Enter and view: Cedar Court Nursing Home, Dementia unit

Healthwatch Derbyshire conducted an announced Enter and View visit to Cedar Court Nursing Home's Dementia unit, a 40 bed Residential Care Home, on 11 February 2014. For the purpose of this visit, Healthwatch Derbyshire wanted to observe ‘What good looks like’ within a care home setting. Cedar Court was randomly selected, alongside 9 other Care Homes who had been awarded the Derbyshire County Council Bronze Dignity Award.

Authorised Representatives were unable on this occasion to approach residents or relatives to informally ask them about their experiences of the home, as would usually be the case. This was because the majority of people living in the unit had an advanced stage of dementia. It also became apparent that family carers mostly visited during the afternoon. One resident was, however, able to tell of their experiences. A large proportion of the visit was therefore observational, involving the Authorised Representatives walking around the public/communal areas and observing the surroundings to gain an understanding of how the home actually works and how the residents and service receivers engaged with staff members and the facilities. There was an observation checklist prepared for this purpose. The sequence of the observation was negotiated with the Manager and included a guided tour of the Dementia Care Unit.

The Authorised Representatives found that, despite the signage from the main road to the unit being small and easily missed, and the track difficult to navigate due to pot holes, there was plenty of parking and good signage to reception, clear instruction for visitors, and a welcoming reception area.

The facilities at the unit are good and provide for the residents’ needs, in particular the introduction of the wet rooms for personal care to promote independence, with evidence of a wide range of activities available. Food is cooked and served in a way that is flexible to the needs of the residents, and assistance is available when needed. Residents were able to exercise choice and control over what they did.

The staff/resident relationship was relaxed, friendly and warm and interaction was personalised to be mindful of the communication needs of the residents. Good partnership working was evident with the local colleges, to the benefit of the residents in terms of innovative projects. The visiting team felt it was clear that practice reflected the Dignity Principles. They also noted there was evidence that feedback from residents and relatives was listened to.

The report makes the following recommendations:

- Address the signage to prevent people from using the back lane.

- Tighten up on the signing-in procedure.

- Explain the procedure regarding the use of the sterilising solution before and after entering the unit.

- Provide information about the differences in staff uniform, so that roles and responsibilities are clear.

- To cater for other choices with regards to hot drinks, i.e. ensure decaffeinated options are available, etc.

The provider response was generally positive and have agreed to change the signage to ensure people use the correct entrance. They are also developing a list explaining the colour coding of the uniforms and will display this in reception. They noted that the Authorised Representatives were asked to sign in on arrival but that this was forgotten during the introductions, they also pointed out that one of the visiting team did not have their ID badge with them at the visit - Healthwatch Derbyshire have addressed this and instigated a pre-visit checklist.

The Provider also suggests that, when visits are largely observational, a longer visit would be useful to gain a fuller picture of the service at the point of delivery. They also mention that Healthwatch Derbyshire's summary of good practice, sent with the draft report, mentioned a 'Dignity Tree' and, as the provider felt this was a such good idea, will also be creating one of these in each of the lounges.