Care Home: The Cedars Rest Home Limited

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What the care home does well Before moving to The Cedars, prospective residents or their relatives may visit to look around. One relative said, "When I looked around I knew it was the right place for Dad, it had the right feel, too". The home provides a clean, homely and comfortable environment for people to live in. Some people said they liked their bedrooms and that the home was always kept clean. The home continues with its programme of redecoration and upgrading. Assessments are undertaken of people before the offer of a place is made at the home. Information gathered at this stage was used to start the person`s care plan. People living at the home and their relatives feel confident the care staff can support them to have their needs met in a kind and caring way. One relative stated, "I am very happy with the care that my relative receives from the staff. They are so kind and considerate. The staff always rings me; they know that I need to be informed of any incident night or day. They are brilliant. I could not cope without them". The staff were seen to support people living at the home in a friendly, supportive and respectful manner. People visiting the home said they are made very welcome and can visit at any time. The records showed that all people living at the home were registered with a General practitioner and it was shown that people who used the service had access to opticians, dentists, chiropodists and community nurses. The proper employment checks are undertaken before new staff start to work at The Cedars. 82% of the care staff at the home has successfully completed training in national vocational qualifications. There are a number of activities, which people who live at The Cedars can choose to join in. People using the service looked well dressed and attention to their hair and fingernails had been made. What has improved since the last inspection? The support that has been identified and recorded to meet the needs of the people living at The Cedars has improved considerably since the last inspection. Care plans looked at were detailed; person centred and showed clearly how the person should be supported. Time had been spent working on the care plans to include the individual preferences for how care should be provided, like bathing routines and assistance with dressing. There had been a number of staff who had attended training courses since the last inspection and this needs to continue to cover more staff working at the home. Staff spoken with and surveys returned said they found training useful to guide them at work. Since the last inspection a number of staff have undertaken training in the safeguarding of vulnerable adults and, when spoken to staff were aware of what to do if they suspected abuse within the home. Some improvements have been made in medication practices, and since the last inspection a list of staff sample signatures has been made available, which details the name, and signatures of those who are responsible for administering medication and who sign the medication administration record. Some areas of the home have been redecorated which has made the environment more pleasant for the people living at The Cedars.There was evidence that since the last inspection a quality review of the service had taken place and a report of the quality of the service was made available. What the care home could do better: Medication must be given to the people living at the home as prescribed. Records must be accurate and show that all medicines can be fully accounted for. Appropriate risk assessments must be in place, which include nutrition and bed rails to minimise the risks to people using the service. The people living at The Cedars generally enjoyed the food provided but they did not have a choice of what they wanted to eat at mealtimes and people were not aware of what the planned meal of the day was until it was being served. As raised at the last inspection people who require assistance at meal times should wherever possible be supported to have their meals at dining tables. Although some staff had received training since the last inspection, some areas such as moving and handling, infection control and dementia care had not been undertaken by a number of staff. Training is required to make sure staff have the skills and knowledge to properly deliver the care to the people living in the home. CARE HOMES FOR OLDER PEOPLE The Cedars Rest Home Limited The Cedars 23 Langham Road Bowdon Altrincham Cheshire WA14 2HX Lead Inspector Elizabeth Holt Unannounced Inspection 7th April 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 The Cedars Rest Home Limited DS0000005600.V361834.R02.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. The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cedars Rest Home Limited Address The Cedars 23 Langham Road Bowdon Altrincham Cheshire WA14 2HX 0161 928 4361 0161 929 5929 keith.symms@caringuk.com 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) The Cedars Rest Home Ltd Ms Christina King Care Home 34 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (34), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (34), Old age, not falling within any other category (34), Physical disability over 65 years of age (34) The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of 34 service users who fall within the category of old age, but may in addition have mental disorder (excluding learning disability), dementia or physical disability will be accommodated of which, at any one time, 2 service users may be under 65 who have dementia. 25th May 2007 Date of last inspection Brief Description of the Service: The Cedars is a residential care home providing 24-hour personal care and accommodation for 34 older people. The Cedars is a large detached property situated in Bowdon. The main building consists of a lower and ground floors and two upper floors. Several lounges and seating places are available for socialising and relaxing, with one lounge and dining room leading onto external patio areas. The home has wheelchair access and there is provision for parking at the front of the building. The rear of the house has a terraced area, where there are two well-appointed patios, with extensive views of the surrounding countryside and well-kept gardens. The patios are used for special events during the year such as birthday parties and other celebrations. The current range of fees at the home is £370.30 - £740 per week. Pricing varies dependant on Local Authority funding and private arrangements, the particular room chosen, views and facilities. The Cedars Rest Home Limited DS0000005600.V361834.R02.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 2 star. This means the people who use this service experience good quality outcomes. This visit was undertaken as part of a key inspection, which includes an analysis of any information received by the Commission for Social care Inspection in relation to this home prior to the site visit. Also before the inspection we (The Commission) asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they did at present, what they felt they did well and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we do. It is one of the main ways that we obtain information from providers about how they are meeting outcomes for people using their service. Service user, staff and relatives surveys were provided for distribution before the inspection and 10 were returned from service users/relatives and 3 from members of the staff team. Comments from these surveys have been included in this report where possible. The visit took place over the course of 7.5 hours on Monday 7th April 2008 and the home did not know in advance that it was going to happen. During the course of the visit time was spent sitting and chatting with people who use the service, some of the staff including the registered manager and visitors to the home. Records were looked at in relation to the running of the home and health and safety and a partial tour of the premises was made. What the service does well: Before moving to The Cedars, prospective residents or their relatives may visit to look around. One relative said, “When I looked around I knew it was the right place for Dad, it had the right feel, too”. The home provides a clean, homely and comfortable environment for people to live in. Some people said they liked their bedrooms and that the home was always kept clean. The home continues with its programme of redecoration and upgrading. Assessments are undertaken of people before the offer of a place is made at the home. Information gathered at this stage was used to start the person’s care plan. The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 6 People living at the home and their relatives feel confident the care staff can support them to have their needs met in a kind and caring way. One relative stated, “I am very happy with the care that my relative receives from the staff. They are so kind and considerate. The staff always rings me; they know that I need to be informed of any incident night or day. They are brilliant. I could not cope without them”. The staff were seen to support people living at the home in a friendly, supportive and respectful manner. People visiting the home said they are made very welcome and can visit at any time. The records showed that all people living at the home were registered with a General practitioner and it was shown that people who used the service had access to opticians, dentists, chiropodists and community nurses. The proper employment checks are undertaken before new staff start to work at The Cedars. 82 of the care staff at the home has successfully completed training in national vocational qualifications. There are a number of activities, which people who live at The Cedars can choose to join in. People using the service looked well dressed and attention to their hair and fingernails had been made. What has improved since the last inspection? The support that has been identified and recorded to meet the needs of the people living at The Cedars has improved considerably since the last inspection. Care plans looked at were detailed; person centred and showed clearly how the person should be supported. Time had been spent working on the care plans to include the individual preferences for how care should be provided, like bathing routines and assistance with dressing. There had been a number of staff who had attended training courses since the last inspection and this needs to continue to cover more staff working at the home. Staff spoken with and surveys returned said they found training useful to guide them at work. Since the last inspection a number of staff have undertaken training in the safeguarding of vulnerable adults and, when spoken to staff were aware of what to do if they suspected abuse within the home. Some improvements have been made in medication practices, and since the last inspection a list of staff sample signatures has been made available, which details the name, and signatures of those who are responsible for administering medication and who sign the medication administration record. Some areas of the home have been redecorated which has made the environment more pleasant for the people living at The Cedars. The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 7 There was evidence that since the last inspection a quality review of the service had taken place and a report of the quality of the service was made available. 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. The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 8 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 The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 9 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): 3. Standard 6 does not apply to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service have their needs assessed before admission to the home is agreed. EVIDENCE: Prospective residents and their relatives were encouraged to visit the home before making a decision to move in to The Cedars. One resident wrote in the survey, “My daughter chose the home as the most suitable for me and I think she was right”. All six surveys returned showed that prospective people who use the service said they received enough information about the home before they moved in. Three peoples care plans were looked at and these included detailed pre admission assessments. For a person who was recently admitted as an emergency with very short notice, the manager had visited the prospective The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 10 resident in his own home to carry out the initial assessment. The information gathered provided her with sufficient information to make a judgement to assess the person’s suitability for the home to be able to meet their health and personal care needs. This person said, “The staff are champions here and I am settling in gradually”. Staff were observed listening and supporting this resident to settle into his new environment. One person placed by the local authority had a care manager’s assessment of needs, which was used to start the care plan, detailing the support the person required. The Cedars Rest Home does not provide an intermediate care service. The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 11 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): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Though there is scope for further improvement, people using this service can be assured that they will be treated with respect and dignity, and members of staff are aware of their individual needs. EVIDENCE: People who use the service have a written care plan in place, which sets out their individual needs and requirements. Four people’s care plans were looked at. The care plans clearly showed that the staff knew the individual people well and had information that assisted them to provide the support required to promote independence. Since the last inspection care plans had been improved to include the individuals’ preferences about how care should be provided, for example bathing routines and assistance with dressing. The care plans looked at gave clear person-centred information and showed the staff how to support the people who use the service and enabled staff that are unfamiliar with the The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 12 person to provide care in the agreed manner. An example is: “ will play with her food, chews it for long times and tries to push it out of her mouth, staff must remain firm and encourage her when she says “I can’t.” Improvements were seen in the records of professional visits, including optical, dental, chiropody and General Practitioners visits. The care provided was person-centred, personalised and specific but some of the care plans and reviews of the care plans seen were not dated which does not show whether the information was still relevant to the persons’ condition. Some shortfalls were identified in risk assessments in the care plans and nutritional risk assessments were not seen at this site visit. A discussion with the manager and a review of the weight records held, showed there were some residents who could not use stand on weighing scales and therefore were not regularly weighed. Although there was a record of the weights of other residents on a monthly basis, these were held in a separate file and not included as part of each individual’s care plan. A record of each person’s monthly weight should be made as part of the assessment process to make sure appropriate action can be taken to address any significant weight loss. Scales that are appropriate for the residents must be provided so their weights can be recorded. There was no comment of any action to be taken or planned action following a recording of any weight loss. For one person the care plan stated “malnutrition. Monitor and record. Fortisips 3 times daily and Callogen diet supplement 3 times daily”. There was no record of a referral having been made to the dietician and there was no record of the dietary supplements on the medication administration record for the staff to confirm these were given as prescribed. The weight chart for this resident showed they had lost 5lbs between February and March 2008. It is acknowledged these people are under the care of a health professional. The National Minimum Standard recommends that each care home should have a procedure for dietary assessment and nutritional screening. Each person should be screened for their risk of malnutrition on admission and monthly afterwards, using a validated nutritional screening tool. It is recommended that better arrangements be made for recording and monitoring the nutritional needs of people living in the home. Some good practice was seen in respect of medication recording and administration, however some improvements are still needed to ensure that all people living at the home receive their medication as prescribed. At this inspection a review of a sample of medication administration records (MARS) identified some gaps. There were examples where it was not possible to be sure that antidepressant and antipsychotic medication had been given properly, as prescribed. For one resident, an antibiotic had been prescribed twice a day, out of two days since the course had started; one of the tablets had not been given although the MAR chart had been signed as given. When some medication was received into the home it was not properly recorded so it was difficult to audit or check this medicine had been given properly. This The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 13 made it difficult to ascertain if medications were being administered as prescribed and that the people who use the service were receiving their medication, as they required. Separate charts were present for lotions and creams and a discussion with the manager highlighted that there should be guidelines for staff as to how the creams should be applied for each person they are prescribed. Throughout the day we spoke to people who use the service and they were observed being treated in a dignified and respectful manner. There were good levels of satisfaction with the care provided. One relative recorded in our survey that, “They look after my aunt with care and compassion; they allow her to keep her dignity.” Another relative wrote, “I have found the care staff to be unfailingly, kind and conscientious. I have no insight into their formal qualifications but their treatment and attitude to mother and myself is excellent.” A staff member reported in the survey that; “Every client is an individual and we do our best to meet their different needs. We offer a range of activities and we all make the clients feel at home. Staff are very good at communicating with each other. We always strive to do our best where our client’s welfare is concerned”. The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 14 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): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have the opportunity to join in social activities and have a well-balanced menu, though some would like a wider variety and choice of meals. EVIDENCE: Each person who uses the service has a social profile, which included preferred activities. The home provides various activities throughout the week such as arts and crafts session, quizzes, shopping, reminiscence etc. The manager also stated that physiotherapy is provided twice weekly. During the inspection we observed the Occupational Therapist who visits the home approximately six hours per week leading a group of nine people who use the service to do questions and answers on general topics. Two of the ladies stated,” it is fun to keep your mind stretched and it keeps us busy”. The therapist said she visited residents in their own bedrooms too and spent some time with them in order to break up their daily routine. Some small scale outings are arranged to encourage involvement in the local community. One person had visited a garden centre recently which she said she enjoyed very much. Detailed information was in place in the care plans to identify the past life experiences of people who use the service and gave information about the The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 15 persons childhood, working life, relationships, marital status and family dynamics as well as hobbies and past interests. Family members had sometimes filled this in and this showed the background, family life and employment history of the individuals People who lived at The Cedars were seen spending time doing activities they chose too. One person was seen doing a crossword; one resident was reading a magazine. One of the residents was supported by the manager to look at some of her photographs on a slideshow computer screen, which her son had bought for her. One person wrote in the survey, “The staff try to encourage my partner to be more mobile and interact with other residents. They have endless patience with him”. People who use the service were observed freely walking around the home independently and with support. One relative stated in the survey that, “My husband appreciates the freedom to wander at will”. A number of the people who use the service still practice their religious beliefs; as a consequence the priest from the local parish visits the home each Friday. People who use the service were encouraged to maintain contact with family and friends and some visitors were seen during the day, sometimes meeting in private with their relative. One visitor who the inspector spoke with said they were always made to feel welcome at the home and they were always kept up to date with their relatives care needs. We sat and joined three people for lunch in the dining room. The interactions observed between the people living at the home and the staff were warm, friendly and supportive. People were left to enjoy their meal at a leisurely pace before they were given a dessert. A number of people were seen to have a doze between the main course and the dessert and there did appear to be a lengthy time period between the main course and the dessert. The midday meal observed was well presented. The meal served was home made shepherd’s pie and vegetables followed by chocolate sponge and chocolate sauce. When asked “Did they know what the meal was before it was served?” two people said, no. One person made a comment that “We eat what we are given, why wouldn’t we?” Of the ten residents/relatives who returned comment cards one expressed they sometimes “like the meals at the home” and another that they usually liked the meals but “it would be nice to be offered an alternative when the set meal is not to my liking”. As raised at the last inspection there was inconsistent practice in supporting people at mealtimes. A number of people who require assistance remained seated in their lounge chair to receive their meals and one staff member was kneeling down to support a person with their lunch until the manager provided her with a chair. It appeared that there was insufficient seating at dining tables for all people who use the service to dine together which does not The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 16 provide them with the same opportunity to experience mealtimes as a social event in the same way as other people living at the home. In order to make sure all people are offered a choice of meal and are made aware of the meal on offer, there is a need to consult with the people living at the home and to keep the menus under review. The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People feel able and know how to complain and policies and procedures are in place to protect people who use the service from abuse. EVIDENCE: The home has a complaints procedure in place. Two complaints were recorded within the homes recording system and the manager advised these were appropriately dealt with. The CSCI have not received any concerns about the care provided at the home. A risk assessment for the use of bed rails for a person who had these in place had not been included in the person’s care plan. The manager showed us the format she had used for another persons bed rails assessment and during this visit requested confirmation from the person’s GP for consent to use bed rails. The information provided and the assessment process must be reviewed and updated to make sure the assessment is carried out in line with current guidance. Since the last inspection eleven staff had undertaken formal Protection of Vulnerable Adults training. Staff members spoken to were aware of the action to take in the event of an allegation of abuse. The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 18 Of the ten relatives/residents surveys returned, all knew how to make a complaint about the care provided. One relative stated, “I do not feel there is anything which could not be resolved by the manager or her deputy.” The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 19 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): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides the people who use the service with comfortable, clean and homely surroundings. EVIDENCE: The Cedars is a large detached property in a lovely setting. People who use the service have access to patio areas to the rear of the home, which enables them to enjoy the views. Internally people who use the service have access to a number of floors. There are handrails and stair and passenger lifts to enable all people to reach all parts of the building. Upgrading continues and parts have received new decoration and carpeting which makes the home inviting and comfortable. The lounge areas are comfortably furnished with fixtures and fittings which suit the age and character of the home. The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 20 Bedrooms viewed were personalised and clean with personal effects and furnishings. Since the last inspection several bedrooms had been refurbished, some carpets had been replaced with non-slip vinyl and a shower room has been added to a bedroom. One room had recently been redecorated and one of the people who use the service said, “I like my room, I have it how I want it and they always keep it clean for me.” As raised at the last inspection the main dining and small lounge area on the lower floor does not reflect the standards shared in other parts of the home. The carpets and skirting boards were marked and furniture was showing signs of general wear and tear. Information provided in the AQAA stated that the programme of refurbishment will continue throughout the home. One relative commented in the survey that they would like to see the environment improved, “I would decorate the home and put down new carpets. I am paying a lot of money. I am happy with the care my relative is receiving. But I am not happy that since she entered the home two years ago it has got very shabby. She had a very nice home and I am concerned about how she is living”. On the day of the inspection the home was clean and free from odours. Although the home accommodates a number of people living there with a dementia type illness there was no visual evidence that any orientation aids were in use to aid people. The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 21 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): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported by adequate numbers of safely recruited staff though further training is required in some areas to ensure they have the necessary skills to meets the needs of individuals who use the service. EVIDENCE: On the day of the inspection the numbers of staff on duty were sufficient to meet the needs of the people accommodated. The staff stated they felt well supported by the home’s management arrangements, the registered manager was on duty on the early shift and the deputy manager was on the late shift to support the staff. Domestic, laundry, catering, administrative staff and an occupational therapist also supported the staff team. It appeared that people’s needs were attended to as needed and there were sufficient staff available to supervise the people living in the home, as they needed support. Three staff personnel files were reviewed. Each file contained a completed application form, confirmation of Criminal Record Bureau checks, written references and copies of passports to confirm proof of identification. It was recommended that the application form should specify clearly the applicant’s previous employment dates to include the date, month and year and good practice would include evidence of interview notes to demonstrate that previous employment was discussed during the interview and a record of this could be held. The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 22 The training matrix provided on the day of the visit and the completed AQAA showed that most staff received fire safety training at 6 monthly intervals. Since the last inspection, two staff members had undertaken training in dementia care, one person had done training in challenging behaviour and another person in mental health awareness; five staff had done training on the mental capacity act and three staff had attended training in infection control. Other training had been undertaken in equality and diversity, health and safety awareness and food hygiene. Mandatory training in moving and handling does not appear to have been updated for eleven staff members even though the home has four staff members who have attended a manual handling trainers course to enable them to act as competent persons within the home. Although there has been some improvement in the staff training programme since the last inspection and staff spoken to say they found training a positive experience, it is recommended the training is provided to more staff to ensure that staff have the necessary skills and knowledge to meet the needs of the people living at the home. The manager reported in the AQAA that 82 of staff of care staff at the home had completed training in NVQ level 2 training or above. Throughout the inspection staff appeared competent in supporting people who use the service and were attentive to their needs. The manager confirmed that staff attended information sharing meetings and staff files confirmed that individual supervision sessions were carried out. Comments made by some of the people in the home during the site visit and from relatives in the surveys included: “I am happy here and the girls are great, they look after me very well.” “The staff are champions, very caring and understanding”. “A very friendly atmosphere and staff are understanding to my mother’s needs. “The care is exceptional. Most importantly, I think, are the day-to-day interaction, the smiles, the chats, and the hand holding which at The Cedars is so clearly genuine? Most of all, my husband needs a calm and friendly environment to feel safe and happy. This by example of the manager and the happy team spirit of the genuinely caring staff is what he has.” The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 23 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): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager strives to run the home in the best interests of the people living there, however some shortfalls in record keeping and the provision of medication have the potential to put people at risk. EVIDENCE: There are no changes to the management structure of the home. The manager has been at the home for some time and has the relevant qualifications to run and manage a care home. She supports the care staff to assist the people who use the service and was familiar with all their needs and individual preferences. The home has quality assurance procedures in place and a report of the audit carried out in 2007 was made available during this visit. Following this site The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 24 visit the manager should review the auditing process to ensure medication and care practices promote the health, safety and welfare of the people accommodated. Accident records were held on individual record sheets. We discussed with the manager that these could be kept together with the individuals care plan to assist in the person’s risk assessment and care plan. For one person who had a record of eight accidents/incidents during a five week period there was evidence of a falls risk assessment in place. The home maintains small balances for resident’s finances. Individual income and expenditures are recorded and receipts retained for all expenditures. According to the AQAA, equipment and health and safety checks are made on an ongoing basis. A fire lecture was being carried out during this site visit and there was evidence that further fire training was being carried out to include the night staff. There was evidence of a list of staff who had attended fire drills in the last six months. The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 25 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 26 Yes Are there any outstanding requirements from the last inspection? 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. 1. Standard OP8 Regulation 13 (4)(c) Requirement Timescale for action 02/06/08 2. OP8 12(1)(a) 3. OP9 13 The manager must have in place appropriate detailed risk assessments, which must include appropriate nutritional assessments. Appropriate equipment must be 15/06/08 provided to make sure the weight of all people living at the home can be recorded and monitored. Medication must be accurately 05/05/08 administered and recorded to ensure the health of people living at the home is not compromised. (Timescale 31/7/06 and 01/07/07 not met) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 27 1. OP7 The information recorded in the daily statements should be linked to the care problems identified in the plan of care. The menu offered should state alternative options and choices at each mealtime, and staff should remind people who use the service of those options. Menus should be provided in a format people understand so are better able to exercise choice at mealtimes. Where possible all people who require assistance at mealtimes should be supported to eat at dining tables and receive one to one uninterrupted support. People who use the service who are at risk of or have identified unexplained weight loss should have accurate records in place which details the action taken to as far as possible maintain and or attain weight again Risk assessments should be in place for the safe use of bed rails. In order to assist people with a dementia type illness, it is recommended that orientation aids are provided to assist them. It is recommended the management review the provision of training to make sure all staff are supported to attend training appropriate to the work they are to perform. This must include updates in manual handling training, which should be recorded on the staff members training profile. The manager should ensure that suitable auditing procedures are in place, for example, for care plans, accidents/incidents and medication practices to make sure the people are safeguarded. 2. OP15 3. OP15 4. OP15 5. 6. OP18 OP19 7. OP30 8. OP38 The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 The Cedars Rest Home Limited DS0000005600.V361834.R02.S.doc Version 5.2 Page 29 - 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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