Please wait

Inspection on 03/02/10 for Camplehaye Residential Home

Also see our care home review for Camplehaye Residential Home for more information

This is the latest available inspection report for this service, carried out on 3rd February 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staff are considered kind and we observed kindness and empathy between staff and people who use the service. Some senior management within the organisation are knowledgeable, skilled and understand how to manage a home in the best interest of people who use the service. Where management have been informed of concerns which might be abuse or bad practice they have responded quickly to ensure people are safe.

What the care home could do better:

Care plans must be `live` documents in that they provide staff with detailed information on how to meet the needs and wishes of the person using the service. As staff do not use them they are of little use at this time. It must be clear within each person`s plan of care whether they, or a person in their best interest, have made arrangements for them not to be resuscitated should they have sudden illness and collapse. Staff must comply with the person`s wishes in this event. Staff must ensure that any sign or symptom of ill health is robustly followed up within a reasonable timescale.There must be, at all times, suitably qualified, competent and experienced staff working at the home in such numbers that are appropriate for the health and welfare of people using the service. This should include additional staff until later in the evening and should any event occur which suggests an increase in people`s needs. Staff must not only receive training in first aid and safeguarding people from abuse but they must have gained knowledge and competence from that training, so that people are safe in their care. There should be staff available who are be able to converse to a satisfactory standard with agencies (such as ambulance, police etc) which may have involvement with the home in an emergency situation. All staff must know how to alert a concern, which might indicate abuse, and must understand their responsibility to do so. Staff must be diligent in following the advice of professionals, in this case ensuring that people were isolated in their own room during the outbreak of illness. The staff roster must be a true record of people who will be working at the home and whether the roster was actually worked. The Commission must be notified, within a reasonable timescale, of any events which adversely effects the well-being of people at the home. This must include staff shortages, infestation and falls resulting in hospital visit.

Random inspection report Care homes for older people Name: Address: Camplehaye Residential Home Lamerton Tavistock Devon PL19 8QD two star good service 18/08/2009 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. 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: Anita Sutcliffe Date: 0 4 0 2 2 0 1 0 Information about the care home Name of care home: Address: Camplehaye Residential Home Lamerton Tavistock Devon PL19 8QD 01822612014 01822611480 avenscare@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Jasmin Harries Type of registration: Number of places registered: Conditions of registration: Category(ies) : Avens Care Homes Ltd care home 43 Number of places (if applicable): Under 65 Over 65 0 43 0 dementia old age, not falling within any other category physical disability Conditions of registration: 43 0 43 The maximum number of service users who can be accommodated is 43. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) Physical disability (Code PD) Date of last inspection 1 8 0 8 2 0 0 9 Care Homes for Older People Page 2 of 14 Brief description of the care home Camplehaye is a large detached period house set in its own grounds on the outskirts of the village of Lamerton. It is registered to provide residential accommodation and personal care, for a maximum of 43 older people for reasons of frailty connected with age, physical disability or dementia. In addition, the home may provide accommodation for people with a physical disability from the age of 55. All health care needs are met through the community health care services, such as the district nursing service. The home provides three lounge rooms and two dining rooms on the ground floor. There are three double bedrooms. All of the bedrooms have en suite facilities or a toilet and sink for personal use close by. Stair lifts and a vertical lift provide access to the upper floors, however a small number of rooms are accessible by a short flight of stairs. Outside space comprises a patio area and enclosed gardens. We were told on 4th November 2009 that fees range from £350 to £450 a week. Additional charges are made for newspapers, personal toiletries, incontinence pads, telephone and transport and escort, visiting hairdresser, dry cleaning, dentist, chiropodist, clothing, and other items of luxury or personal nature. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at /www.oft.gov.uk . Care Homes for Older People Page 3 of 14 What we found: We received concerns from Devon and Cornwall Constabulary and South Western Ambulance Service relating to the evening of 6th January 2010 when each visited Camplehaye following the unexpected death of a service user. Both raised issues which might indicate that people who use the service are at risk. We therefore did a random, unannounced inspection. We looked at issues of staffing numbers, training and competence. Also, the homes policy relating to the sudden collapse of service users, such as resuscitation, end of life choices etc. We also took the opportunity to check compliance with requirements made at the previous key inspection of the service, 18th August 2009 and other concerns which were identified during this inspection process. Toward this random inspection we spoke with district nurses with knowledge of the home and a representative of the Health Protection Agency (HPA). We had also received information about the service from other agencies involved in separate safeguarding alerts, which are still being considered by Devon County Council safeguarding team. We did two unannounced visits to the home, both which included the tea time period that the Special Constable and South Western Ambulance crew had highlighted for concern. During our two visits we looked at the care records of 23 people who are currently resident or recently deceased and we read the communication message book. We interviewed six care staff, each having been on duty at the time of the incident. We spoke with five people who use the service and met many others. We also visited most parts of the home on each occasion. The manager Jasmin Harris and her line manager were available and helpful throughout both visits. We needed to establish whether staff were clear as to when and how they should make efforts to revive a person should that person have a sudden collapse that might indicate the need for first aid resuscitation. Toward this we looked at the records of the last person to be admitted. Although their assessment did include questions about Power of Attorney and Living Will (now both superseded following new legislation) there was no indication as to the persons wishes regarding resuscitation and therefore no written information available to inform staff. We asked staff what they should do should a person collapse. The care assistants told us that they would call the senior carer on duty and dial 999. One of the two senior carers specifically said it was not the homes policy to resuscitate people. The response from the second senior carer, on duty when the collapse occured, was unclear. None of the staff mentioned checking the persons records to ascertain their wishes in this matter. We asked a senior member of Avens Care Ltd. if there was a policy on resuscitation. A policy should be an operational statement of intent which helps staff make sound decisions and take actions which are legal, consistent with the aims of the service, and in peoples best interest. Although no policy could be found we were told that it was the policy to make every effort to resuscitate a person who has collapsed, unless their records clearly indicate otherwise. Care Homes for Older People Page 4 of 14 We had established that staff did not know the policy and did not consider checking the persons individual records where their arrangements in this event should be recorded. However, we were told that assessment documentation is already under review at the home. We asked staff questions so as to check their knowledge of first aid. Records indicate that staff have received first aid training in the previous few months. It was clear from some staff response that their knowledge was not adequate. For example, one staff could not describe the correct first aid for a scold, which is a highly probable occurrence as people can easily spill a hot drink. This dealt with promptly and correctly can prevent a serious wound. We asked staff about the types of abuse and how they should respond should they have concerns, which might indicate abuse. We gave the example of a staff member shaking a person and being rough. None of the six staff interviewed knew how to alert concerns to Devon County Council safeguarding team. Each told us that they would: Tell a senior, or a manager. When pressed further one told us that, having reported concerns to her manager her responsibilities had been met. It was a previous recommendation that all staff should be fully conversant with the protocol for alerting concerns which might be abuse. This is clearly unmet, despite training received by staff within the previous few months. However, management at the home have acted swiftly and correctly to protect a person who may have been subject to abuse at the home. We needed to establish staff ability to communicate effectively as this had been raised as a concern. Toward this we asked each of the staff we interviewed to describe the care of one person at the home. We concluded that the standard of English is reasonable under normal circumstances. Each of the five staff on duty during the evening of 6th January have English as their second language. We could converse with the three staff that the Special Constable and ambulance crew had spoken with provided the staff spoke slowly. With the heightened stress of the incident it is understandable that communication was poor. Also, we believe we would have been unable to understand the person who had been left in charge and made the 999 call to the ambulance service. From asking staff about peoples needs we established that there was some lack of knowledge about peoples needs. The person in charge on the evening of the event did not know the deceased had dementia, why he presents with challenging behaviour or how she should respond (correctly) in the event of his behaviour becoming a challenge. None of the six staff interviewed made any reference to peoples care plan, which should describe the care they need, their wishes and how staff are to ensure those needs and wishes are met. It was clear that care plans at Camplehaye are not live reference documents for staff as they must be. We looked at the care records of the person who died the evening of 6th January. We saw that staff had reported both am and pm that he felt cold. One also demonstrated how he had been pulling his jumper around himself as if he was cold. We also saw from his records that he had symptoms of Norovirus: diarrhoea and vomiting. We did not establish how long he had been unobserved at the home but staff interviews suggest that he was not seen from the time of mid afternoon tea (about 3:30) to main tea at 5:30, when he was found collapsed on the floor. Although staff had reported symptoms which Care Homes for Older People Page 5 of 14 indicated he was unwell they did nothing specific for him to ensure his wellbeing that afternoon. However, there are records which indicate that the home is generally good at ensuring peoples care and health care needs are met and a district nurse told us: mostly people are well dressed, fed and happy. More general events surrounding the incident on the 6th of January are relevant to this report. There had been continual snow and ice for some time. Throughout the country this had a serious effect on transport and travel. Camplehaye is a rural care home and as such the weather conditions impacted greatly, affecting staff ability to get to their place of work. Arrangements had been made to ensure there was a full compliment of staff on duty on the 6th. However, the registered manager was not at work due to sickness and her line manager could not get to the home because of the bad weather. The first symptoms of Norovirus, those being diarrhoea and vomiting, had been recorded on the 5th January. The homes communication book indicates that there were six people to be barrier nursed (kept in isolation if possible) on the 6th January. In the afternoon of the 6th the person in charge (the deputy manager) became ill and left the home at around 4 pm. The kitchen assistant, who we were told could not get home without the others transport, also left. By 5:30 pm this left five staff in the building for thirty seven residents. One of those staff told us that she undertook kitchen duties as the kitchen assistant had left. Records of staffing indicate that it is normal at Camplehaye to have five care staff and one kitchen assistant over the tea time period. However, on the 6th staffing was reduced to four care assistants and a kitchen assistant. This reduced staffing was at a time when people were ill with diarrhoea and vomiting and staff were also to isolate people with illness. Neither was there any management on the premises. Staff then found a person to have collapsed and there was another person in the home who required hospital admission during the tea time period. The ambulance crew that attended on the 6th described the staff as being in shock adding that they did not know what to do. We were told: The language barrier was obstructive. The Special Constable that attended, as is normal with an unexpected death, said that none of the staff were fully conversant in English and communication was strained. She added: The most senior member of staff appeared to be stressed, agitated and harassed by the strain and indicated that she was struggling to cope. The home has a policy on Emergency Planning for the home. This includes winter emergencies, medical emergencies and public health emergencies. However, although staffing had been considered regarding winter weather, it had not been considered regarding the outbreak of diarrhoea and vomiting. Although this was a reasonably sudden event, starting on the 5th, it was quite clear by the morning of the 6th that there was an outbreak of illness which would greatly increase the needs of people and therefore the workload of staff. The registered manager Jasmin Harris told us she had not made any arrangements for this additional work load (she was away with sickness); neither had her line manager, her deputy manager nor the service provider. The staff roster shows that staffing numbes were not increased at all during the period of sickness, which lasted from 5th to 13th January. A district nurse who visited during this period told us: Clients were quite wet through the recent diarrhoea outbreak. We also found that the staffing roster was not a true record of people working at the Care Homes for Older People Page 6 of 14 home; Both Mrs. Avens, the registered provider, and Jasmin Harris, the registered manager were recorded as being at the home on the 6th when they were not. We spoke with the person in charge of the night time period at the home. On the 6th January she arrived for work at 7:30 pm. The home normally provides for three staff between the hours of 7:30 pm and 7:30 am. She describes the normal situation at nights as extremely difficult at times, especially during the period that she is administering medicines, which leaves only two care staff assisting up to 43 people. Camplehaye provides a service to many people with dementia and we see when we visit that many wander in the home. District nurses tell us of the high needs of some people at the home and staff told us of the agression of one person. Peoples needs vary from confused and mobile to frailty and illness requiring full care, which would require two staff in attendance. We spoke with a District Nurse Team Leader. She told us she sees staff rushing around and made the point that the home goes along on the edge. Although we have not personally witnessed a lack of staff when we have visited the home, staffing arrangements between tea time and people retiring to bed, do not appear to be appropriate for the health and welfare of people who use the service in that there will be periods when there are insufficient staff to ensure each persons safety. We looked at how well the home had managed the outbreak of diarrhoea and vomiting, which we were not aware of until we received information from Devon and Cornwall Constabulary. It is expected that any outbreak of this nature is reported to the Health Protection Agency (HPA) at the first opportunity. The first recorded illness was the 5th January. (It might have been an isolated case). By the 6th January we know that there were at least six people with the illness, as recorded in the homes communication book. The home then contacted the local G.P. surgery who attended the home and advised on how to reduce the spread of infection. However, according to the Health Protection Agency records, the home did not inform them at all (as they should) and on the 9th January a doctor who had visited Camplehaye did so instead. A HPA representative then made contact with the home with further advice. The home provides antiseptic hand gel for staff and visitors to use, as routine. There is also a notice at the entrance asking people not to visit if they have any illness. However, no notice was displayed to tell people about the probable Norovirus and ask them not to visit. The Special Constable who attended on the 6th told us: At no point had I been informed that there was the possibility of Norovirus being present and I had removed my gloves and protective clothing. When she found out about the illness she informed the ambulance crew. We contacted South West Ambulance Service who confirmed that they were not informed of the illness by the home. Clearly, it was of great importance that the information was passed to these agencies as they visit other vulnerable people, including hospital. The home did ensure that the local G.P. surgery was fully informed about peoples illness and G.P.s did visit from the first day of illness. However, advice to isolate people in their room to prevent the spread were not followed. Peoples individual records at the home told us: 6th January: Severe diarrhoea and sickness. Assisted to the dining room.... 7th January: Bad diarrhoea at night, and pm Diarrhoea today. Relaxed in the lounge. Records indicate that the outbreak lasted from 5th to 13th January. Care Homes for Older People Page 7 of 14 The home is required by law to notify the Commission of any events which adversely affect the well-being of people who use the service. Clearly, during a very difficult phase, such as the outbreak of illness, a telephone call would suffice until a written notification can be completed. However, we were not informed about the illness until 22nd January. We also saw from the homes records that other events should have been notified to us; this includes an infestation. Records provided by Southern Western Ambulance also indicate events which should have been notified but were not, such as people having been conveyed to hospital following a fall. We checked compliance with requirements made at the last key inspection, August 2009. We found the laundry room to be clean and orderly and dirty laundry was being handled in a way which would reduce the possibility of cross infection or contamination. We found that there is now a record of consultation with the person using the service, or their representative, when planning or reviewing the persons care and that the plan does reflect all aspects of the persons needs. However, as staff do not refer to the care plans peoples health and well-being are still not being properly promoted. There are now good records as to under which circumstance as necessary or as required medicines may be administered so their use is consistent and the possibility of mishandling is reduced, and we saw that stock is now properly controlled to help prevent confusion or mistakes. The home has yet to fully comply with the safe storage of medicines known as controlled drugs but we saw how it intends to comply. What the care home does well: What they could do better: Care plans must be live documents in that they provide staff with detailed information on how to meet the needs and wishes of the person using the service. As staff do not use them they are of little use at this time. It must be clear within each persons plan of care whether they, or a person in their best interest, have made arrangements for them not to be resuscitated should they have sudden illness and collapse. Staff must comply with the persons wishes in this event. Staff must ensure that any sign or symptom of ill health is robustly followed up within a reasonable timescale. Care Homes for Older People Page 8 of 14 There must be, at all times, suitably qualified, competent and experienced staff working at the home in such numbers that are appropriate for the health and welfare of people using the service. This should include additional staff until later in the evening and should any event occur which suggests an increase in peoples needs. Staff must not only receive training in first aid and safeguarding people from abuse but they must have gained knowledge and competence from that training, so that people are safe in their care. There should be staff available who are be able to converse to a satisfactory standard with agencies (such as ambulance, police etc) which may have involvement with the home in an emergency situation. All staff must know how to alert a concern, which might indicate abuse, and must understand their responsibility to do so. Staff must be diligent in following the advice of professionals, in this case ensuring that people were isolated in their own room during the outbreak of illness. The staff roster must be a true record of people who will be working at the home and whether the roster was actually worked. The Commission must be notified, within a reasonable timescale, of any events which adversely effects the well-being of people at the home. This must include staff shortages, infestation and falls resulting in hospital visit. 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 9 of 14 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 13 Medicines known as 30/11/2009 Controlled Drugs must be stored in compliance with the Misuse of Drugs (safe custody) Regulations 1973. To reduce the likelihood of mistakes, mishandling and to comply with the law. Care Homes for Older People Page 10 of 14 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 Peoples wishes regarding 31/03/2010 the use of resuscitation must be recorded and those wishes followed in the event of sudden illness and collapse of the person. To promote and make proper provision for the health and welfare of people who use the service. 2 7 12 Staff must be using care 28/02/2010 plans as live documents to inform them how to deliver the care and support identified during assessment and review. To promote and make proper provision for the health and welfare of people who use the service. 3 8 12 Assistance and medical attention must be provided where a person is showing signs or symptoms of ill health. To promote and make proper 28/02/2010 Care Homes for Older People Page 11 of 14 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 provision for the health and welfare of people who use the service. 4 18 13 (6) All staff must know how to alert a concern, which might indicate abuse, and must understand their responsibility to do so. To protect vulnerable people from abuse. 5 27 18 There must be, at all times, sufficient staff and skill mix appropriate to the needs of people who use the service, the size, layout and purpose of the home. This must include early and later evening. So that there are sufficient staff to ensure individual needs are met and those with dementia who wander are safe. 6 30 18 Staff training must equip them for the work they do and their knowledge and competence must be checked. This includes the subjects of first aid, safeguarding vulnerable adults and infection control. So that staff are trained and competent to do their jobs. 7 37 17 The roster must be an accurate record of who is working at the home and a record of who actually worked. 18/02/2010 30/04/2010 31/03/2010 28/02/2010 Care Homes for Older People Page 12 of 14 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 It is a legal requirement to do so and it protects people who use the service. 8 37 17 The service must notify the 18/02/2010 Commission of any events which adversely affects the well-being of people who use the service. This will protect both the person using the service and the service itself. 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 29 There should be staff available who are be able to converse to a satisfactory standard with agencies (such as ambulance, police etc) which may have involvement with the home in an emergency situation. Care Homes for Older People Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission 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 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 14 of 14 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!