Inspection on 14/09/07 for Camber Lodge

This inspection was carried out on 14th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Camber Lodge 18/06/08

Camber Lodge 29/01/07

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Camber Lodge 93 Lydd Road Camber Rye East Sussex TN31 7RS Lead Inspector Jason Denny Key Unannounced Inspection 14th September 2007 10:45 Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 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 Camber Lodge DS0000067943.V348301.R01.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 Adults 18-65. 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. Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Camber Lodge Address 93 Lydd Road Camber Rye East Sussex TN31 7RS 01797 222360 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) camber.lodge@btconnect.com Nellsar Limited Vacant Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users to be accommodated is eight (8). Service users must be aged between eighteen (18) and sixty-five (65) years on admission. Service users with a learning disability only to be accommodated. One named service user aged sixty-five (65) years on admission to be accommodated. 29th January 2007 Date of last inspection Brief Description of the Service: Camber Lodge is a large, modern two storey detached property sited on the Main road of Camber, a small holiday village 4 miles from Rye. Sand dunes are within a 100 yards of the home accessible by crossing the Main road. A small general shop is within walking distance of the home along with a bus stop, which provides public transport to historic Rye several times daily. Rye has a mainline train station. The home has ample off road parking facilities within its own enclosed grounds. Camber lodge was originally a Motel and has been renovated, redecorated, and refurbished to a good standard in order to provide residential care for up to 8 adults. Bedrooms are of a good size with ground floor bedrooms sufficient in size for wheelchair users. All rooms have en-suite facilities. Communal areas such as the lounge, reception, dining, and kitchen areas are spacious. The home has its own minibus type vehicle. Camber Lodge has been under the new ownership of Nellsar ltd since August 2006. The home first opened in the summer of 2005 under a company called Camber lodge care owned by MR and Mrs Winder. Current fees charged ranges from £860 to £1187 per week. Inspection reports are routinely sent out to families and advocates who express an interest in the home or who specifically request a report. A copy is contained with the home’s guide [Service User Guide] kept on display in the reception area of the home. Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced key Inspection, which included a visit to the home which took place between 10.45am and 5.50pm on September 14, 2007. The homes last inspection was on January 29th, 2007 of which this report should be read in conjunction with. The timing of this inspection was brought forward due to a range of concerning information being brought to the Commissions attention. This information relates to how the home is being run and supported by the organisation Nellsar Ltd and the extent to which recent changes are affecting the stability of the home and outcomes for residents. This report takes into account findings from this visit along with informationreceived from the organisation that the Commission wrote to in August 2007 requesting an investigation into these concerns. Being a key inspection the inspection covered all main areas. This included care records, health and medication needs, how the home is staffed and managed, food, resident’s lifestyles, the environment, how resident’s complaints are handled, how they are protected, and what measures are in place to monitor and improve the service. The inspection focused in detail on how the service is being resourced in terms of staffing and activities, as this was a central concern of the last inspection. All of the four current Residents were spoken with and observed during the inspection. The visit also included discussion with four staff and the acting manager along with observation of care-practices. The inspector received the Commission’s survey cards from relatives of three of the current residents. The inspector also rang some of these relatives and two social services caremanagers of residents the inspector focused upon. The person who the organisation describes as being responsible for the day-today running of the home was not present during the inspection. However this person did send the Commission an annual quality assurance assessment [AQAA], which was received, at the Commissions offices within the timescales, during the day of the visit. The inspector was unable to use this document to plan the inspection but has referred to relevant sections when compiling this report. Three areas are judged as Good, four as Adequate and in need of some improvement, and one Poor and in need of urgent improvement. What the service does well: The home is good at meeting basic care needs with positive comments from families and social services. All Residents have settled into the home and get on well with each other and staff. Relatives indicated how the service represents an improvement on the residents last home. All Residents receive prompt meeting of health needs, which has led to some clear improvements. A Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 6 calm and relaxing atmosphere is maintained in the home, which allows Residents comfort and freedoms. Staff are committed to their work and positive about residents. Assessments on prospective new Residents are detailed including plenty of trial visits where compatibility and suitability is thoroughly assessed to ensure minimal disruption to existing Residents. Useful care-plans have been developed, with a stress on improving communication and personal care, with detailed guidance. Record keeping is of a good standard. Residents live in a spacious, clean modern, and nice environment, which is personalised to their tastes. Residents enjoy good supplies of fresh food, which they enjoy. What has improved since the last inspection? What they could do better: The high turnover of staff reported at the last inspection has increased further which has also resulted in the experienced manager who opened the home leaving. The service currently lacks an experienced day to day manager and overall management arrangements for running the home are confused and in staff words “uncertain”, particularly in terms of decision making and the homes future direction. This uncertainty is also evident in communications being sent to the Commission from both the home and the organisation, which indicate confusion around responsibilities and care home regulations. Staff, relatives, and other evidence indicate that the organisation needs to explore ways of creating a more positive and effective management atmosphere. An Immediate requirement was made at this Inspection in respect of ensuring that proper recruitment checks are carried out on new staff before they permanently live in the same home as vulnerable people and start work. Such staff also need to commence appropriate inductions when starting work in the home to ensure that as soon as possible they know the basics to reduce risks to Residents. A further immediate requirement was made in relation to the home reporting various types of incidents involving Residents without delay. Any allegation made by a vulnerable person needs to reported and investigated by the relevant authorities and without delay. The home needs to ensure that any complaint made by a Resident is properly recorded. The safety of Residents will be further supported once appropriate adaptations are made to the home such as grab rails for those accessing the stair-lift and who use rooms on the first floor. Whilst some staff training has taken place in preparation for a new Resident no current staff have the basic Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 7 qualification, National Vocational Qualification in Care level 2. If new staff are not going to commence this course they need to access learning disability type training. Along with an increased reliance on inexperienced and agency staff the home is not demonstrating it has enough staff to meet Residents needs such as activities. Those activity schedules developed are not regularly being followed especially where they indicate trips into the community. There is further scope to develop activity schedules further as identified by the service. The organisation need to ensure they are effectively measuring and improving upon quality such as completing and then sending monthly reports to the Commission. Care is needed to ensure that these and other reports are accurate and comprehensive. Resident, staff, and relatives will benefit from the organisation developing an annual development plan for the home based on their views as requested at the last inspection. Clarity around extra costs charged to Residents is needed to ensure full transparency and agreement. 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. Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Prospective new residents benefit from ample chances to visit the home before moving in although information given to them needs to be up to date and in a format, which is accessible. Resident’s rights will be better protected once contracts are clearer. The home ensures it gets full and good information before a new resident is accommodated. EVIDENCE: The inspector examined the home’s service user guide and statement of purpose. The home has since clarified its admittance policy, which states that the home is suitable for those with a moderate to severe learning disability, that emergency admissions are not appropriate, with the home not suited for those will mental health issues as their prime need or have what is termed serious challenging behaviour. The homes current Statement of Purpose continues to lack updates between inspections to reflect changes such as the high number of staff that have left and that the manager listed has left the home. The homes Annual Quality Assurance Assessment identified that this Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 10 document needs review although this needs to be done timelier given that the home is currently advertising its current 3 Resident vacancies where the Statement of Purpose is sent out to interested parties. The home is again asked to look at how this important information contained in the [Service User] Resident guide could be better presented to learning disabled adults such as in the use of digital photography and a talking or videotape. The home has produced staff photographs, which are displayed in the home The current Resident group were observed to be relaxed around one another with the last two admissions being people who have known each other for 25 years and who moved in together. Detailed assessments by the previous home manager were found on all current Residents. These assessments included trial visits to the home and the manager going out to visit the person in their previous home and collecting extensive information from the family in one instance. These assessments were complemented by social care assessments. It is evident that any decision to move someone into the home is carefully planned involving a number of trial visits. A prospective new Residents due to move into the home the week following the inspection has had 3 separate trial visits including overnight stays lasting several days. The acting manager could not locate the assessment carried out by the then home manager but showed a range of comprehensive information from Social Services. The home had recorded in a dedicated book to show how each trial visit has gone. The acting manager was also found to be putting together an initial care plan based on the care planning information from the previous placement. Staff spoken with indicated a basic knowledge of the key issues in respect of caring for the new Resident. Transparency is needed around contracts/terms and conditions. This was made a requirement at the last inspection. These need to show the fee and room to be occupied along with clearer information about what additional charges are made on residents, such as holidays. A recent Social Services review of one Resident in August 2007 indicated that clarity was needed around extra charges /costs such as holidays with the quality assurance manager indicating that such clarity will be organised. Overall feedback from relatives and Social Services care mangers spoken with indicated that the Camber lodge was still an improvement for current Residents based on their previous placements. However they also indicated some concerns about the recent stability of the service in relation to staffing and management and how this was, or could be, affecting Residents. Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, & 9. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from good care planning which is carried out in practice although evidence of more regular review and clear aspirational goals will be helpful. The home has identified that some Residents will benefit from independent advocacy but this continues to be delayed. EVIDENCE: The inspector examined the care-plans of two residents, one who has been the subject of recent incidents and another where there has been a query about Moving and Handling. Care-planning arrangements in place for a new resident due to move into the home was also examined. The care-plans have developed from the original assessment information. The care-plans ware found to be well presented and fully detailed subject to regular Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 12 updating. One of the plans had timescales, which had expired for some aspects such as risk assessments with no indication of whether any review had taken place. However this was not found to be affecting outcomes in practice. The resident concerned had a Social Services review in March 2007, which indicated satisfaction with the service with the resident playing a full part. Some of this review information is waiting transfer to the current plan. The acting manager indicated that the person has some goals such as swimming which has recently started but understands that goals needs to be written down with clear plans. The social worker for this resident indicated satisfaction based on the last review but informed the Inspector that they want to revisit the placement shortly in light of the registered manager leaving. Another resident was found to have regular updates made to their care plan in light of changing needs. Staff were found to have good understanding of resident including the best way to support them. Staff were also clearer about to support someone when they choose to remain on the floor. The care plan relating to this person had clear and appropriate guidelines in respect of moving and handling. It is again recommended to the home that independent advocacy links are developed to ensure that residents have someone outside the home and family who they can ask advice from and have a voice on their behalf. The service has identified that a current resident and new resident due to move in require this type of service although the homes Annual Quality Assurance Assessment indicated a lack off success at finding an advocacy service. Residents were found to have a range of useful risk assessments to protect their interests, and clearly presented missing persons procedures including useful profiles. Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16, & 17. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Residents do have some stimulating activity but this is not regular or based on predictable routines, which Residents have control off. Resident’s benefit from a good supply of fresh food based on their needs and preferences. EVIDENCE: The inspection took place between 10.450am and 5.50pm. On arrival routines were found to be flexible with one resident having brunch as they were going hydrotherapy/swimming at 12 noon. This resident required 2 of the 3 care staff on duty, which left one carer for the other 3 residents. This staff person was also required to attend to housework and lunch preparation. The 3 residents who did not go swimming spent the whole inspection in the home and mainly occupied themselves with activities, such as jigsaws. One resident briefly Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 14 played snooker with staff after lunch and helped with cake making for tea around 5pm. The resident who went swimming returned at 2pm and used their own activity aids in the lounge and bedroom. The activity timetable showed that a cinema/bowling trip was due in the afternoon for all residents. As was the case at the last Inspection the person in charge of the home explained that these timetables are not regularly followed due to staffing and other resources. Staff explained that trips out in the vehicle for residents have to be justified due to budgets and work around this by combining with food shopping trips. On the day of the Inspection the home were unsure about whether the bus was insured. The swimming trip for one resident was dependent on using a taxi. One resident indicated how they were looking forward to going back to college with the autumn term due to start although. They raised concerns about the frequency by which they go to church and the type of church they occasionally visit, as they would prefer a Catholic Church, which is further away. Relatives of another resident indicate that another person no longer goes to church but were not sure if this was due to personal choice. Staff explained that due to staffing numbers, other tasks and skills levels, along with the availability of drivers that outings are not as regular as they would like. The home is located in a small village with the main town and activity centres such as gyms 5 miles away, which requires using the homes minibus vehicle to access. One of the residents has since moving into the home developed further activities and now goes horse riding and half day sessions at college but most of the week lacks regular activities. Those Records looked at for residents showed that activities were neither predictable nor regular. The acting manager highlighted some ideas about how to improve the range stimulating activities by bringing in specialists or creating a sensory room. The homes Annual Quality Assurance Assessment indicated that activities need improvement. No concrete plan was put forward about how this area will improve. A statement in the Annual Quality Assurance Assessment, put activities as one of the things that the home does well. Records, menus, discussions and observations showed that residents enjoy a varied and tasty diet based on healthy eating advice. Menus are regularly reviewed with residents. Newer and existing residents who could verbalise an opinion confirmed they liked the food. Care-plans were found to have clear information of likes and dislikes. Food stocks inspected showed a high amount of fresh ingredients such as fruit, vegetables and meats. Staff indicated that they have access to monies and can also order food from a supermarket website. Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, & 20. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Resident’s health needs are met with the home responding well to changing needs. EVIDENCE: Personal care guidelines were examined which included looking at detailed bathing and showering guidelines, which showed resident’s preferences, along with what they could do for themselves, and what support they required. Care-plans itemised health needs with records kept of health appointments and follow up action. Records showed a significant focus on long-standing health issues for current residents. It is evident that within a short space of time that some immediate improvements have occurred. One resident confirmed in conversation what was seen in records that a medication review has led to them having some positive medication changes to cope with an unsettled period such as changes in staffing and management. The home was shown to have responded promptly to these changing needs and overall supports residents to have the minimum of necessary medication. Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 16 Staff, relatives, and observation of this resident confirmed that recent medication changes were having a positive effect. This person has also successfully lost weight as part of a goal plan. Another resident was found to have had greater focus on nail care and opportunity for other tests such as for diabetes. Medication stocks and records were examined along with staff being observed giving medication with no concerns noted. All staff were found to have completed appropriate training. Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, & 23. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Residents do have their views listened too although they are not properly recorded and are not always protected by adherence to safeguarding practices. EVIDENCE: An Inspection of the home’s complaints file, discussion with the acting manager, along with looking at the homes Annual Quality Assurance Assessment, indicated no recorded complaints. However it is evident in at least two recorded incidents of a resident complaining about a person working in the home that complaints have been made. The first recorded incident [July 2007] involved a resident making an allegation about someone working in the home with safeguarding procedures not followed. The alleged perpetrator continued to work in the home. The incident report was not sent to the Commission over 2 weeks after the events and only when an allegation had been made that the organisation were concealing the incident. The incident was reported to the resident’s care manger but not the local community learning disability team as required. An investigation carried out by the organisation’s quality assurance manager indicated that the organisation at that time did not think the incident needed to be reported. The perpetrator completed the incident from with no explanation from the organisation. Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 18 A second similar incident was reported appropriately to the Commission although the report lacked detail and completeness although it confirmed that the alleged perpetrator was suspended whilst an investigation took place. The details of the investigation were not detailed with no indication of whether this incident has been reported to the local community disability team. In respect of both incidents the home ensured that the resident received support from specialists or the person’s social worker within the same week. The organisation is therefore advised to ensure that all incidents are reported without delay and that all safeguarding procedures are followed to allow necessary authorities to make their own judgement. Established Staff have previously shown through discussions, a sound understanding of how to both identify and report suspected abuse. Two new staff who have recently started work in the home did so without the appropriate induction commencing for several weeks. Part of the appropriate Skills for Care Induction is covering how to both identify and report suspected abuse. Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 29, & 30. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a homely and comfortable environment although ongoing delays in addressing maintenance areas affect safe accessibility to all parts of the home. Resident’s benefit from bedrooms, which they have personalised. Some improvements have been made to adapting the home to meet Residents needs although further work is needed. EVIDENCE: The inspector toured all communal areas and looked at the bedroom of one resident who has recently moved upstairs along with the bedroom for the new resident due to move in. The bedrooms of the other three residents were looked at on the last inspection. The resident who has moved upstairs has mobility needs with the newest resident due to move in being assessed to need Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 20 a ground floor room, which has now been made vacant. The resident who has moved room made it clear that it was their choice with the acting manager confirming that this had been part of long term plan. The home has recently installed a stair lift. The resident was observed to comfortably and independently use the machine. When they dismounted the stair lift at the top of the stairs the resident needed to grab the walls to maintain balance, as there are no handrails fitted. The acting manager confirmed that the Social Services care manager has previously requested grabrails to be fitted. Bedrooms were found to be personalised according to resident’s choice and preferences. One resident has recently purchased from their own money brand new set of furniture. The crack to the driveway around the side and rear of the home reported in the last report was found to be have been tarmaced over making it safe for residents to access. The home has outside seating area to the rear of the property. This area is not currently accessible to residents as tiles and paving slabs are raised along with a man hole cover which makes it dangerous to some residents. The acting manager indicated that this has been an outstanding maintenance job since October 2006 and was observed on the last inspection. Other maintenance jobs included a broken seat in one resident’s bedroom. The acting manager confirmed that she carries out weekly checks but confirmed that she lacks expertise in these areas. The home confirmed that they have obtained a portable ramp to assist access to the rear of the property and car park. The home was found to be clean, fresh smelling, and free from offensive odours. The kitchen is purpose built and has good accessibility. Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, & 35. Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. Residents will be better protected when the service follows proper recruitment checks and carries out proper inductions when staff start work. Residents are not always supported by sufficient numbers of staff that also lack some training and experience. EVIDENCE: On the day of the Inspection there were 3 staff on the morning shift with the acting manager also on the rota as working 8-4pm although they had to leave at 2.30pm for a hour for prearranged appointment. Of the 3 staff on duty one was an agency, one a new staff person who is working through their induction, and a senior. The acting manager explained that this has recently increased from two staff persons on shift in order to be prepared for the new resident moving in the week following the inspection. The rota showed that for the following week a third of shifts are to be covered by agency staff including along with a new waking night position where they will work alone. Despite three staff on shift the acting manager highlighted a concern about how she was not going to have enough staff to cover college days for some Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 22 residents and swimming for another. The home was therefore asked to review staffing levels and ensure that sufficiently experienced staff are on each shift including drivers. The acting manager explained how she hopes to get a dedicated cook in addition to these staffing levels. The acting manager indicated that they have not been given permission to do this from the organisation and has no indication of what the staffing budget is. Over the last year as confirmed by records and the homes Annual Quality Assurance Assessment the equivalent of a whole staff team and manager, 7 full time and 2 part time staff have left the home. No one in the current staff team has a National Vocational Qualification in Care level 2 according to records in the home and the acting manager. Some staff have dropped out of an existing course. The homes Annual Quality Assurance Assessment confusingly states that 2 of the 8 staff have this qualification. The inspector found through inspecting staff files that two recently appointed members of staff had moved into the home used by Residents without a criminal records bureau [CRB] disclosures being carried out. In addition both care workers had officially started work in the home without POVA firsts having been received. One staff member, who moved into the home prior to the start date of 6th June 2007, had their POVA first received back on 12th June and the police CRB disclosure received back and dated 19th June 2007. The other staff person started work on July 23rd 2007 with a POVA first received back on August 24th 2007 and had no copy of a CRB on file although the acting manager VW indicated seeing it returned during the week of the Inspection. In respect of the two staff persons identified as starting work without the necessary checks it was found that they had not undertaken the structured Skills for Care Induction from commencement of their employment in the home. A staff person who started on July 23rd 2007 was not issued according to the staffing file, with an appropriate induction book until August 31, 2007. The other staff person who started on June 6th was issued with their induction book on September 3rd 2007. In addition one of the foreign workers referred to indicated that they did not have any previous experience of this resident group hence the increased importance of an appropriate induction. Both staff persons live in the home and they also take meals with, and live on the same floor as some residents. There was no evidence that this situation was affecting outcomes. The commission did not receive an training plan as requested at the last inspection but it is noted that staff have recently undertaken epilepsy and diabetes training in preparation for a new resident. The Commission will await confirmation of sufficient staff studying for National Vocational Qualification in Care level 2 and in its absence the learning disability award framework type training to support staff to have sufficient understanding of resident needs. Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, & 42. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Residents are not currently benefiting from effective and clear management which, is affecting staff, relatives and the ethos of the home. The organisation has recently identified area some areas for improvement and but needs to demonstrate a full understanding of its responsibilities. Residents will benefit from more effective and regular ways of measuring quality and identifying the future direction of the service. EVIDENCE: The experienced manager who opened the home has left since the last inspection with current management arrangements for running the home found to be confused and in some cases ineffective. Recent communications sent to Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 24 the Commission by the organisation indicates that the day to day management arrangements are handled by the company quality assurance manager who will visit the service one to three times per week with it not clear what the role of the acting manager is. Throughout the inspection visit the quality assurance manager was not present. The communication book and staff notice board identified the quality assurance manager as the day-to-day manager and the point of contact for staff. The acting manager was observed to be making management decisions such as to the rota and staffing numbers with the quality assurance manager confirmed as visiting the service twice a week. The visitor’s book showed the frequency of these visits to be much less. The acting manager indicated that not all visits are recorded. Confusingly the person called the day-to-day manager undertook the last regulation 26 monthly inspection report and intends to continue to carry out future reports. The Commission are additionally confused by the variations in the information coming from the home and that from the organisation. Evidence indicated that the acting manager has requested support from the organisation, as this is their first management role. Information from the organisation indicates that this support needs to be more effective. In relation to a number of areas such as recruitment procedures the organisation has indicated some confusion. The service is therefore required to clarify who is managing the home on the basis of having a suitable full time manager who will be put forward for registration. This clarification should include Job descriptions for both the acting manager and the quality assurance manager along with confirmation of who is the day-to day manager. Staff and some relatives spoken with or who completed survey cards indicated that the management atmosphere needs to be more open and positive and that the home needs clear direction. One care manager spoken with after the inspection was not aware that the previous manager had left the home .The Commission was also not made aware at the time and found out accidentally. The organisations own investigation requested by the Commission found evidence of regulation 37 incidents, which affect the welfare of resident not being reported at the time based on incorrect assumptions. Similarly, a regulation 26 monthly visit report did not occur in June. The most recent regulation 26 report for August sent to the Commission was not found in the home with the acting manager not aware of any action plan. The report contained a range of inaccurate or incomplete information. The report describes the two staff on duty as working in the home for 3 months implying an inexperienced shift. An Inspection of staffing records showed that one of these staff persons had worked in the home for over a year. The report did not make reference to a serious incident, which had just occurred affecting a resident, or the situation regarding the acting manager. Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 25 The home was advised at the last inspection to devise an Annual Development plan for 2007. This has not occurred although the homes Annual Quality Assurance Assessment written by the quality assurance manager indicates a commitment to now meet outstanding requirements with it not clear what has caused the delay. Mains electricity work has been completed since the last inspection and according to the home’s Annual Quality Assurance Assessment all other necessary health and safety areas are met. The Annual Quality Assurance Assessment indicates the safety issues around the rear seating areas at the back of the home, which could be enjoyed by residents. The homes Annual Quality Assurance Assessment Identifies that current policies and procedures in the home need review and that they contain a mixture of being produced by two different companies. The last Environmental Health visit of March 7,2006, produced a positive report and no requirements. An immediate requirement was left in relation to reporting significant incidents without delay, in accordance with the regulations without delay. The most recent correspondence from the organisation received by the Commission on the day of the inspection indicates a willingness to operate in more open and transparent manner with the investigation report of the quality assurance manager showing some indication of this by indicating some errors and areas for improvement. Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 2 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 3 32 1 33 2 34 1 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 2 2 X X 2 X Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 27 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 YA1 Regulation 5 Requirement That the Registered Person must ensure the homes Statement of Purpose is kept up to date. That an updated copy is sent to the Commission by the date shown. 2. YA5 5 [ as amended 2006 That the Registered Person must ensure that all Service Users have a contract/terms of conditions which is signed and sets out all the necessary information as included in amendments to Regulation 5 effective from September 1 2006. That the specific cost of extras such as holidays is specified. Requirement of the last 2 Inspections. Requirement first made January 29th, 2007 3 YA12 16[m] & [n] That the Registered Person must ensure that each individual Service User has a suitable programme of activities and predictable routines. 16mn121a That the Registered Person must DS0000067943.V348301.R01.S.doc Timescale for action 14/12/07 14/12/07 14/11/07 4. YA14 14/11/07 Page 28 Camber Lodge Version 5.2 ensure that Service Users have a regular range of leisure and other stimulating opportunities which meets their diverse needs and preferences. Requirement of the last 2 Inspections. Requirement first made January 29th, 2007 17[2] That the Registered Person must schedule 4 ensure that a record is kept in the complaints file of complaints made by Service User s about the operation of the care home. 13[6] That the Registered Person must ensure that any allegations made by Service Users are promptly reported to all necessary authorities and that appropriate safeguarding actions are undertaken. 23[2][b] That the Registered Person must ensure that the premises are kept in a good state of repair both externally and internally. Requirement of the last 2 Inspections. Requirement first made January 29th, 2007. 8 YA29 23[2][n] That the Registered Person must ensure that suitable adaptations are made to the home such as the provision of handrails to assist users of the stair lift as they dismount and move around the home. That the Registered Person must ensure that a sufficient number of staff achieve the National Vocational Qualification course in care at level 2 or above, as soon as possible. 14/12/07 5 YA22 14/10/07 6 YA23 14/10/07 7 YA24 14/12/07 9. YA32 18[c] 1] 14/03/08 10. YA33 18[1][a] That the Registered Person must 14/10/07 ensure that sufficient numbers of experienced staff are working in the home at times to meet DS0000067943.V348301.R01.S.doc Version 5.2 Page 29 Camber Lodge assessed needs including activities. Requirement of the last 2 Inspections. Requirement first made January 29th, 2007. 11 YA34 19 schedule 2[as amended July 26, 2004 That the Registered Person must ensure that appropriate recruitment procedures are followed in order to protect Service Users. That staff do not live in the home without first having CRB checks and do not start work until POVA checks have been carried out. Immediate requirement made on the day of Inspection That the Registered Person must ensure that staff undertake the appropriate induction on commencement of employment in the home and before starting any shifts as required by Skills for Care. Immediate requirement made on the day of Inspection That the Registered Person must ensure that the home is managed in way which meets the needs of Service Users. That the arrangements for managing the home is clarified, including job descriptions, and is sent to the Commission by the date indicated. 14/09/07 12 YA35 18[c][1] 14/09/07 13 YA37 12[1] 14/10/07 14 YA39 24 That the Registered Person must 14/12/07 ensure that an Annual development plan is developed for the home based on the needs and views of Service Users and stakeholders. That the Registered Person must DS0000067943.V348301.R01.S.doc 15 YA39 26 14/10/07 Page 30 Camber Lodge Version 5.2 ensure that regulation 26 reports of monthly visits are undertaken each month. That such reports are accurate, complete, comprehensive and refer to significant events and are carried out by suitable persons. 16 YA42 37 That the Registered Person must give notice to the Commission without delay of any occurrence listed in the regulation. Such as any event in care home which adversely affects the well being of a service user, or any allegation of misconduct. Immediate requirement made on the day of Inspection 14/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 4. 5. 6 Refer to Standard YA1 YA6 YA11 YA7 YA24 YA38 Good Practice Recommendations That the service user guide is reproduced in a accessible format for existing and prospective Service Users That care plans show more evidence of regular review as per the timescale indicated. That aspirational goals are clearly identified for each Service User That independent advocacy links are established. That level wheelchair access is fully available around the rear entrance to the property That the managing organisation explore ways of improving the management atmosphere of the home. Camber Lodge DS0000067943.V348301.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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