Inspection on 26/03/09 for Camelot House, Wellington

This is the latest available inspection report for this service, carried out on 26th March 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Camelot House, Wellington 21/07/08

Extracts from inspection reports are licensed from CQC, this page was updated on 20/06/2009.

Inspecting for better lives Random inspection report Care homes for older people Name: Address: Camelot House, Wellington Camelot House, Wellington Chelston Wellington Somerset TA21 9HY two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: kathy McCluskey Date: 2 6 0 3 2 0 0 9 Information about the care home Name of care home: Address: Camelot House, Wellington Camelot House, Wellington Chelston Wellington Somerset TA21 9HY 01823666766 01823667568 info@camelothousenursing.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Camelot Care (Somerset) Ltd care home 66 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 66 66 Rooms 1, 2, 3 and 5 can only be used by people who are fully mobile. The maximum number of service users who can be accommodated is 66. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) Mental disorder, not including learning disability or dementia (Code MD) Date of last inspection Brief description of the care home Camelot House is registered with the Commission for Social Care Inspection to provide nursing care for up to 66 older people who have a dementia or mental disorder. The home is not registered to provide care to people who have a primary diagnoses of a Care Homes for Older People Page 2 of 13 1 5 1 2 2 0 0 8 Brief description of the care home learning disability or to those who require general nursing care. The home is owned by Camelot Care (Somerset) Ltd. The responsible individual is Mr J.Teasdale. The registered manager is Mr Ty Taylor. Camelot Care (Somerset) Ltd was first registered by the Commission in February 2008 although the directors, Mr and Mrs Teasdale have owned the home since 2003. The home have been awarded a 4 star excellent rating from Environmental Health. It has also achieved the Investor in People Award for its commitment to staff training. Camelot House is a detached property situated on the main road between Taunton and Wellington and is on the bus route to both towns. Local amenities, which are close by, include a garage with a small convenience store and two garden centres. The home has recently benefited from major building and refurbishment works which have included a new extension which has been designed to meet environmental recommendations for people with dementia. This unit was registered by the Commission in June 2008. Several improvements have also been made to the existing environment and garden areas. The home has a large car park. We were advised that current fee levels are between 390 pounds & 750 pounds per week. Additional costs met by people using the service include; Hairdressing, personal items/toiletries and chiropody. Some activities incur some costs such as entrance fees, outside entertainers etc. Care Homes for Older People Page 3 of 13 What we found: This random inspection was conducted over one day (7.5hrs) by CSCI Regulation Inspectors Kathy McCluskey and Gail Richardson. The Commissions regional lead pharmacist Brian Brown was also present to examine the homes procedures for the management and administration of peoples medication. The homes last key inspection was conducted on 12th and 14th January 2009. This has not been identified on the front of this report under the heading of date of last inspection as the report is currently in draft format and has not yet been made public. This being the case, this inspection report does not identify any outstanding requirements which may have been identified. The purpose of this inspection was to follow up on some of the requirements raised at the homes last key inspection which was conducted in January 2009. We focused on care planning procedures, staff recruitment and the management and administration of medication. We toured the premises and were able to see evidence that the four immediate requirements raised at the last inspection relating to the heath and safety of persons at the home had been addressed. Identified windows above ground floor level had been restricted and substances hazardous to peoples health were noted to be appropriately stored. Two relatives approached us during this inspection and stated that they were very happy with the care their relative received at the home. One relative made the comment that communications had improved. During this inspection we examined six care plans and tracked the care of four people who had recently moved to the home. We found evidence that people had been assessed by the home prior to admission. One pre-admission assessment had not been signed or dated. The clinical nurse told us that she had carried out the assessment whilst the individual was in hospital. Care Plan 1. - A pre-admission assessment was in place as were assessments from other health care professionals. We were able to see that a temporary care plan had been raised and this appeared to identify all needs as detailed in the pre-admission assessments and the individuals preferences had been recorded. We examined the wound care plan as we had been informed that the individual had sores to both legs. A wound care plan had been raised. This included photographs of the wounds on admission. The wound care plan contained information about the size/status of the wounds and the dressings to be applied. Information about the frequency of treatment/dressings and review date had not been completed. The wound care plan was dated 19th March 2009 and we noted that there had been no entries to indicate that the wounds had been dressed in the eight days that the plan has been in place. We met with the person in their bedroom and noted that the bandage to the right leg was hanging off and was not actually covering the sore area. There was evidence of fluid seepage through the bandage on the right leg. The individual could not recollect when the dressings were changed. This person did not have access to a drink in their Care Homes for Older People Page 4 of 13 bedroom. They stated that there was a tap in the en-suite that they could use. The pre-admission assessments and the care plan in place identified that this person did not drink tap water and preferred bottled water. When we discussed this with you we were informed by Mrs Teasdale that the jug of water had been removed as it had been spilt by the individuals husband who also resides at the home. The clinical nurse stated that bottled water was kept in the kitchen fridge for this person. We discussed the need to ensure that there is access to their preferred drink in their bedroom at all times. This person was positive about the care they received and commented on the kindness of staff. Care Plan 2. - This contained evidence of a pre-admission assessment and assessments from other health care professionals. This individual is an insulin controlled diabetic. A care plan was in place which stated that blood sugar levels should be taken twice daily. The care plan also contained information for staff as to the action to be taken should blood sugar levels fall below 4mmols. Information about the signs and symptoms of hypo and hyperglycemia had been recorded. It has been recommended that the care plan details the normal upper and lower blood sugar readings for the individual. We examined the blood glucose monitoring form which commenced on 19th February 2009 and found that out of 35 days, staff had only recorded BM readings twice daily on 21 occasions. When we brought this to your attention we were informed by the clinical nurse that readings were often recorded on the handover sheet by the night staff and we were shown evidence of this at the time. We discussed the need to ensure that a consistent approach is taken to the recording of the individuals blood sugar levels as this would assist with the monitoring and review process. A recommendation has been raised. A MUST nutritional assessment was in place which identified weight as 41.5kg on 18/02/09 with a score of 1 medium risk. This had been reviewed on 02/03/09 where weight had dropped by 4kg to 38.2kg. The MUST score had changed to 2 high risk. A care plan was in place and this had last been reviewed on 02/03/09. We found that the care plan had not been updated to reflect significant weight loss. The care plan contained the weight and MUST score of the 18/02/09. The care plan did not identify any action to address the significant weight loss such as increasing the calorific content of meals, offering snacks between meals or that the use of supplements had been discussed with the GP. We examined the diet and fluid intake chart for the individual and, as discussed with you, we have recommended that a more detailed description of all meals taken is recorded. The records examined did not evidence that additional snacks or supplements were being offered in addition to the main meals. The care plan stated that the individual should be weighed weekly but records did not support that this was taking place. Entries showed that the person was weighed on 18/02/09, 28/02/09 and 15/03/09. It has been required that the care plan is fully reflective of the individuals assessed needs and that care is delivered in accordance with their assessed needs. We examined a fluid balance chart which was in the bedroom of JC and this indicated that regular fluids had been offered up to 10:00hrs. There were no entries made on the chart from 10:00hrs to 14:00hrs. When we discussed this with the clinical nurse we were informed that staff had recorded further fluid intake on the dietary monitoring sheet. Documented evidence was available to support this. It has been recommended that staff follow a consistent approach with regard to where information is recorded. A wound care plan was in place dated 02/03/09. This again contained appropriate Care Homes for Older People Page 5 of 13 information regarding the size and status of the wound and treatment prescribed. Information about the frequency of treatment/dressings and a review date should be recorded. Entries made by staff ranged between 1 and 5 days demonstrating that a consistent approach was not being taken. Information recorded by staff was insufficient and did not identify information about the status of the wound. Staff had recorded only that the wound had been cleaned and redressed. Care plan 3. - A pre-admission assessment was in place but this had not been signed or dated. A risk assessment was in place which identified that the individual was at risk of throwing themselves from their chair. As identified in the care plan, there was documented evidence that a carer was allocated to sit with the individual for nine hours during the night. Records did not however confirm that the individual was being checked every 5 minutes during the day as stated in the plan of care. During this inspection we observed periods when the identified person was in the lounge without staff presence. A member of the activity staff informed us that she spent some one to one time with the individual. Care staff appeared unclear as to who was responsible for regularly checking the individual. One carer informed us that it was the registered nurse on duty and another that it was the activity co-coordinator. Daily records identified that the individual had been found on the floor on four occasions during the evening and at night. To ensure the safety of the individual and to ensure care is delivered in line with assessed needs, it has been required that records clearly identify how the assessed needs will be met. Systems must also be in place which identify how the 5 minute checks will be monitored and by whom. A wound care plan was in place for this individual dated 05/03/09. Information about the size and status of the wound, photographs and details of the dressings prescribed had been documented. The frequency of treatment/dressings had not been recorded and there were no entries to demonstrate that the wound had been attended to since the plan was implemented on 05/03/09. Care Plan 4. - We checked the wound care plan for one individual that was noted to have a dressing to their ear. The wound care plan was dated 10/03/09 and whilst there was information about the status of the wound and prescribed dressings, there was again no information about the frequency of treatment/dressings. There were only two entries made by staff on 10/03/09 and 13/03/09 which stated dressing changed/wound cleaned. Records therefore indicated that the wound had not been cleaned and dressed for 13 days. Care Plan 5. - Daily records identified that this person had made several recent attempts, some successful, to leave the home. A risk assessment was seen to be in place dated 19/07/07. This had last been reviewed on 15/11/08. No changes had been made to reflect the recent attempts to leave the home. Care Plan 6. - After examining accident records, we noted that there had been two recent incidents of physical aggression by a person using the service towards another. Whilst a care plan was in place relating to challenging/aggressive behaviour and that this had been reviewed on the day of the most recent incident, 25/03/09, we could not see any evidence that the care plan had been changed and there was no reference made to the recent incident. Daily records for this individual made reference to the incident and stated that 15 minute observations commenced. Records relating to any observations had not been completed and no further reference to the incident or Care Homes for Older People Page 6 of 13 observations had been made. In summary, there was no effective care plan in place to address the increased aggression towards an individual using the service. We found that the home has available sufficient secure storage for all medicines and they were kept in these cupboards. However the cupboard for storing the Controlled Drugs whilst being constructed to comply with the current regulations was not fitted to the wall in accordance with the regulations and could lead to an increased risk of diversion. We also checked the stocks of the Controlled Drugs cupboard and found two discrepancies. These were discussed with the manager and clinical lead during the inspection and they have subsequently carried out an investigation into these and have had a discussion with all members of staff involved in the receipt and administration of these medicines. We observed that the medicines trolley was locked between administrations and that the person administering only prepared and gave medicines to one person at a time. We did however observe that the administration record was not filled in at the time of administration but that all records were completed at the end of the round. We found that when people were prescribed medicine with a variable dose that it was not always possible from the records made to determine what dose had actually been administered. This could lead to a person not receiving an appropriate dose at the next administration time and will also hamper the prescriber in reviewing the effectiveness of a persons medicines. For some people prescribed antibiotic liquids we found that the records indicated that they had received more doses than were actually contained within the bottle. This means that we cannot be confident how these people received their medicines as the records cannot indicate what has happened. Also one person had been prescribed antibiotics for a seven day course but the chart had course completed written on it after only four and a half days. We saw that this person had a covert administration agreement in place and we were told that his medicine is disguised in their drink but would not drink this if it had gone cold, so doses would have been discarded. There was no record of discard of these doses and also no record of a request for further supply from the prescriber. Not giving antibiotics for the prescribed time may lead to the infection developing resistance and to them subsequently not working for the person. When we asked the Clinical Lead and the Manager how frequently the medication administration record charts were audited they told us that at present this did not happen so meaning these discrepancies would not have been picked up within the home. This may lead to people not receiving medicines as they need them. We found that for one person who is an insulin dependent diabetic that there were good records of contact with the specialist nurse and prescriber to monitor this persons condition. However we also found that the home were not using the recommended lancets for obtaining blood samples from diabetics to monitor their blood sugar levels. This has been the subject of four national alerts in the past five years and may leave people at risk of cross infection. We also found that for people prescribed creams that a record is made of their application, however it was not easy to find information relating to where the creams were to be applied. To follow up on the requirements raised at the last inspection, we requested and examined files relating to two staff who had been recruited since the last inspection. Recruitment files for the two staff recruited since the last inspection were found to contain all required documentation. We were able to see evidence that staff had not commenced employment until receipt of a satisfactory CRB, POVA check and two satisfactory references. Care Homes for Older People Page 7 of 13 What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 13 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 13 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, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 (1) The registered person 20/05/2009 must ensure that care is delivered in line with individuals assessed needs and plan of care. This relates to people who require a close level of supervision to keep them safe. This is to ensure the health and welfare of people using the service. 2 8 12 (1) The registered person 20/05/2009 must ensure that nutritional care plans are up to date and reflective of individuals assessed needs. This is to ensure that peoples nutritional needs are met where concerns have been identified. 3 8 12 (1) The registered person 20/05/2009 must take steps to ensure that effective and up to date care plans are in place to address concerns for those exhibiting challenging behaviour. Care Homes for Older People Page 10 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 This is to ensure the health and welfare of people using the service and to reduce the risk of harm or abuse. 4 8 12 (1) The registered person 20/05/2009 must ensure that wound care plans contain information about the frequency of any treatment along with dates for reviews. This is to ensure that treatment is delivered in a consistent manner and that the effectiveness of treatment is monitored. 5 9 13 (2) The registered person 20/05/2009 must make arrangements to secure the Controlled Drugs cupboard in accordance with the current regulations This is to ensure that the risk of diversion of these medicines is minimised 6 9 13 (2) Arrangements must be 20/05/2009 made to ensure that the actual dose administered is recorded when medicines are prescribed with a variable dose. This is to ensure that it possible to monitor a persons reaction to a particular dose and then provide the next dose appropriately. 7 9 13 (2) Arrangements must be 20/05/2009 made to ensure that there is Page 11 of 13 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 an efficient system in place to audit the medication administration records and the stocks of controlled drugs. This is to ensure that discrepancies in stock balances and recording errors are discovered promptly. 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 1 8 The registered person should ensure that staff follow a consistent approach for the recording of information about people using the service. This relates to the recording of blood sugar levels and the recording of peoples fluid intake. The registered person should ensure that dietary monitoring sheets contain more detail regarding the amount and type of food that an individual has eaten. Diabetic care plans should contain information about the normal acceptable blood sugar readings for an individual. It is recommended that the home review how they make available the directions of where on the body prescribed creams are to be applied. It is recommended that the home review the lancets they are using to obtain blood samples and that future requests are onlymade for those complying with the MHRA alerts. 2 8 3 4 8 9 5 9 Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 13 of 13 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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