstanding about an individual`s care needs. Key inspection report Care homes for older people Name: Address: The Cedars 45 Queens Road Oldham OL8 2AX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Steve Chick     Date: 1 7 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: The Cedars 45 Queens Road Oldham OL8 2AX 01616264665 F/P01616264665 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Eileen Ashton Name of registered manager (if applicable) Mrs Eileen Ashton Type of registration: Number of places registered: care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies of service only: Care home only - Code 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 - Code OP (maximum number of places: 12 Dementia - Code DE (maximum number of places: 12) The maximum number of service users who can be accommodated is: 12 Date of last inspection Brief description of the care home The Cedars is a small, family run care home for up to 12 service users. At the time of our visit there were nine people living at the home. The home is situated one mile from Oldham town centre, close to local amenities and public transport. Accommodation is provided in six single bedrooms, four of which have en-suite toilet facilities, and three twin rooms with en-suite toilets. Privacy screens are provided in the shared rooms. There is a large lounge, a lounge/dining room and a small separate Care Homes for Older People Page 4 of 26 3 0 0 9 2 0 0 9 12 0 Over 65 0 12 Brief description of the care home lounge at the rear of the property, which is a designated smoking area for service users. The front of the home provides a large garden which overlooks the park. The garden had seating areas for the people who live at the home. A small amount of car parking space is available at the rear of the property. The weekly fee is £375.63, that does not include hairdressing, clothes and newspapers. A copy of the most recent inspection report was on display in the entrance hall. A service user guide was given to people who were thinking of using the service Care Homes for Older People Page 5 of 26 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: two star good 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 two star. This means the people who use this service experience good quality outcomes. We (the Care Quality Commission) undertook a key inspection, which included an unannounced visit to the home. This meant that no one at The Cedars knew that the visit was going to take place. For the purpose of this inspection one service user was interviewed in private, as were two staff members. Additionally discussions took place with the Manager who is also the owner. This inspection visit was unannounced and we were in the home for about four hours. During that time no visitors were available for us to talk to. We also looked at what the service has told us about certain things that may have happened in the service, these are called notifications, and any relevant information Care Homes for Older People Page 6 of 26 from other organisations or sources. We asked the Manager to fill in a questionnaire, called an Annual Quality Assurance Assessment (AQAA). This is a legal requirement. The AQAA told us what they thought they did well, what they need to do better and what they have improved upon. We asked for surveys to be distributed to some service users and staff. At the time of writing this report, we had not received any completed surveys. We undertook a tour of the building and looked at a selection of service user records as well as other documentation, including staff rotas, medication records and staff files. We have not received any complaints about the service since our last Key Inspection, nor have we been made aware of any safeguarding concerns. Care Homes for Older People Page 7 of 26 What the care home does well: 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 Care Homes for Older People Page 8 of 26 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 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 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users needs are assessed before moving to the home to ensure that their needs can be appropriately met. Evidence: We were told by the manager, in the AQAA, that prospective service users needs are assessed before a decision is made for them to come to the home. This was confirmed by staff who we asked. We looked in a selection of service users files and there was documentary evidence of an assessment having been undertaken. In the file of one recently admitted service user there was a very helpful and detailed assessment of their circumstances. This would assist staff in understanding the needs of that individual. The Cedars does not offer intermediate care. Care Homes for Older People Page 11 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users health, personal and social care needs are met by the consistent implementation of policies and procedures. Staff practices also serve to promote the dignity of the service users. Evidence: We looked at a selection of service users files. All had a copy of a written care plan. There was good documentary evidence that these care plans were regularly reviewed and that, where possible, service users were involved in discussions about the way in which their care needs were met. The manager personally undertook a thorough review of each service user on a monthly basis. Examples were seen of recent reviews involving staff from Oldham Metropolitan Borough Council, which identified positive outcomes for the service users. We saw some examples where the written care plans themselves had not been updated following a change in the service users circumstances. However, staff who we talked to were very confident that they had up-to-date information about the current care needs of each individual service user living at The Cedars. The Cedars is a Care Homes for Older People Page 12 of 26 Evidence: relatively small home, with a low turnover of staff. The combination of staffs personal knowledge of each individual service user, the written care plans, the verbal handover at each change of shift and the good communication which existed between staff members, helped to ensure that service users needs were effectively met. We spoke with one service user who was positive about the way in which their care needs were met as well as the attitude of the staff. They told us that one of the things they valued highly was being treated like an adult. Staff who we asked, were confident that they could meet the needs of the service users and described the co-operative staff team amongst whom it was easy to ask for support if necessary. There was good documentary evidence that service users have access to the full range of medical services available in the community. Staff and service users who we spoke to confirmed that both routine medical support and, if necessary, more urgent intervention was always made available. The manager, whenever possible, escorted individual service users to routine hospital appointments. We looked at a small sample of medication administration records which presented as being appropriately maintained. This is important to ensure that the right medication is given to the right person at the right time and in the correct dose. We were told that no service user was administering their own medication and none were currently prescribed any controlled drug. Observation and discussion with staff and a service user indicated that people were treated with respect and had their privacy and dignity maintained. Care Homes for Older People Page 13 of 26 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. An appropriate range of activities was available for service users, and visitors were welcome to the home. The provision of food was good. Evidence: We were told in the AQAA that a range of activities were undertaken with service users such as quizzes, bingo, armchair basketball and boardgames. We spoke with one service user who was provided with quizzes and puzzle books which she enjoyed. We saw documentary evidence in service users files of activities having taken place. Staff who we asked confirmed that periodic activities were provided. We were told that, due to lack of demand, no communal outings had taken place nor were planned for this year. During this visit the weather was very pleasant and service users were observed enjoying the sunshine on the patio of the well maintained garden. There was documentary evidence of a vicar visiting one Thursday a month. We were told by the manager and staff who we asked, that visitors were welcomed at The Cedars and that there were no unreasonable restrictions on visiting times. During this visit to the home there were no visitors with whom we could confirm this information, Care Homes for Older People Page 14 of 26 Evidence: although there was no reason to doubt it. We were told by staff who we asked, and the service user who we talked to, that there were no restrictions on people exercising choice so, for example, people could get up when they wished, go to bed when they wished and spend time either in their own personal room or the communal areas as they wished. During this unannounced inspection visit we sampled a meal which was pleasantly presented and tasty. There was a four-week menu cycle to ensure variety of food. The service user who we spoke with confirmed that if anyone did not like the menu choice an alternative was provided. The manager told us that three service users particularly enjoyed a curry and consequently this was periodically provided for them. This was confirmed in discussion with staff and the service user. One member of staff cited the provision of meals as amongst the best thing about the home and told us that staff also ate the meals provided for the service users. Care Homes for Older People Page 15 of 26 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. Service users are protected from abuse or exploitation by the homes policies and practices and are confident that any complaints they may have would be dealt with appropriately. Evidence: The manager told us that each service user and their family is given a copy of the complaints procedure. She also told us that no complaints had been received since the previous key inspection. As a consequence of this we did not look at the complaints log. All service users and staff who we asked were confident that any complaints could be raised and would be appropriately dealt with. The service user who we spoke to said that staff are always asking if everything was OK and if not they would want to know what was wrong and put it right. Some staff had received training in connection with the Mental Capacity Act, which is intended to protect the interests of service users who may have difficulty in making certain decisions independently. Literature about the impact of this Act was also available at the home. It was noted that specific training in the protection of vulnerable adults was last undertaken by many staff in 2007. However we were told by the manager that six of Care Homes for Older People Page 16 of 26 Evidence: the eight care staff also held the NVQ II (National Vocational Qualification) which would include modules on the awareness and understanding needed to effectively protect the interests of vulnerable adults. Staff who we spoke to were confident that people living at The Cedars were effectively protected from abuse or exploitation. They also demonstrated an understanding of the need to be vigilant in this respect and told us that, if necessary, they would be willing to whistleblow. We had received no complaints, nor been made aware of any allegations, in connection with The Cedars since the previous key inspection. Care Homes for Older People Page 17 of 26 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. The home is appropriately maintained, decorated and cleaned to enable service users to live in a pleasant, safe and hygienic environment. Evidence: During this unannounced inspection visit we undertook a tour of the building. This included communal areas and some of the service users own bedrooms. Bedrooms presented with various degrees of personalisation and the manager told us that, subject to health and safety considerations, people are encouraged to bring in their own furniture and belongings. The building itself dates from the Victorian era and many of the original features have been retained which adds to its individuality. The manager told us that the issues identified by the fire service and commented on the last inspection report had all been addressed satisfactorily. We identified no issues concerning the fixtures and fittings of the building which needed any remedial action. The home was clean and tidy and free from unpleasant smells at the time of this visit. Staff and the service user we spoke to confirmed that this was the usual state of the building. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers and skills mix of staff on duty promotes the independence and wellbeing of service users. However, recruitment procedures are not applied with sufficient rigour to minimise the risk of potentially inappropriate staff being employed. Evidence: The manager told us that staffing levels were usually provided on the basis of 2 carers between 08:00 -- 10:00; 3 carers between 10:00 -- 13:00; 2 carers between 13:00 -21:00, and 1 carer plus 1 member of staff sleeping in between 21:00 -- 08:00. We were given an copy of the staff rota for the week beginning the 24th of May 2010 as evidence of this. Additionally ancillary staff were employed including cooks and cleaners. The manager told us that these staffing levels were sufficient to meet the needs of service users who are resident. The service user who we spoke to was very positive about the care that she received. We are told in the AQAA that 6 of the 8 care workers employed, held NVQ II or above. The NVQ (National Vocational Qualification) is intended to improve the knowledge and skills base of the workforce. Certificates confirming the NVQ II achievement for individual staff members were displayed in the hallway. The proportion of qualified staff at The Cedars exceeds the national minimum standards. Staff who we talked to confirmed that training opportunities are available and Care Homes for Older People Page 19 of 26 Evidence: participation is encouraged by the manager. As an example of the commitment to training there was evidence that one long-standing member of staff had successfully completed a four-day moving and handling facilitators course. This would mean that they could pass on their knowledge and understanding of that field to other staff at the home which would in turn improve the safety of staff and service users. It is a legal requirement that certain specified information is obtained from prospective employees and that certain specified checks are made before any person starts working with vulnerable adults. This is so that the responsible person can make a reasonable decision about their suitability, based on available information. We looked at a small selection of staff files relating to recently recruited staff members. Whilst these indicated that most of the required vetting and checks had been undertaken, there were some omissions. In one example seen no dates were provided in the persons employment history. This meant that it was not possible to tell if there had been any gaps in that persons employment history and consequently the reason for any gaps could not be explored. Similarly personal references had been provided, but none from an employer and there was no written explanation as to why this was the case. We were aware of no negative information in connection with the competency or attitude of the staff. Observation and discussion with the service user and staff members indicated with staff team were relaxed and approachable. The service user we spoke to said the staffs favourite phrase was are you all right love. Care Homes for Older People Page 20 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is competent to run the home and implement the health and safety procedures for the benefit of service users and staff. Evidence: The manager has many years experience of running this care home. The manager both encouraged and personally offered a high level of individual commitment and care. Examples of this included time spent escorting service users to hospital for routine appointments and bringing in meals she had prepared at home. The manager told us that satisfaction questionnaires were periodically done although none had been so far this year. The Cedars is a small home in the manager and staff presented as having a good understanding of the needs and level of satisfaction experienced by individual service users through day-to-day interaction and periodic more structured meetings. We looked at a small sample of records relating to money held by the home on behalf Care Homes for Older People Page 21 of 26 Evidence: of service users. These presented as being appropriately maintained to protect the interests of service users and could account for any money spent on behalf of individual service users. The manager had told us in the AQAA that the home had health and safety policies and procedures and that equipment used in the home was serviced or tested when required by legislation. We looked at a small sample of records in relation to the maintenance and servicing of equipment, including the fire detection and alarm system and the passenger lift. These presented as being in order. The manager told us that personal protective equipment such as disposable gloves and aprons were provided to staff to minimise the risk of cross infection. Staff who we asked confirmed their availability and use. Care Homes for Older People Page 22 of 26 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 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 12 Requirements. The responsible individual must ensure that all the legally required information in connection with any prospective employee is obtained before a decision is made as to their suitability to work at the care home. This must include all the information set out in legislation. This is to minimise the risk of service users being looked after by inappropriate individuals. 16/07/2010 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 7 The responsible individual should ensure that the written care plans are always updated to reflect any identified changing circumstance of the service user which may have Page 24 of 26 Care Homes for Older People 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 an impact on the way in which their care needs are met. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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