Care Home: The Cedars

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What the care home does well The home is well managed in the interests of the people who live there. The manager is competent and experienced and people spoken with were complimentary about the way she manages the service. People are supported by a competent, stable staff team. Relatives of people living in the home spoke positively about the way staff provide care and their comments are included in the body of this report. There was a range of activities in place that were designed to meet people`s wishes and needs. The home encourages and promotes the involvement of family and friends. Relatives spoken with told us that they are always made welcome and are consulted with about their relatives care needs. What has improved since the last inspection? People looking to move into the home are now provided with the necessary information about the fees. Care plans have been further developed and now include the necessary information regarding pressure area care. The registered person is now ensuring that all appropriate pre-employment checks of new staff are undertaken before people are employed in the home. What the care home could do better: The home`s complaints policy needs to be amended to include the correct contact details of the current regulation body. Some areas of the older part of the house require updating, to ensure that people living in the home are living in a pleasant and well maintained environment. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Cedars Sudbury Road Halstead Essex CO9 2BB     The quality rating for this care home is:   two star good 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: Neal Cranmer     Date: 2 4 0 7 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 27 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 27 Information about the care home Name of care home: Address: The Cedars Sudbury Road Halstead Essex CO9 2BB 01787472418 01376334892 Cedarshalstead@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Balkrishna N Patel,Mrs Anjana Balkrishna Patel care home 46 Number of places (if applicable): Under 65 Over 65 46 46 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 46 0 The Cedars is situated in Halstead, Essex, close to the town centre and local communities. The home was built in the 18th century and has had a newer annex built onto the rear of the premises. Inside it has retained many of its original features (e.g. fire places). It is a two-storey building with access to the first floor by stair lifts in both parts of the building (new and old). There is a pleasant sunroom and external patio area facing the rear garden. The owners are in the process of building a second unit in the grounds of the home. The home is suitably furnished, decorated to a good standard and offers a homely and caring environment to the service users who live there. The home is registered to provide care for 46 older people over the age of 65 with dementia, and provides 24 hour personal care and support. Care Homes for Older People Page 4 of 27 Brief description of the care home The current fees charged at The Cedars range from £453.11 to £550.00, not including personal items such as hairdressing and chiropody services. The manager advised that the homes Service User Guide is available in the office. This information was provided to us at the time of the inspection visit by the registered manager. Care Homes for Older People Page 5 of 27 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 service was last inspected on the 3rd of August 2007. A range of evidence was looked at to enable us to compile this report including documentary evidence, such as care plans, rotas, menus and personnel files. The manager completed an Annual Quality Assurance Assessment, which they are required to complete by law, which provides us with information about what the manager believes they do well and how they intend to improve further. Throughout the report this document will be referred to as the AQAA. A visit to the home took place on the 24th of July 2009 and included a tour of the premises, discussions with people living in the home, members of the staff team and Care Homes for Older People Page 6 of 27 visiting relatives. Observations of how members of staff interacted and communicated with people living in the home have also been taken into account. On the day of the inspection we were given every assistance from the proprietors, the manager and the staff team for which we offer our thanks. 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 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 8 of 27 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 9 of 27 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. Through the comprehensive admission process people choosing to live at the Ceders can be confident their needs will be met. Evidence: The manager told us in the AQAA, we provide all of the required information about the home to prospective service users and we meet and assess the needs of people and only accept them if the home is able to meet their needs. From examination of the homes Statement of Purpose and Service Users Guide it was evident that the home was providing prospective service users or their representatives with a good level of information to enable them to decide if the home would be able to meet their needs. This information included the aims and objectives of the home, the staff structure and qualifications of the staff employed, the accommodation provided, what the fee level was for living in the home and what was and was not included in the Care Homes for Older People Page 10 of 27 Evidence: fees and the process for keeping peoples care plans under review. Also included in both documents was reference to the homes Complaints Policy. Both documents were last reviewed and updated in September 2008. A sample of four care plans of people recently admitted to the home showed that preadmission assessments had been carried out by either the homes registered manager or their deputy. These assessments looked at peoples needs around a range of areas including their personal care, dietary preferences, oral health, foot care, mobility, dexterity, history of falls, mental health state, hobbies and interests, personal safety and risk and carer and family involvement. Where people were placed by a local authority there was also an assessment on file which had been carried out by a representative of the placing authority, these assessments are known as Community Care Assessments or COM 5s. The assessments seen indicated that there was a good process in place to enable the manager to determine the needs of the person and make a decision as to the homes ability to meet the persons assessed needs. Care Homes for Older People Page 11 of 27 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. People using the service can expect their personal and health care needs to be identified and met in a way that they would wish Evidence: The manager told us in the AQAA that following assessment a detailed person centered care plan is formulated with involvement of the person themselves and their family which includes an action plan to enable staff to know how to meet the persons needs. These care plans they went on to say are reviewed as and when needs change or at the very least on a monthly basis. The AQAA states that at the same time as developing the care plan an assessment is undertaken of the persons manual handling needs. On the day of the inspection a sample of four care plans were examined. These care plans all clearly identified peoples needs and provided staff with clear guidance about how people needed to be supported to enable their needs to be met. Care Homes for Older People Page 12 of 27 Evidence: Each person had a manual handling assessment in place that set out details of any factors that might have an impact on the persons manual handling needs including behavioral risk factors, physical risk factors or any known history of falls. We observed that good practices were being followed when supporting people with their moving and handling needs. Staff spoken with were knowledgeable about peoples individual needs and abilities. All of the care plans seen had been signed by the person themselves or a representative and all contained evidence of being kept under review on a monthly basis. Care plans were seen to be in place for supporting people with their personal care needs, moving and handling needs, night time support needs, dietary needs and pressure area care. Staff spoken with indicated that they felt the care plans provided them with all of the necessary information they required to enable them to meet peoples needs. Relatives spoken with on the day of the inspection were very complimentary and enthusiastic about the care provided by the home, comments included brilliant place always made to feel welcome it is a family environment, and the staff are always polite and respectful further comments included the staff have a good awareness of my relatives care needs. The manager told us in the AQAA that healthcare professionals are involved as and when required and records are kept of their involvement. They went on to say that the home works closely with doctors and district nurses and both are requested to visit as and when necessary. Peoples individual files contained evidence that peoples health care needs were being well met. There were records of appointments with and visits from a range of health care professionals including doctors, district nurses and chiropodists. There were charts in place for recording and monitoring of peoples weight, which were completed appropriately with sufficent detail and no evidence of any gaps. The manager told us in the AQAA that medication is ordered, stored, administered and returned in accordance with the homes medication policy and procedure. On the day of the inspection the system for storage, administration and recording of medication was examined and found to be safe and robust. There was appropriate secure storage for medication including a controlled drugs cupboard. Medication administration records (MAR) sheets and records relating to controlled medicines examined were appropriately completed and records were well organised. Care Homes for Older People Page 13 of 27 Evidence: Staff spoken with were aware of their responsibilities around following appropriate procedures when dealing with medication. Care Homes for Older People Page 14 of 27 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 who live in the home experience variety and choice in their daily lives and peoples expectations and preferences with regard to lifestyle are well met. Evidence: The manager told us in the AQAA that activities are organised by their activities coordinator and include cake making, musical bingo, crosswords, playing games, make up sessions, pub lunches and music and movement. Care plans examined contained details of activities that people had taken part in, such as cake making and musical bingo sessions. On the day of the inspection the activities co-ordinator was observed supporting people during one to one sessions where they were observed chatting and reminiscing. On the day of the inspection visit there were visitors coming and going throughout the day. One relative spoken with was very positive about the support provided and the lifestyle that their relative enjoyed in the home. They said that they visited the home two to three times a week and there always seemed to be something of interest going on in the home. Church services are held in the home monthly and other Care Homes for Older People Page 15 of 27 Evidence: denominations visit individual people regularly. The home has a Best Friend this is an ex member of staff who worked in the home for many years and who retired some years ago but who has chosen to continue to visit people. They visit weekly and help to look after peoples plants and flowers. Many of the people living in the home were unable to discuss with us how they make choices. However, relatives spoken with told us that staff listen to their wishes and go out of their way to find out what people like and enjoy. It was evident from discussions with the manager and staff that they knew people well and go to great lengths to ensure that people are treated in ways that they prefer. Interactions observed between staff and people living in the home were calming, relaxed and caring. One relative spoken with was very positive about the support provided for their relative, they described the home as a brilliant place and said that the staff were always polite and respectful. Meals are provided with a variety of options allowing people to choose what they prefer to eat. The days menu is written up on the menu board and explained to people. Records seen showed that meal choices were recorded as well as how much each person eats and drinks. Hot and cold drinks were seen to be made available throughout the day and a visiting relative said that they to could receive a meal if they required one. Care Homes for Older People Page 16 of 27 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 using the service can be confident that their concerns will be listened to and acted upon. Evidence: The manager told us in the AQAA, that both they and their deputy spend time going around the home visiting people and listening to any concerns they may have. They went on to state that all concerns or complaints received are logged and all complainants are provided with notification of the outcome of their investigation. It was evident from discussion with the manager that the ethos of the home is to take every concern or complaint seriously and to deal with issues as they arise to ensure that people remain happy. Sampling of records showed that the home had received 6 concerns since August 2008, all of these had been logged and provided evidence of the investigation undertaken and its outcome. A copy of the homes complaints policy and procedure is included in the homes Statement of Purpose and Service Users Guide, which the manager stated was provided to service users or their representatives at the point of admission into the home. Relatives spoken with during the course of the inspection were confident that any Care Homes for Older People Page 17 of 27 Evidence: concerns raised would be dealt with appropriately, however they were quick to point out that they had no such concerns. The manager told us in the AQAA, that all staff are trained in safeguarding ( previously known as Protection of Vulnerable Adults or POVA) as part of their induction and all newly employed staff are checked through the criminal records bureau (CRB) before commencing their employment. Examination of recruitment records showed that there was a robust recruitment process in place which ensured that all relevant checks were undertaken before someone commenced working in the home. Personnel records examined contained evidence that staff had received training around safeguarding ( previously known as protection of Vulnerable Adults or POVA). Members of staff spoken with were able to demonstrate a good understanding of their responsibilities around recognising and reporting suspicions of abuse or poor practice. Care Homes for Older People Page 18 of 27 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. People live in an environment that suits their lifestyle and which is homely, well maintained and clean. Evidence: The manager told us in the AQAA they, they make every effort to ensure that the home is kept clean, odour free and well maintained and we strive to create a social environment which increases the quality of live for the service users whilst maintaining a high standard of care. Communal areas of the home were homely and the furnishings and fittings were of a good quality and were generally well maintained. Peoples individual rooms were personalised with a range of possessions, including photographs, ornaments and other personal effects. The standard of cleanliness throughout the home was good and everywhere visited was fresh and odour-free. Some areas of the older section of the building were starting to look a little tired and worn and in need of some refurbishment. The manager told us that they recognised this and plans were in hand to address this issue. The homes laundry is equipped with industrial style washing machines and tumble Care Homes for Older People Page 19 of 27 Evidence: dryers and the home benefits from having a sluice room which enables them to meet the needs of people who may have continence problems. The manager reported that none of the people living in the home were able to take responsibility for looking after their own laundry, this task is undertaken by staff as part of their duties on peoples behalf. On the day of our visit all of the people seen and spoken with were tidy and well presented, which indicated that the homes laundry facilities were meeting the needs of the People living in the home. Care Homes for Older People Page 20 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident of being cared for by a staff team who are competent and well trained and who can meet their needs. Evidence: The manager told us in the AQAA, we have a well trained and experienced staff team who have a wide mix of skills who are supported by an experienced manager and deputy manager. Records examined showed that staffing levels are appropriate for the size of the home and the needs of the people living there. Typically during the day there are seven care staff on duty supported either by the deputy manager or the registered manager. These care staff are supported by domestic and catering staff. On the day of the inspection staffing levels were observed to be good and peoples needs were being attended to promptly. The staffing levels enabled staff to care for people in a relaxed manner, no-one was seen to be hurried or left waiting for their needs to be meet and staff were seen to have time to spend chatting with people. Staff spoken with on the day of the inspection had a good knowledge and understanding of good care practices and of the specific needs of the individuals living in the home. Care Homes for Older People Page 21 of 27 Evidence: The relatives of someone living in the home told us, the staff are very caring, nothing is to much trouble for them and they are always polite and respectful and understand by relatives needs well. All of the staff files examined contained the appropriate documentation as required by regulation including proof of identity, written references, an appropriately completed application form and evidence of a Criminal Records Bureau Check (CRB) having been undertaken. All of this documentation and checks are necessary to ensure that the home has in place a robust recruitment process which protects people. All of the records examined contained evidence to show that staff receive a formal induction upon commencement of their employment in the home. The home maintains a staff training record of all training undertaken. Sampling of this record showed that staff were being provided with a good range of training which included moving and handling, fire safety, health and safety safeguarding and emergency first aid. In addition to this training staff were receiving training that was more specific to the needs of individuals, this training included dementia awareness, diabetes and management of incontinence. Staff spoken with indicated that access to staff training provided by the home was good. Care Homes for Older People Page 22 of 27 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 home is appropriately managed in a way that ensures the best interests of the people living in it. Evidence: The manager told us in the AQAA that what they do well is, manage the home in the best interest of the people living in the home by carrying out internal quality audits. Strive to have an open and respectful atmosphere between all staff in order to allow everyone to feel free to contribute to the improvement and everyday running of the home. The Ceders is run on a day to day basis by the registered manager supported by a deputy manager, both of whom have particular areas of expertise and who complement each other and work well together. People who were spoken with during the course of the inspection were very complementary about the way in which the home is managed, relatives spoken with described the home as being a family run Care Homes for Older People Page 23 of 27 Evidence: environment, where nothing is to much for anyone. The AQAA submitted by the manager prior to the inspection was completed to a good standard and contained appropriate information about all aspects of the home and the service it provides. Other evidence examined as part of the inspection process confirmed that the information provided in the AQAA was accurate. The manager told us in the AQAA that they, conduct an annual quality assurance audit based upon the views of peoples relatives and staff. Sampling of relative surveys returned in January 2009 indicated that all of the responses received were positive, comments included my relative is always clean and well cared for, and always appears happy the registered manager is always quick to inform us if our relative is unwell or if there have been any problems or upsets I find that the care that the home provides to my relative provides me with peace of mind. Relatives of people living in the home spoken with on the day of the inspection told us that their opinions and views were always listened to and valued. A sample of health and safety records were examined and were found to be in order, including electrical and gas installation certificates, fire detection and alarm test records and lift service inspection reports. It was evident from a tour of the home that the premises and grounds were safe and well maintained. Care Homes for Older People Page 24 of 27 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 25 of 27 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 23 2 The registered person must 31/12/2009 ensure that the home is kept in a good condition internally as well as externally. To ensure that people living in the home are supported in an environment that is well maintained. 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 16 It is recommended that the homes complaints policy be updated to reflect the current contact details of the new regulator. Care Homes for Older People Page 26 of 27 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 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!