Care Home: The Cedars Nursing Home

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What the care home does well The Cedars have a committed staff team, and a supportive owner who responds positively to any requests or suggestions for improving the standards at the home. There is a pleasant, relaxed atmosphere in the home, all staff were observed interacting well with the residents, relatives and other staff members during the inspection. Visitors are welcomed to the home at any time. The home is well maintained, and stands in beautiful landscaped gardens which are accessible for residents to use and can accommodate wheelchairs. The bedrooms are personalised to reflect the individual and this assists with the homely atmosphere. The management of medication is well organised. A good range of activities and pastoral services are available for the residents. What has improved since the last inspection? Since the last inspection the home has updated their recruitment procedure. Investment has been made to the laundry to assist with the management and organisation of this service. The home has changed their pharmacy supplier and this has improved the service in response for prescriptions being dispensed. The gardens have been further developed since the last inspection, providing easier access for residents in wheelchairs. Social intervention and activities have improved; the home takes into account the individuals wishes, and maintains a record of their participation in activities. What the care home could do better: The home actioned the requirements of the last inspection and have met and exceeded the standards at this inspection. It was recommended that the home include the fees into their Service User`s Guide. CARE HOMES FOR OLDER PEOPLE Cedars Nursing Home, The Cedar Park Road Enfield Redditch Worcestershire B97 6HP Lead Inspector Chris Potter Unannounced Inspection 29th February 2008 09:30 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedars Nursing Home, The Address Cedar Park Road Enfield Redditch Worcestershire B97 6HP 01527 63038 01527 63038 thecedars@thecedarsnh.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Robert Delaney Mrs Denise Goldman Care Home 40 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (40), of places Physical disability (4), Physical disability over 65 years of age (40), Terminally ill (4) Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The category PD is in respect of persons aged 55 - 65 years. The category TI is in respect of persons aged 60 and over. Date of last inspection 6th March 2007 Brief Description of the Service: The Cedars nursing home is a late Victorian manor house that is located on the outskirts of Redditch town centre. The home is registered to accommodate forty older residents requiring twenty-four hour nursing care. The home stands in beautiful landscaped gardens, which are easily accessible for residents in wheelchairs. The home is owned by Mr R Delaney who is the sole provider, who visits the home frequently and inputs into the day-to-day management of the home. Mr Delaney employs an administrator who manages the business and financial side of the business. The registered manager is Mrs Goldman who is a first level registered nurse with many years experience in managing care homes. The Cedar’s rates are reviewed annually residents are notified one month in advance. The additional charges to residents are detailed in the Service User Guide. This is clearly laid out in the terms and conditions. The current fees for The Cedars range between £550.00 - £675.00 per week these were correct at the time of the inspection for more up to date information please contact The Cedars direct. Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. This was the homes key unannounced inspection – this is where we look at a wide range of areas. The inspection was carried out over one day on the 29th of February 2008. To help us plan for the inspection we looked at pre – inspection information requested earlier in the year, this included the Annual Quality Assurance Assessment (AQAA). A range of evidence was used to make judgements about this service. This includes: information from the provider, staff records kept in the home, medication records, discussion with people who use the service, discussions with the staff team, discussion with the manager, tour of the premises, previous inspection reports, quality assurance process, and observation of care experienced by people using the service. Feedback received from residents, and relatives were complimentary about the home and the care provision, comments included: “Home is marvellous”. “Cleanliness is very good” “Food is very good” “the staff are really helpful” What the service does well: The Cedars have a committed staff team, and a supportive owner who responds positively to any requests or suggestions for improving the standards at the home. There is a pleasant, relaxed atmosphere in the home, all staff were observed interacting well with the residents, relatives and other staff members during the inspection. Visitors are welcomed to the home at any time. The home is well maintained, and stands in beautiful landscaped gardens which are accessible for residents to use and can accommodate wheelchairs. The bedrooms are personalised to reflect the individual and this assists with the homely atmosphere. The management of medication is well organised. A good range of activities and pastoral services are available for the residents. Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2,3 standard 6 is not applicable for this service, as they do not provide intermediate care. Quality in this outcome area is good. Prospective residents and their representatives have the information needed to assist them with their choice of home. Prior to admission a health and physical needs assessment is completed, to ensure they can safely meet the person’s needs. A contract is provided which tells them about the service they will receive, and the homes terms and conditions. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 9 On enquiring to the home for a suitable placement, the home would supply a brochure containing brief details and verbal information. The home then invites the representative to visit the home, and discuss in more detail about the homes services and finances. A copy of the Service User’s Guide would then be provided to further assist with making a choice. If the representative requests a place, the manager then goes out to complete an assessment of the person. This is to ensure that they could meet their health and physical needs safely. The assessment takes into account the individual needs, concerns and anxieties of the prospective resident and their families about moving into a home. If possible the potential resident would be invited to spend time in the home to give them a better insight in to the home and the service provision. At the time of the inspection a representative who was going through the process was visiting. They confirmed that the home had been very helpful in providing guidance for them. They had provided the appropriate information and assistance to them. The need to include the homes fees in the Service User’s Guide was advised during the inspection. On admission to the home, they provide a contract detailing their terms and conditions, and the home retain a signed copy with their records for reference. Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10 Quality in this outcome area is good. The health and personal care that people receive is based on their individual needs. The home has an efficient medication policy supported by procedures and practise. All staff ensure the dignity of the residents and respect their need for privacy and each individual requirement. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 11 Three resident’s care files were reviewed at the time of the inspection. The care plan had been developed from the assessment completed prior to the resident’s admission to the home. Care plans contained sufficient information to assist the nurses and carers to meet the resident’s health, physical and social care needs. All staff demonstrated a good knowledge about the residents, and were observed interacting well with them during the inspection. Risk assessments had been completed for any potential problem, which could be a problem for individuals. The risk assessments showed evidence of frequent review and update. The need to ensure that all nurses sign and date all entries for accountability was advised during the inspection. The home provides a wide range of pressure relieving equipment and aids to assist staff when moving residents. The AQAA received form the home is realistic and states that they hope to improve by ensuring that reviews are done more frequently. The home continues to work towards accreditation for the gold standards framework. They have introduced more clinical updates for the nurses including abuse, peg feeds, pressure area care, diabetics, law and ethics. Residents have access to health care services that meet their assessed needs within the home this includes General Practitioners, specialist nurses, chiropodist, optician and Dentist. The home has a medication policy which is accessible to staff, medication records are up to date for each resident and medicines received, administered and disposed of are recorded. Since the last inspection the home has changed their pharmacy supplier and stated that this has improved the service for them. Residents and relatives spoken with during the inspection stated they were happy with the way that staff deliver their care and respect their dignity. Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15 Quality in this outcome area is excellent. A range of activities are available in the home these are individually tailored to meet the varying needs of the residents. Residents are offered a varied choice of food, this is acceptable for the residents, and specialist diets are catered for. People living in the home are able to maintain open contact with family and friends. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the home have further developed their activities and social intervention for the residents. The activities organiser has developed a book about each residents advising of their life history, likes and dislikes and this includes photographs. The activities organiser is trained in aromatherapy and they have developed a sensory room for the residents who wish to have Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 13 an aromatherapy treatment to use. Various outings and in house activities are organised depending on the individuals needs. A list of the forthcoming activities was displayed in the entrance area of the home. The home has also replaced the televisions in the lounges to assist the residents who wish to watch it. The home has the benefit of being surrounded by large landscaped gardens, which are accessible for residents in wheelchairs. The home has won several awards for there picturesque grounds. The homes AQAA advises that they have 2 pastoral assistants who organise activities which include: Musicians and singers, theatrical groups, Bingo and quiz’s 3 x a month. Weekly Church services. The home’s further plans for improvement in entertainment, by replacing televisions in the bedrooms for small digital ones. The home has open visiting arrangements and relatives were present during the inspection times both in the lounges and the resident’s bedrooms. The food in the home is of good quality, well presented and meets the dietary needs of the residents. The residents are consulted about their likes and dislikes and the cook tries to meet the preferences and suggested dishes when preparing the menu. The cook is able to cater for all special diet requirements. Residents are able to choose to eat in their own room if they wish. Regular drinks and snacks are available throughout the day. The cook maintains appropriate food records, and has a cleaning schedule in place. Residents have a choice of cereals or a cooked breakfast every day. A choice of a cooked lunch is provided at 12.30pm and a varied tea menu at 5.00pm. The cook confirmed that all staff have access to the kitchen to do snacks for residents if they request anything. Residents and staff stated that the meals were very good. Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. The home has a clear policy on how to deal with complaints and the residents and staff are aware of this. Staff receive training to assist them in recognising potential abuse. Policies and procedures are in place to further safeguard the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home receives few complaints and none have been made to the home or the Commission since 2005. A copy of the homes complaints procedure is displayed in the home, and a copy is provided in the Service User’s Guide, which is available in the resident’s bedrooms. All staff receive training to assist them in recognising potential abuse. The induction training also covers the basics about abuse. Staff spoken with were confident that they would have no hesitation in reporting any concerns to ensure that residents were safe. Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 Quality in this outcome area is good. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Cedars is a Victorian Manor house set in an acre of beautiful landscaped gardens. The home provides accommodation for residents in both single and shared bedrooms. Bedrooms have been personalised by the resident to reflect their individual personality, and residents are encouraged to take small items of furniture, pictures and ornaments. Residents stated that they were happy Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 16 with their bedrooms and found them very comfortable. Some residents confirmed that they preferred to stay in their bedrooms in preference to using the communal areas of the home. The home is in good decorative order throughout and plans are in hand to upgrade the decoration throughout the ground floor. The home has two large lounge areas and a dining room on the ground floor for residents to use if they wish to. There is also a quiet area by the entrance for residents who wish to sit quietly. Since the last inspection the home has invested in automatic lights in the toilets. The lights switch on when the sensor is activated which assists the residents with mobility problems. The home stands in an acre of landscaped gardens, which have won the Redditch in bloom competition. Garden furniture is provided for residents to use who chose to sit out. Some bedrooms have difficult access with steps to assist the residents in these bedrooms a special chair is provided and the residents are carefully assessed for these rooms. All areas of the home were observed to be clean and tidy and the management of odours was commended. Residents and staff complimented the home for its cleaning standards. “Cleanliness is very good”. Following the last inspection the home has invested into the laundry, to improve the service and assist the operative with the organisation of this area. Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30 Quality in this outcome area is good. There are sufficient staff on duty at all times to ensure that the needs of the residents are met. The home follows a rigorous recruitment procedure to further safeguard the residents. The home prioritises on staff training to ensure that the staff have the skills and competencies to meet the resident’s health and personal care needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rota was seen which showed that the staffing levels were sufficient for the number of residents. Staff spoken to confirmed that they felt that the staffing levels were right for the number and dependency of the residents. Residents spoken with confirmed that they did not have to wait long for Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 18 assistance when they used their call bell. Residents and relatives gave positive comments about all the staff, and the care provided at the home. The home has a good training program in place, new staff are provided with an induction programme when they commence. Induction is the same for whatever experience or qualifications the applicant has. Mandatory training courses are updated annually, and a matrix is maintained to identify when training is due for renewal. The homes AQAA states that they are developing the training for the nurses in the clinical areas. The manager is undertaking a post registration course in dementia. The home has met the standard of having more than 50 of there staff with an NVQ level 2 qualification in health care or equivalent. 6 of the staff have completed NVQ level 3 in health care. Three staff files were reviewed at the time of the inspection. The files showed that the home had followed a rigorous recruitment process. Plans for supervision to monitor the performance of staff are in place. The manager has not been able to provide a supervision meeting for all staff. All files showed that the home had completed the appropriate safety checks prior to the staff commencing. This assists in safeguarding the residents further. Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 Quality in this outcome area is excellent The management and administration of the home is based on openness and respect, and effective quality assurance systems have been developed by them so that the residents can have a voice in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 20 There is a good management structure at the home; this is evidenced at their response to requirements and commitment in providing a quality service for the residents and their families. The owner provides regular input into the service with the administrator and registered manager responsible for the dayto-day management and organisation of the home. The registered manager has been in post for four years and is a first level registered nurse with many years experience in managing a care home. She has also completed the Registered Managers qualification. All staff confirmed that the manager is both supportive and helpful. The manager demonstrated a good understanding of the residents and their health needs. The administrator as worked at the home for many years and has completed the NVQ level 4 in management. She is well organised with all the health and safety aspects of the home, and all the required records were provided for the inspection. Staff is given training in health and safety. All fire records were checked and up to date at the time of the inspection. An effective quality audit is in place and the home welcome comments and suggestions on how the home could be improved. i.e. the laundry received some negative comments and the home has invested to improve this facility. Generally all the comments from the audit were either good or excellent. Resident’s finances are usually managed by themselves or representative the home does not manage any resident’s finances. The administrator will invoice for hairdressing and other services which the resident may use. The home’s philosophy in relation to equality and diversity, they treat all people the same and respect their wishes and preferences. The AQAA was well completed and provided an accurate reflection of the home, and how they were going to further develop the home in the next 12 months. Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 4 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X X 3 X 4 Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The home include the fees in there Service User’s Guide to assist residents with their choice. Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cedars Nursing Home, The DS0000004102.V360405.R01.S.doc Version 5.2 Page 24 - 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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