Care Home: The Cedars Nursing Home

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What the care home does well The Cedars Nursing Home and the staff it employs provide prospective residents and their relatives with written information about the services the home provides, and encourage people to visit and spend time at the home. Their assessment process is robust which ensures that peoples needs can be met upon admission. The nursing and personal care of residents is provided by nursing and care staff who have a good understanding of the needs of residents, who are supported by care plans and assessments which are regularly updated and reviewed. Residents, their relatives and friends are supported to influence the care and services they receive through a range of committees and meetings which focus on improving the experiences and quality of life of those in residence. The Matron and her team are pro-active in seeking views and working with resources within the community to enhance the quality of life and experiences of residents. Residents are supported by staff who work well together as a team, and who have access to a range of training which enables them to provide good quality nursing and residential care. Staff are encouraged to attain additional skills and experience through community links with specialist health care professionals and through their own personal development. The Matron of the home and staff work well together to promote an inclusive and friendly atmosphere for residents to live. All staff demonstrate a commitment to improve the service they provide and value their working environment. What has improved since the last inspection? The Cedars Nursing Home is now part of Avery Healthcare and therefore documentation, policies and procedures have been reviewed consistent with organisational expectations. The Cedars Nursing Home continues to attain awards received from other organisations which demonstrate its continued ability to provide good quality nursing and personal care to its residents. Staff continue to access training and work with health care professionals external to the home, to improve the quality of care they are able to provide. Opportunities for residents and other interested parties continues to be reviewed and updated, with new initiatives put into place to seek peoples views to improve the service. The home now employs a full time Activity Organiser who works along side staff to provide a range of individual and group activities for residents. All staff at the home remain committed to improving the quality of lives of those in residence by working with the local community. The home has been extended to provide all residents with single rooms with en-suite facilities and additional communal accommodation, whilst other areas of the home have been decorated, which has included the provision of new furnishings and fixtures. Communication systems have been provided to enhance and promote resident understanding through loop and WiFi systems. What the care home could do better: Information known by staff about residents should be incorporated into residents Person Centred Care Plans to further develop the information contained, to ensure that residents aspiration`s, goals and views are recorded to ensure that their continued nursing and care needs are met. Key inspection report Care homes for older people Name: Address: The Cedars Nursing Home Church Walk South Street Bourne Lincs PE10 9UQ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Linda Clarke     Date: 0 6 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: The Cedars Nursing Home Church Walk South Street Bourne Lincs PE10 9UQ 01778421555 01778421622 cedars.bourne@averyhealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cedars Health Care Limited Name of registered manager (if applicable) Mrs M H Brewster Type of registration: Number of places registered: care home 56 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The Home is registered to provide personal care with nursing for service users of both sexes whose primary needs fall within the following categories:- Old age, not falling within any other category (OP) - 56 Dementia - over 65 years of age (DE(E)) - 56 Physical disability (PD) - 5 The maximum number of service users to be accommodated is 56. Date of last inspection Brief description of the care home The Cedars Nursing and Residential Home is situated close to the town centre of Bourne, which has a range of shops and facilities. The property was originally the Vicarage and stands next to the Church in its own landscaped grounds, leading down Care Homes for Older People Page 4 of 30 Over 65 56 56 0 0 0 5 Brief description of the care home to a river with paths and seating for residents. The building has been extended over recent years and provides accommodation in single rooms all en-suite, on the ground and first floor. There is a choice of lounges for residents to use. There is a circular driveway with car parking to the front of the property. The home is registered to provide nursing care for up to 56 people including older people, people with dementia, adults with a terminal illness and adults with a physical disability. There are also 5 beds contracted with the Primary Healthcare Trust for intermediate care. Information about the services provided at The Cedars Nursing Home along with fees are available by contacting the Matron of the home, and are also detailed within the homes Statement of Purpose and Residents Handbook. Care Homes for Older People Page 5 of 30 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: three star excellent 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: We as it appears throughout the Inspection Report refers to the Care Quality Commission. The inspection process consisted of pre-planning the inspection, which included reviewing the Annual Quality Assurance Assessment (AQAA), which is a selfassessment tool completed by a representative of the service, reviewing previous Inspection Reports, and any other information we have received. The unannounced site visit commenced on 6th April 2010, and took place between 09:30 and 17:30. The focus of the inspection is based upon the outcomes for people who use the service. The method of inspection was case tracking. This involved identifying people with varying levels of care and nursing needs and looking at how these are met by the staff at the Cedars Nursing Home. Four people were chosen and discussions with held with some of them, along with others who were in residence. We also spoke with relatives Care Homes for Older People Page 6 of 30 and friends who were visiting residents on the day of our site visit, as well as speaking with staff who work at the home. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? The Cedars Nursing Home is now part of Avery Healthcare and therefore documentation, policies and procedures have been reviewed consistent with organisational expectations. The Cedars Nursing Home continues to attain awards received from other organisations which demonstrate its continued ability to provide good quality nursing and personal care to its residents. Staff continue to access training and work with health care professionals external to the home, to improve the quality of care they are able to provide. Opportunities for residents and other interested parties continues to be reviewed and updated, with new initiatives put into place to seek peoples views to improve the service. The home now employs a full time Activity Organiser who works along side staff to provide a range of individual and group activities for residents. All staff at the home remain committed to improving the quality of lives of those in residence by working with the local community. The home has been extended to provide all residents with single rooms with en-suite facilities and additional communal accommodation, whilst other areas of the home Care Homes for Older People Page 8 of 30 have been decorated, which has included the provision of new furnishings and fixtures. Communication systems have been provided to enhance and promote resident understanding through loop and WiFi systems. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 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. Individuals moving into the home can be confident that Cedars Nursing Home can meet their needs as they are encouraged to visit the home and are provided with information about the services provided, and are involved in the assessment which determines their needs. Evidence: We wanted to find out how individuals who required residential or nursing care can be confident that the Cedars Nursing Home can meet their needs, we did this by looking at the self assessment tool called the Annual Quality Assurance Assessment (AQAA) and by talking to people who live at the home and their relatives, we also looked at records when we visited the home as part of our Key Inspection. The Cedars Nursing Homes has a Statement of Purpose and Residents Handbook, which provides information as to the services the home provides, and also includes information about staff, significant policies and procedures and information about the Care Homes for Older People Page 11 of 30 Evidence: local community and services. We noted that when we walked around the home, that a copy of these documents is available in each persons bedroom for their reference. We sent surveys to people who live at the home of which one was returned, information in the survey told us that they had received sufficient information about the home prior to moving in, which enabled them to make an informed choice as to whether the home was the right place for them. The AQAA was completed by the Matron ( Registered Manager) and returned to us prior to our site visit, information in the AQAA told us how prospective residents are supported when considering accessing nursing or residential care, in that they are provided with information about the services the home provides, and are encouraged to visit the home to help them to make a decision. We spoke with five people who live at the home and they told us that they had been given information about the home before they moved in, and that either they or a relative had visited Cedars Nursing Home on their behalf, to look around to see if it was the right place for them. One lady said Its the best decision I have ever made, its lovely here. We looked at the records of four people who reside at the Cedars Nursing Home, who were in receipt of either residential or nursing care, we found that an up to date assessment of their needs had been carried out by the home, and in some instances included an assessment undertaken by Social Services or the Primary Care Trust. Assessments are used to develop a care plan detailing the care and support required by each person. People living at the home have their needs met as staff at the home have access to a range of training, which enables them to deliver good quality care and support, this is supported by external links with health care professionals who have specialist areas of expertise which reflect the needs of those living at the home. This enables staff to be aware of new practices with regards to nursing care, and implement these for the benefit of those who receive a service. The Cedars Nursing Home also provides intermediate care for up to five people which is funded by Lincolnshire Health Authority, who are accommodated in identified bedrooms within the home. Care Homes for Older People Page 12 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and welfare of individuals is monitored and regulalry reviewed to ensure that residents receive the care and support they need and expect, supporting them in life and at the time of their death. Evidence: We wanted to find out whether people living at the Cedars Nursing Home receive the care and support they need, and whether they are encouraged to influence the service they receive. We sent surveys to people who live at the home of which one was returned, information within the survey told us that they always receive the care and support they need which includes medical care. The AQAA was completed by the Matron ( Registered Manager) and returned to us prior to our site visit, information in the AQAA told us that residents are supported to make decisions, which includes being involved in development of their care plan to ensure that the care and support they receive is as they would wish and expect. Care Homes for Older People Page 13 of 30 Evidence: We spoke with six people who live at the home, which included two people whose records we had viewed. Everyone told us that they were very satisfied with the care and support they receive, and said that their was nothing the home could do to improve the care they receive. One lady said Id prefer to be at home, but its not possible, however they do everything for me, and I cant think how they could improve it. Staff listen to how I want things doing and act upon it. Whilst some told us The service is excellent, I have no concerns. The staff are very friendly and helpful. When I press the buzzer staff always come, sometimes it takes a little longer during busy times, but I understand this and it doesnt cause me any problems. We spoke with two relatives and a friend who was visiting on the day of our site visit, they all expressed satisfaction with the care and support provided to their relative and friend, and relatives told us that they were kept informed about events which affected their relative. One relative told us Im very happy with the care my husband receives, they tell me what is going on, and I am happy with the staff. We looked at the care plans and records of four people who were in receipt of residential or nursing care when we visited, we found that care plans included additional assessment tools which monitor an individuals specific health care needs, these were regularly reviewed and updated appropriately. The Cedars Nursing Home has recently changed their care plan documentation and therefore the completion of information is in its infancy. Discussions however with staff of various designations confirmed that staff do refer to care plans and have a very good understanding of the needs of those living at the home, including information as to individual preferences, this is information needs to be included into a persons care plan, to ensure that peoples views are recorded. Observations on the day of our visit showed that staff promote the privacy and dignity of those living at the home, staff knocked on doors before entering a persons bedroom, and personal care was always carried out with privacy in mind. Staff were polite when speaking with residents, and listened and acted upon what they said. One lady told us I prefer to keep my bedroom door open so as I can see whats going Care Homes for Older People Page 14 of 30 Evidence: on in the home, but they always close it when necessary. We spoke with care staff who told us that the training they receive enables them to provide good quality care to those in residence, whilst some staff told us that they had links with specialist health care professionals, which meant that they attended meetings external to the home, which helped them to keep up to date with changing care practices. We observed in part the administration of medication at lunchtime, which was managed consistent with good practice to ensure the well-being of those living at the home, we noted potential shortfalls in the same procedure for the tea time medication which we brought to the attention of the Matron. This was dealt with immediately by Matron to ensure the safety and welfare of residents. We looked at the medication records and medication of the four residents whose records we had viewed, and randomly viewed the records for some of the Controlled Drugs prescribed, we found all to be in good order. Medication in the home is managed by Nurses. The Cedars Nursing Home has attained Beacon status with reference to the Gold Standards Framework End of Life Care. The Gold Standards Framework supports those residents who are unwell and to die with dignity, whilst remaining within the home and have their wishes carried out by staff and other supporting health care professionals who are familiar to them. Everyone living at the home is given the opportunity to discuss what it is important to them and has had their views recorded. We spoke with a member of staff who told us that when they had attended a meeting with health care professionals, they had been made aware of a project referred to as Butterflies are Free, which supports the social and emotional needs of those who are unwell and their significant others to complement the health care received as part of the Gold Standards Framework. The AQAA submitted by the Matron, referred to this project, which we discussed with them when we visited. The Matron and staff told us of their commitment to implement this to provide an holistic approach to meet the individual needs of those who are unwell, as well as supporting their relatives and significant others. Care Homes for Older People Page 15 of 30 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. Systems are in place for residents and other interested parties to influence the range of activities and events provided by the home, which has a positive impact on the quality of lives of residents. Evidence: We wanted to find out what opportunities are available to residents at Cedars Nursing Home to engage in activities and participate in community events. We also wanted to find out the views of residents about the meals provided. We sent surveys to people who live at the home of which one was returned, information gathered from the survey told us that they take part in activities organised by the home and that they always like the meals. The AQAA was completed by the Matron ( Registered Manager) and returned to us prior to our site visit, information in the AQAA told us that residents and relatives through meetings and committees are encouraged to share the views about the day to day running of the home included activities and meals. We spoke with the Activity Organiser who works five days week, they told us that they Care Homes for Older People Page 16 of 30 Evidence: have worked at the home for a year and are responsible for devising and delivering the activities programme. Staff working at the home support the Activity Organsier in delivering activities. We spent time in one of the communal areas of Cedars Nursing Home in the morning, in the room were two budgerigars, and an hatchery with six baby chickens which had recently hatched. Staff and residents told us that the hatchery had arrived with eggs, and many had watched the eggs hatch over several days. One resident told us, I cant get out of bed but staff brought me one of the chicks to hold, and again today, its amazing to see how much they have grown in a short space of time. We observed another resident referring to one of the budgerigars who was very vocal in there cage, it was clear to see that residents and visitors alike took great delight in interacting and observing the animals. Matron also told us that lambs are brought into the home for residents to interact with, and talks and display slides take place with regards to wild life, which many residents enjoy. We noted that the home and individual residents have newspapers delivered, and we observed that several residents sitting in one of the communal areas in the home reading their newspapers, and in some instances talking to staff about what they were reading. We noted in one lounge a display of Easter Bonnets which had been made at the time and entered into a competition, the Activities Organiser also told us that an Easter Egg hunt had taken place the weekend prior to our site visit. One resident told us that they had made an Easter Bonnet, unfortunately they hadnt won. In the afternoon we witnessed a group of residents supported by the Activity Organiser, staff and relatives engaged in a game of bingo, which everyone appeared to be enjoying. One relative told us:- I visit most days, and usually take part in the activities. I usually come to the Coffee Mornings as well. One resident told us that the home always organsies a party for special occasions, including birthdays. Another resident told us that they prefer to spend time in their bedroom and watch television and complete puzzle books. Our site visit and information we read informed us that a range of activities are organised for the benefit of residents, and that these are open to relatives and visitors. Discussions with residents and our observations showed us that residents make choices as to what they wish to do, and are supported in this. Care Homes for Older People Page 17 of 30 Evidence: Cedars Nursing Home has technology to improve and enhance the quality of lives of those in residence which includes a Loop System, which supports those with a hearing impairment. WiFi has also been installed to improve communication facilities for residents, residents in some instances have computers in their bedrooms to enable them to keep in contact with people important to them. We asked residents about the meals provided, comments were positive and included:The meals are lovely, you never need to complain. Were asked every day what we want for our meals the following day. Specialist diets are catered for, which are recorded within a residents individual care plan, and are monitored. We observed meals being served at lunchtime, with a majority of residents choosing to take their meal in one of the dining rooms. Residents who require support with eating were supported by care staff as detailed within their care plan. Care Homes for Older People Page 18 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported and cared for by staff who are trained and confident in promoting individual rights and choices, whilst policies and procedures and the open and inclusive environment, encourages individuals to raise concerns and contribute to the care and support they receive. Evidence: We wanted to find out how peoples rights were supported, and whether residents living at Cedars Nursing Home know how to raise concerns, we also wanted to find out whether people felt safe. We sent surveys to people who live at the home of which one was returned, information gathered from the survey told us that staff listen and act on what they say. It also advised us that they have someone to speak to informally if they are unhappy, but also know how to make a formal complaint. The AQAA was completed by the Matron ( Registered Manager) and returned to us prior to our site visit, information in the AQAA told us that the home has received one complaint which is currently being investigated, we viewed the documentation with regards to this as part of our site visit, and found the complaint and investigation had been documented well. The AQAA also told us that staff receive training to enable them to promote the rights and welfare of those in residence, and that this includes assisting residents to take part in politics though the use of postal votes. We the Care Care Homes for Older People Page 19 of 30 Evidence: Quality Commission have not received any concerns or complaints about the home in the previous twelve months. When we spoke with one resident they told us that they use the postal vote system, and went onto say I take an interest in politics, and now that a General Election has been called, theyre plenty of television programmes to keep me entertained. One resident told us, I always go to the meetings, if I have any concerns or ideas Id speak about it at a meeting, theyre always willing to listen to what you have to say. Visitors we spoke with on the day were confident that concerns would be listened to and acted upon, and said that all staff were approachable. We spoke with five members of care staff, all were knowledgeable as to the role and responsibilities in ensuring residents welfare was maintained, and were able to talk about how they had received training which identified the forms which abuse may occur, and their responsibility in reporting concerns. One member of staff we spoke with told us that she was a trained trainer, which meant part of her role was to train and support newly recruited staff in a variety of topics, which include protecting vulnerable adults from abuse. The staff member went onto explain that they use scenarios and ask questions to promote staffs understanding and encourage debate. Discussions with staff evidenced that staff have a good understanding as to their roles and responsibilities and that they are confident to raise any concerns they have, as all commented that the Cedars Nursing Home has a open and inclusive atmosphere. Documentation we viewed as part of our site visit, including care plans and minutes of a range of meetings evidences that the home provides a variety of opportunities for residents and interested parties to discuss what is important to them, including day to day decisions which are personal to them. Care plans identify that residents have capacity to make decisions. We are confident that Matron and other staff at the home have the necessary understanding and capacity to promote peoples rights, as information within the AQAA and training undertaken by staff demonstrates the homes commitment to encourage residents to maintain responsibility for their lives, but are aware of relevant legislation and organisations who will support residents should it be identified that individuals lack capacity. Care Homes for Older People Page 20 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Cedars Nursing Home provides residents with a safe and comfortable environment to live that is well maintained. Evidence: We wanted to find out whether the Cedars Nursing Home provides a comfortable and well maintained environment for people to reside. We sent surveys to people who live at the home of which one was returned information in the survey told us that the home is well maintained and is always clean and fresh. The AQAA was completed by the Matron ( Registered Manager) and returned to us prior to our site visit, information in the AQAA told us that the home has recently benefited from an extension, which has enabled all residents to have their own bedroom. The AQAA tells us of planned improvements for the next year, which includes the decoration and the provision of new furnishings for one of the wings. Their are also plans to install a new fire system. The Cedars Nursing Home is a large detached property, which benefits from parking to the front of the home, and has a well maintained garden, which is accessible to residents and visitors. Care Homes for Older People Page 21 of 30 Evidence: We had a tour of the home, which included the recent extension which compromises of additional bedrooms with full en-suite facilities and an additional communal room, which has access to the garden via a decked ramp with balustrade. In addition the Cedars Nursing Home has three other wings, all of which benefit from communal areas and bedrooms that have en-suite facilities which include a wash hand basin and toilet. We found all communal areas of the home including corridors to be decorated and furnished to a high standard, with all areas being light and airy. Communal areas had a view of the garden. The garden is well maintained and has a river running through it, a bridge has been constructed so that residents and visitors can cross the river to enable them to access other areas of the garden, including the Sensory Garden. On the day of our visit we saw ducks wandering around the garden and swimming on the river, residents told us that the chicks in the hatchery would be moving into the garden when they had grown. We spoke with one resident who said that in the summer they have a Garden Party, which she looks forward to. Whilst one gentlemen said he liked visiting the garden when his relatives visited. When we spoke with some residents in their bedrooms we noted that equipment is provided to promote residents welfare, care and safety which included profile beds and moving and handling equipment. Communal bathrooms and toilets are sited throughout the home, and benefit from equipment and adaptations such as assisted baths to promote the independence of residents. The Cedars Nursing Home employs a range of staff who are responsible for ensuring that the home is clean and well maintained, which include domestic, housekeeping, gardening and laundry staff. Trained and care staff also have links with infection control specialists to promote the health and safety of residents and staff. Care Homes for Older People Page 22 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by staff who have undergone a robust recruitment process and who are qualified and have access to training that enables them to provide good quality care and support. Evidence: We wanted to find out whether the care and support people receive is provided by staff who have the relevant training and experience, and who have been recruited using a robust recruitment process. We sent surveys to people who live at the home of which one was returned information in the survey told us that staff are usually available when they need then. The survey contained additional comments:Friendly staff. Helpful staff from cleaners, catering and nursing. The AQAA was completed by the Matron ( Registered Manager) and returned to us prior to our site visit, information in the AQAA told us that the home employs sufficient staff to meet the needs of those in residence, and that agency staff are not used, instead financial incentives are offered to existing staff to work additional hours where required. Information also stated that staff undergo a robust recruitment and induction process, which is supported by ongoing training. Care Homes for Older People Page 23 of 30 Evidence: Our observations showed that on the day of out visit their were sufficient staff to meet the needs of those in residence, their were trained Nursing and care staff on duty, supported by a range of ancillary staff who support other aspects of the day to day running of the home. Call bells were responded to well, and conversations with residents confirmed this. We looked at the recruitment records of three recently recruited members of staff, which included two carers and a Registered Nurse. Records we viewed showed that the home has a robust recruitment process which means that two satisfactory written references are obtained along with a satisfactory Criminal Record Bureau (CRB) disclosure prior to commencement of work, which means that those employed to work with vulnerable adults have been vetted. In additional Nursing staff are checked to ensure that they are registered with the National Midwifery Council and licensed to practice as Nurses. We spoke with five members of staff, one member of staff had recently commenced work at the Cedars Nursing Home, they told us that their induction for the first three days consisted of undertaking training in a variety of topics which included, protecting adults from abuse, moving and handling, health and safety, infection control and fire safety. The staff member went onto say that following the initial three day training moved onto the Skills for Care induction programme, supported by a mentor from the home. All staff spoken with expressed confidence in the training they receive, and all stated it enabled them to provide the care and support residents required. Staff told us that in addition to mandatory training, some had received training in dementia care, Parkinsons disease awareness, and palliative care. One member of staff we spoke with has completed trained trainer course, which enables them to provide training and support to newly recruited staff. Care Homes for Older People Page 24 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Cedar Falls Nursing Home is managed by a competent and experienced person who actively seeks and encourages views from a range of sources to ensure that the home is run in the best interest of its residents. Evidence: We wanted to find out whether Cedars Nursing Home was managed in order to promote the health, welfare and safety of those in residence and is run in their best interests. The AQAA was completed by the Matron ( Registered Manager) and returned to us prior to our site visit. The AQAA was comprehensively completed and showed us that the Matron has a good understanding as to their role and responsibility in managing the home well. It also showed us that the Matron has the best interests of those in residence, and operates an open and inclusive environment for all interested parties. The AQAA has evaluated the homes current performance, and details what improvements it will have to make to improve the service it provides. Care Homes for Older People Page 25 of 30 Evidence: We spoke with Helen Brewster who is the Matron (Registered Manager) of the home, Helen is a Registered Nurse who accesses regular training to ensure that she is up to date with current practices. Helen is supported by her Deputy Matron who is also a qualified nurse. We spoke with five members of staff who were on duty when we visited, all said that they found the Matron and all staff at the home to be supportive, and confirmed that they all worked together as a team. All were confident that they could approach Matron with any concerns they had. Staff told us that they have regular staff meetings, which they are confident to contribute to as they know that their views will be considered and acted upon. They also told us that they meet to discuss how they are working, including areas for improvement and identified training needs. Comments made by staff included:I really like it here its friendly and we deliver good quality care. I just love it here Ive never been happier. Good support from Matron, good team work, I have a really good time when Im at work. I feel valued, and our opinions are listened to. We spoke with residents who lived at the home, they told us that they liked living at the home, and they were able to talk about things that were important to them. I like living here, I go to the meetings and talk about things. Matron is pro-active in encouraging residents and their relatives and friends to comment on the day to day running of the home, this is done through a range of committees and meetings, whose focus is to improve the service provided by the home. We viewed minutes of meetings held, which shows that issues raised are dealt with, and that the home works towards implementing ideas. The home produces a monthly newsletter which includes information about past and planned activities and events, along with puzzles and quizzes. When we looked at the March newsletter we found it to contain significant historical points of interest which happened in the month of March, as well as information as to birthdays and anniversaries of residents and staff. Care Homes for Older People Page 26 of 30 Evidence: Cedars Nursing Home is owned by Avery Healthcare, which has a quality assurance system which seeks the views of residents and other interested parties. A range of groups and committees are in place, and comments are reviewed. Quality assurance processes also review additional elements which are required for the day to day running of the home, which include health and safety and environmental health. Information submitted in the AQAA detailed the regular maintenance of health and safety systems within the home, including fire systems and equipment, central heating systems and emergency call systems. Care Homes for Older People Page 27 of 30 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 28 of 30 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 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 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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