Care Home: The Cedars Care Centre

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What the care home does well A new and experienced manager has been employed. The activities of the home are good and the people who use the service are engaged. New and existing residents can expect good assessment and care plan systems which enable them to receive support they need. The home has committed staff available in sufficient number to care for the people. The location of the home, the size of the communal areas and cleanliness of the facilities have enabled the residents to live in a comfortable environment. What has improved since the last inspection? The home now provides training for night staff as required at the last inspection. What the care home could do better: It is needed that a system of auditing medication administration and recording is put in place. This ensures that medication is administered correctly and risk to the people who use the service is eliminated. The manager is also required not to move the residents to a shared room without consultation with the residents and their representatives. The storage of hoists and wheelchairs in toilets or bathrooms can be risk to the health and safety of the people who use the service and the residents. The manager must find alternative storage space for hoists and wheelchairs. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Cedars Care Centre 12 Richmond Road New Barnet Hertfordshire EN5 1SB     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: Teferi Degeneh     Date: 2 2 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 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 26 Information about the care home Name of care home: Address: The Cedars Care Centre 12 Richmond Road New Barnet Hertfordshire EN5 1SB 08444725176 08444120626 h_asslanian@btconnect.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) : Cedar Gardens Care Limited care home 45 Number of places (if applicable): Under 65 Over 65 45 old age, not falling within any other category Additional conditions: 0 Specific service user: One specific service user who is under 65 years of age and has mental health needs may be accommodated in the home. This condition will need to be reviewed at such time as the service user attains the age of 65 years or vacates the home. Date of last inspection Brief description of the care home The Cedars Nursing Home is a care home registered for a maximum of 45 older people who require nursing care. It is one of a number of care homes owned by Cedar Gardens Care Limited. The present owners have owned the home since 1999. The aim of the service is to provide quality nursing care in a supportive environment. The home is a large detached two storey house. There are thirty five single bedrooms and five double bedrooms located across the ground and first floors. All the bedrooms have ensuite facilities. Air conditioning is provided in the home. There is a shaft lift serving the ground and first floor. The communal areas, including a dining room and two interconnected lounge areas, are on the ground floor. There is a well maintained garden with a patio area to the rear of the home. There is also a small parking area at the front of the home. The home is situated in New Barnet, a short distance from the Care Homes for Older People Page 4 of 26 Brief description of the care home Great North Road and in a quiet residential area. It is about a mile from shops and other community facilities located in High Barnet. The weekly fees for the home range from £610 to £860. A copy of the inspection report can be requested and obtained either from the home or from the CQC website. 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 inspection took approximately eight hours beginning at 08:45 am and completing at 17:00 pm on 22 April 2009. The manager, who is yet to be registered by the Care Quality Commission (CQC) and, therefore, referred to in this report as the manager or acting manager, was present throughout the inspection. The inspection activity undertaken included a tour of the building, the examination of the residents files, the examination of health and safety records, the viewing of staff rotas and discussions with and observation of people who use the service, care staff and the homes management. We also spoke to three relatives who were visiting the residents. The annual quality assurance assessment (AQAA) which the home had completed and sent to the Commission as part of the inspection was also considered Care Homes for Older People Page 6 of 26 for the purpose of this inspection. The AQAA is a yearly self assessment which the care home completes and sends to the Commission. 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 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 9 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. The people who use the service can be confident that their admission to the home is based on the ability of the home to meet their assessed needs. Evidence: Five residents files were randomly chosen and examined. Each of these files contained evidence of assessments before their admission. There is also evidence showing that assessments have been received from health or social work professionals. It was clear from conversations with the acting manager that the home admits residents only if it believes that their needs can be met. Discussions with the people who use the service and their relatives confirmed that information about the home was available to help them make a decision about their admission. Three relatives who were visiting the home explained how they came to choose the home. They said they had looked at other homes but preferred this one as they believed it meets the residents needs. The acting manager said the residents and their families are invited to visit the home to Care Homes for Older People Page 10 of 26 Evidence: see if the facilities and services are suitable for their needs. She said that the service users guide is given to each resident. 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. The homes good care plans and risk assessments have enabled the people who use the service to receive care and support they need.However, despite the arrangements put in place for the residents to access healthcare, the residents are put at risk by lack of effective medication administration auditing system. Evidence: The five residents files examined showed that the home has completed the residents risk assessment and care plans. The care plans seen were detailed with information about the residents individual needs and how the staff can support them. The manager said she is introducing a person centred care plan (a care plan which details the likes, wishes and dislikes of all aspects of a residents life). The home is also in the process of joining a national initiative known as Golden Standards Framework (GSF) which helps the home to be able to support people in end of life care. The files of the residents showed that the home keeps daily records of interactions and significant events for each service user. Care Homes for Older People Page 12 of 26 Evidence: From discussions with some residents, visitors and the acting manager and from observations it was clear that a physiotherapist visits the home to assess the residents and to provide training and advice in order to make sure that the residents are safe. Records in the files showed that the residents regularly see health care professionals. The home has a general practitioner who visits once every week to review the medical needs of the residents. A resident spoken to told us that they attended a hospital appointment a day before the inspection. The residents records contained evidence of visits made by a chiropodist, opticians and dentists. There was a written evidence to confirm that the tissue viability and district nurses come to the home. A hair dresser was also at the home all day on the day of the inspection. The residents were seen to be well dressed and comfortable. Verbal feedback from the residents and the visitors showed that the staff are polite and they treat the residents with respect and dignity. Medication is administered and signed by registered nurses. There is a medication auditing system. This is done by the deputy manager who checks medicines and records weekly on Monday. An inspection of the medication record sheets showed that there were some gaps where staff did not sign to confirm that medicines were administered. We checked the blister packs and confirmed that the medicines were taken. This indicated that the medicines were given but not recorded. However, we were concerned that the auditing system did not pick up these gaps. Also we noted from an observation of a resident that the staff leave tablets for a resident to take instead of waiting and witnessing that the tablets are taken as required in the care plan. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service have benefited from a range of activities arranged for them by the home. There are good opportunities for the residents to be visited by relatives or friends and to choose meals that meet their needs. Evidence: From discussions with the manager and the review of the staff rota it was evident that at least one activity co-ordinator is at home during the days to help the residents engaged. On the day of the inspection the two staff who arrange activities for the residents were present. The residents spoken to had positive opinion about the activities and the staff. They mentioned the name of both co-ordinators and said they are good. It was clear that each resident has a programme of activity that reflects their individual needs. One of the activities co-ordinators who was spoken to explained how the activities are planned and provided. It was explained that meetings are held with the residents to discuss their interests, likes and dislikes and to arrange activities that meet individual needs. The activities provided at the home include quizzes, count down, bingo, crafts, music, sing along, outings, going to the parks, knitting and reminiscence classes. From discussions with the residents it was evident that they are supported to use the garden and to visit friends, for example, in a home owned by the Care Homes for Older People Page 14 of 26 Evidence: company. It was also clear that voluntary workers and local school children visit the home to entertain the residents. On the day of the inspection a musician was observed playing music to the residents in the garden. People from the church were also at the home as part of their ongoing plan to visit and conduct spiritual teachings. The residents were seen participating actively in all these activities. The home has two chefs who work in shifts. The chef we saw on the day of the inspection has a long experience of working at the home. The chef was supported by an assitant. From discussions with the residents, the chef and the acting manager it was evident that the residents are consulted about the type of meals they would prefer. Records and discussions indicated that the residents dietary, religious and medical needs are taken into account when providing them with the meals. A resident spoken to said: if you dont want what they give you, you get something else. The three visitors spoken to said the meals are good. There is a rotating menu and the meals provided on the day of the inspection refleced the menu for the day. The visitors and the residents said they are happy with the presentation, amount and quality of the meals. Observations showed that the staff were available to provide support to the residents as needed. Water and juice drinks were also available for the residents not only at lunchtime but also at all times in the jugs in their rooms and sitting areas. Snacks are also provided between the meals. Discussions with the acting manager and the administrative staff confirmed that the home does not manage the residents finances. However, the home charges the residents for toiletries, newspapers, chiropody expenses and hairdressing costs. The residents or their relatives give the home money for these expenses. The records of these expenses are kept through the homes special computer system, an example of which was seen and deemed to be appropriate and transparent. From the residents files and the visitors book it was clear that the residents are visited by their relatives and friends. Observations and conversations with the people who use the service and the visitors also showed that the residents are visited. The three visitors spoken to said that either they or their family members come to the home regularly to see the residents. As mentioned above people from the local place of worship and school children also come to see some residents. 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. The people who use the service are confident that their concerns can be listened to and dealt with by the homes management. The people can be sure that they are safeguarded by the homes policies, procedures and by committed and caring staff. Evidence: The home has a complaints policy. The residents and the visitors spoken to said that they know how to make a complaint if they have concerns. A visitor said if they have a concern they talk to the manager. They Commission had previously received an anonymous complaint which the manager investigated and dealt with following the homes procedure. A resident confirmed that they are able to speak to the staff or the manager if they have a problem. A policy on safeguarding was also available for inspection. It was evident that the home has obtained the local authoritys policy and procedure on adult safeguarding. The AQAA states that the staff need to report any incidents or accidents regardless of seriousness of allegation or actual abuse. Four care staff, who were interviewed were able to demonstrate their knowledge and experience of safeguarding people. They said they know the homes safeguarding policy and whistle blowing policy, which they follow to deal with an allegation of abuse. Care Homes for Older People Page 16 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 people who live at the home have benefited from the cleanliness and spacious size of the rooms. Evidence: The home was clean and tidy on the day of the inspection. The residents and the relatives spoken to said they are very pleased with the home. A number of the bedrooms seen were comfortable, well furnished and personalised with individual choice of decorations. A number of the residents have personal items such as family pictures and televising sets in their bedrooms. A discussion with a visitor and the manager revealed that the home was planning to move a resident to a shared bedroom. The visitor said they were concerned about this plan. During a feedback session at the end of this visit we discussed this issue in detail and pointed out that the plan contradicts the service user agreement. The home is aware that no resident should be asked to move a room without proper consultation with all people concerned. There are three main communal areas and a dining room on the ground floor. The home has a plan to create a lounge and a small dining room on the first floor. There is a well looked after garden at the back of the home a car park space by the front of the Care Homes for Older People Page 17 of 26 Evidence: building. The home is located in a quiet residential area close to shops and public transport facilities. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are trained and committed care staff in sufficient number to meet the needs of the residents. Evidence: The residents and the visitors spoken to said the staff are very nice and caring. From observations it was evident that the staff talk to the residents in a respectful manner and with dignity. A member of staff was seen knocking on the door before entering a residents bedroom. The staff interviewed said they always take into account the residents needs, wishes, rights and choice when supporting them. It was clear from the staff interview that they had experience and knowledge of working with older people in a care or private home. Seven staff files were checked and all contained evidence of checks by the criminal record bureau (CRB). It was also evident in the files that written references have been obtained for each member of staff. The staff have been given terms and conditions of service. From the AQAA, staff files and discussion with the staff and the acting manager it was clear that the staff have attended training programmes in moving and handling, health and safety, basic food hygein, dementia, infection control and fire safety. Discussions with the acting manager and service manager revealed that the home has a plan to organise detailed and intensive dementia training for all the staff. Care Homes for Older People Page 19 of 26 Evidence: The AQAA confirms that fourteen members of the staff have achieved a care qualification equivalent to NVQ level 2. The remaining thirteen permanent staff have either embarked on or planning to start training to achieve a similar qualification. The acting manager confirmed that night staff have access to ongoing training as required at the last inspection. The staff rota and conversations with the acting manager showed that the day shifts are covered by five care staff, two registered nurses, activities coordinators, a laundry person, a chef, kitchen assitant, and a maintenance person. The acting manager is available between 9 am and 5 pm. 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 people who use the service can be confident that the manager consults with them to improve the quality of the service and to ensure that they live in a safe and comfortable environment. Evidence: The home has recently employed a new manager, who has applied to the Commission to be registered. The AQAA states: We have a new and enthusiastic manager in place with over 23 years nursing experience and 5 years experience in a senior role within a nursing home including Assistant Clinical Manager in a 178 bed nursing home where duties included all operations of that home. The staff and visitors spoken to said the manager is understanding and helpful. They said that she is approachable and easy to talk to. The manager is supported by senior managers who regularly visit the home. There is also an administrator who supports the manager. The home does not manage the residents money. However, the home keeps some Care Homes for Older People Page 21 of 26 Evidence: money for some residents for additional expenses such as hairdressing and toiletries. Records and receipts of this money is kept by the administrator. The home has a computer software for recording and managing the residents personal allowance. From discussions with the manager it was evident that the home has a quality assurance system. This includes a questionnaire which is given out to the residents and families to seek their views about the services and facilities of the home. We noted that the manager has taken action to improve the service following residents and relatives feedback. The manager informed us that a committee which comprises five residents and two staff goes through the outcome of the feedback and make recommendations as to how to address any issues. The manager said that there is a daily audit system to check the completion of all tasks. The service manager visits the home monthly to undertake the audit of the facilities and services. As mentioned above the home was clean and tidy on the day of the inspection. An environmental health officer who visited the home on 10 November 2008 rated the home as very good. We noted that staff have attended basic food hygiene and infection control. The incident and accident book showed that there have been eleven recorded incidents since January 2009. Most of these incidents involved residents falls, which the manager said have been dealt with by reviewing their risk assessments. During a guided tour of the premises we observed that hoists and wheelchairs were stored in toilets or bathrooms. We asked the manager to not to store the hoists and wheelchairs in bathrooms and toilets as such a practice can be a health and safety risk to the people who use the service. From discussion with the manager and the AQAA it was evident that fire risk assessments have been completed and regular maintenance works have taken place. 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 9 13 There must be robust and effecive regular auditing system to ensure that medicines are administered and recorded coorectly. This is to protect the health of the residents. 15/05/2009 2 24 23 The residents must not be asked to move to a shared bedroom without their agreement and appropriate consultation. The residents rights and choice can be ensured in this way. 31/05/2009 3 38 23 Suitable facilities must be provided for the storage of hoists and wheelchairs. This will reduce risk to the people who use the service and the staff. 30/06/2009 Recommendations These recommendations are taken from the best practice described in the National Care Homes for Older People Page 24 of 26 Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 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. 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