Inspection on 25/07/08 for Camberley Lodge

This inspection was carried out on 25th July 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Camberley Lodge 01/05/07

Camberley Lodge 09/05/06

Camberley Lodge 03/02/06

Camberley Lodge 12/10/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Camberley Lodge 99 Fronks Road Dovercourt Harwich Essex CO12 4EQ Lead Inspector Ray Finney Unannounced Inspection 25th July 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Camberley Lodge DS0000063329.V369005.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Camberley Lodge Address 99 Fronks Road Dovercourt Harwich Essex CO12 4EQ 01255 552976 01255 552976 Crlbrough@aol.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Bibi Shimintaz Mohedeen Carol Brough Care Home 13 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (13) of places Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, over the age of 65 years, who require care by reason of old age only (not to exceed 13 persons) Three service users, over the age of 65 years, who require care by reason of dementia, whose names were made known to the Commission The total number of service users accommodated in the home must not exceed 13 persons 1st May 2007 Date of last inspection Brief Description of the Service: Camberley Lodge is an established care home situated in a residential area of Dovercourt, close to the sea front and within easy reach of the shops. The home provides care and accommodation for up to 13 people over the age of 65. Accommodation consists of seven single bedrooms and three double rooms. The majority of the rooms are on the first floor. Access to the first floor is by means of stairs or a chair lift. Communal areas include a large lounge and dining room. There is a small garden and a patio at the rear of the home and parking facilities to the front of the property. The home charges between £410.00 and £430.00 a week for the service they provide. Other services such as hairdressing and chiropody are available at an additional charge. This information was given to us in July 2008. Information about the home can be obtained by contacting the manager. Inspection reports are available from the home and from the CSCI website www.csci.org.uk Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. A range of evidence was looked at when compiling this report. Documentary evidence was examined, such as menus, staff rotas, care plans and personnel files. Completed surveys were received from members of staff, people living in the home and their relatives. The proprietor and manager completed an Annual Quality Assurance Assessment with information about the home. This document will be referred to as the AQAA throughout the report. An unannounced visit to the home took place on 25th July 2008 and included a tour of the premises, discussions with people living in the home, the manager and members of staff. Observations of how members of staff interact and communicate with people living there have also been taken into account. On the day of the inspector’s visit the atmosphere in the home was relaxed and welcoming and we were given every assistance from the manager and the staff team. What the service does well: What has improved since the last inspection? Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 6 There have been some improvements to the environment including some redecoration, new carpets, new doors on the kitchen cupboards and two new ‘whirlpool’ baths have been installed. Since the last inspection there have been some improvements to staff training, including an improved induction programme for new staff. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (standard 6 does not apply to this service) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People choosing to live at Camberley Lodge can be confident their needs will be assessed before admission. EVIDENCE: The manager states in the AQAA, “On admission the residents’ needs are assessed by the registered manager and a full history is taken. The resident also has a month’s trial to see whether they adapt to the new environment before deciding whether to stay long term or not”. A sample of three care plans examined all contained pre-admission assessments. These were mainly in a ‘tick box’ format. Areas covered in the assessments included mobility, cognitive ability, mood or behaviour, skin (including a Waterlow Assessment for pressure sores), continence, vision, eating habits, oral hygiene, grooming, medication and activities. Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 9 Camberley Lodge does not offer intermediate care, therefore National Minimum Standard 6 does not apply. Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service can expect their personal and healthcare needs to be identified and to be provided with the support to ensure these needs are met. EVIDENCE: The manager states in the AQAA that, following the pre-admission assessment, “a care plan is devised accordingly involving the resident and reviewed after a month to see whether their needs have changed or not. If their needs have changed, the care plan is updated”. On the day of the inspection a sample of three care plans were examined. All had a ‘Resident Summary Profile’ that outlines individual care requirements and preferences around daily routines for morning, afternoon and night-time. The format for the care plans was to identify the need, then the goal that they are aiming for and what action needs to be taken to meet the need. An identified need for one person was “Personal Hygiene” and the aim was to “help maintain [the person’s] dignity by ensuring [they are] always kept clean and tidy”. The actions required to meet the need simply stated “staff are to Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 11 assist [the person] with all [their] personal needs” as they like to look smart, clean and tidy. There were no details to guide staff as to what level of assistance the person needed or how they wished the support to be provided. One care plan examined contained a ‘Record of Infringement of Rights’ relating to the use of bed rails for a person who has an identified risk of falling out of bed. The assessment states that the manager discussed the use of bed rails with the person in the home and with a relative and that the GP was also consulted. The bed rails were referred to in the document as ‘cot sides’, terminology that is more appropriate to children’s services and is not appropriate in relation to adults. There were risk assessments around ‘mobilising and falls’, which gave a score around various areas of risk. The record for one person gave a high score indicating a high risk of falls for the person. However, the only guidance for staff was “two carers required when bathing, toileting, transferring”. Other information was minimal such as “staff are to monitor this [person] daily as [they are] sometimes very confused, plus [they get] good and bad days where [they are] sometimes very shaky and [aren’t able to hold their] cup at times”. There were no instructions to staff as to what support was required on days when the person was having these difficulties. The manager stated in the AQAA, “Each resident has a GP who is always called if the resident needs medical attention. They are also seen by the chiropodist, dentist and optician regularly. If they need the community nurse the registered manager will refer them”. Records examined confirm that people living in Camberley Lodge are supported to access relevant healthcare professionals according to their needs. There are a range of charts and health records in the care plans. However in the sample of records examined, these were either not completed or had no recent entries. There were weight charts in all files, but the last entry was some three months previously. The manager said that people have been weighed since then but it has not been recorded. Similarly there is a chart to record visits relating to doctors, other healthcare professionals and hospital appointments. The daily recording sheets in individual files documented a number of GP, district nursing services and hospital visits but these were not recorded on the person’s healthcare records. Because healthcare information is recorded throughout the daily recording sheets and not transferred to the relevant healthcare records, it is difficult to monitor the person’s progress. Three people living in the home take insulin for diabetes. The manager stated in the AQAA, “A diabetic diet is provided and several staff have attended a course on diabetes in order to understand the disease better and give appropriate care”. Staff spoken with said that they do not administer insulin, although they support two people by ‘setting the dial for them’ and showing them the setting before the person administers their own injection. A third Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 12 person has their insulin administered by the manager who has received training or, in her absence, by the District Nurse. Overall health issues were not well recorded in care plans, although staff spoken with were able to demonstrate a good knowledge of people’s healthcare needs. A completed survey made positive comments about staff’s understanding of their relative’s healthcare needs and said, “Talks have been arranged for the staff to learn about Parkinson’s, which my [relative] suffers from” and “Staff respond well when mobility is a problem for my [relative]”. The manager states in the AQAA, “All the senior carers are trained to administer medication to the resident and the medication comes in blister packs with their names clearly labelled. We have records of all the medication administered and if there is a mistake on the medication pack or if staff have doubts, the GP or pharmacist is contacted”. There have been some improvements to the home’s systems around medication and action was taken relating to the requirements made following the last inspection. These improvements include the provision of an appropriate Controlled Drugs Register. However, there continues to be some areas of the processes for the recording and storage of medication that are not sufficiently robust to ensure people living in the home are safeguarded. Storage for medication is a metal stationery cupboard, but this is not fixed to the wall and the locking mechanism is not sturdy. The storage of Controlled Drugs is in a locked metal box that is secured inside the medication cupboard, which does not comply with the latest legislation relating to the storage of controlled drugs in registered care homes. Some medication waiting to be returned to the pharmacy, including Oramorph which is a controlled drug, were stored in an unlocked, glass fronted cupboard in the office. This cupboard also contained a number of other medications and topical creams that had been prescribed but were not yet opened. There is a small refrigerator for the storage of insulin and this has now been fitted with a lock as required at the last inspection. A carer spoken with said that this was only for storing insulin and medication such as eye drops would be stored in the medication cupboard. This would be inappropriate storage for preparations like eye drops that need to be stored in a controlled temperature after opening. Opened bottles of liquid medication that cannot be stored in the Monitored Dose packs had the date of opening recorded on the label, although one bottle of laxative did not have the date of opening recorded on the label. Medicine Administration Record (MAR) sheets were examined and medicines that had been administered were all signed for appropriately with no missing signatures. However, there were handwritten additions to the sections Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 13 containing information about the name of the medication, the dose and instructions for administration, which the manager said would have been written by staff. Many of these additions were to give further details about the frequency of when the medication was to be taken in cases where the printed instructions were ‘as directed’ or ‘as required’. Care plans had no information relating to individual medication that was prescribed on an ‘as directed’ basis, therefore it was not clear from the records examined if the information written on the MAR sheets was precisely what the prescribing GP had directed. Medication that does not need to be taken regularly, such as painkillers or laxatives, may be prescribed on an ‘as required’ basis (sometimes referred to as PRN medication). Care plans did not contain any protocols to guide staff as to the circumstances when PRN medication should be administered. In one person’s daily reporting sheet, dated on a Friday, there was a record for senior staff to administer someone’s Oramorph four times a day as they had run out of MST tablets (Morphine Sulphate). It stated the manager had been informed and would order some on Monday. We discussed this with the manager and she confirmed that they had contacted the surgery and it was on the advice of the doctor that they had put in the temporary action, however, this was not recorded. The manager states in the AQAA, “The resident’s privacy and dignity are always respected by all personnel. All bedrooms have locks on their doors to respect residents’ privacy and staff always knock before entering the bedroom”. During the course of the inspection a carer was observed to knock on doors if there was a possibility of someone being in the room but not if someone was believed to be in the lounge. One room was entered without knocking when a person was receiving personal care, although the member of staff withdrew promptly, the situation could have been avoided if the basic good practice was followed of always knocking on the door and awaiting a response before entering. Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in Camberley Lodge can expect to enjoy a lifestyle that meets their wishes and interests. EVIDENCE: The manager states in the AQAA, “Daily activities are provided to each resident individually by staff and are recorded. We have provided several activities such as a tabletop sale, coffee morning, Halloween party and Christmas party”. On the day of the inspection we examined the activities file that is completed on a daily basis and which records what activities people take part in during the course of the day. The majority of activities consisted of watching television, listening to music, having hair done, resting in the lounge and chatting to staff. There were a few infrequent entries that included playing ball games with other residents and watching a DVD. One person’s record had frequent entries about reading books and another ‘doing puzzle books’. However, there was little evidence that stimulating activities are organised in the home on a daily basis. The manager said they had taken everyone out a few days before the inspection for a day at the beach and a ‘fish and chip’ lunch. One person Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 15 spoken with said they had enjoyed this immensely. It was stated in the AQAA that they have plans to, “organise more outings for residents”. Daily records examined confirm that families and friends visit frequently, as stated in the AQAA, “We have open visiting whereby visitors are welcome at any time provided the resident wishes to see them”. On the day of the inspection one person spoken with was waiting for a relative to pick them up after lunch to go out for a few hours. Another person said their relative visits every week. As reported at the last inspection people were observed to have choices about their daily life in the home, such as where they spent their day and whether they had their meals in the dining room or in their own bedroom. We had a discussion with the cook, who said she prepares the type of foods that people like. The home has a three weekly rolling menu that consists of a range of traditional foods such as beef stew, steak and kidney pie, fish and chips, roast beef and quiche. The main meal is at lunchtime with a snack meal such as sandwiches, poached egg on toast, pork pie or macaroni cheese at teatime. One option on a particular day is sweet and sour chicken but the cook said that only a few people choose this with the majority opting for cottage pie. One person needs to have their food mashed or blended and the cook said that each item is pureed separately so that there is a variety of tastes. The kitchen folder contains information about people’s preferences and the cook was able to demonstrate a good knowledge of individual likes and dislikes. The manager states in the AQAA, “We have a monthly meeting with residents who have the opportunity to express their views and choose what they would like to eat before the menu is changed every six months”. The minutes of Residents’ Monthly Meetings contain some comments about bread being dry and pork being hard to chew. People spoken with had no complaints about the food and it is evident that people’s wishes and comments are taken into account. Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that their concerns about how they are treated are listened to and acted upon as stated in the complaints and safeguarding procedures. EVIDENCE: As at the last inspection there is an appropriate complaints procedure in place. The manager stated in the AQAA, “Our Statement of Purpose and Service User Guide is available to all residents and they have details of how to make a complaint and how it would be investigated. When we have a complaint, the registered manager investigates it and the matter is always resolved quickly”. The manager confirmed that no major complaints have been received in the last year and minor issues are dealt with “as and when” they arise. We discussed documenting minor concerns and how they are dealt with as evidence that they listen to people’s concerns and take them seriously, which will form part of the home’s own Quality Assurance process. A relative who completed a survey told us, “We have no complaints. Service is excellent, staff very friendly and good to [our relative]”. When asked if they were satisfied with the way the home deals with concerns and complaints, a relative said, “This has never occurred as my [relative] is well looked after”. Personnel records confirm that staff have received training around safeguarding (previously referred to as Protection of Vulnerable Adults or Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 17 POVA). Staff spoken with were able to demonstrate that they were confident that they would recognise signs of abuse and were aware of their responsibilities around reporting suspected abuse. This confirmed what the manager stated in the AQAA, “each staff has an enhanced CRB check done before providing care to the residents. Each member of staff also has an induction whereby they are taught about protecting vulnerable adults and how to report if they witness any incident or abuse”. There have been no safeguarding referrals made in the past year and people living in Camberley Lodge can be confident that staff and the management team provide a service that keeps them safe from risk of abuse. Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can enjoy living in an environment that suits their lifestyle and which is homely and clean, although improvements could be made to the standard of maintenance in the home. EVIDENCE: During a tour of the premises it was noted that the standard of furnishings throughout the home was variable. In one or two rooms, where people had brought their own furniture the quality was significantly better. However, some other rooms had much older furniture that was in a poor state of repair such as broken drawer fronts and missing handles. The manager said that some of the older furniture also belonged to residents. Some of the furniture could have been maintained better. Two wardrobes in one of the shared rooms had been fitted with hasps for padlocks, although they were not padlocked closed, which gave an institutional feel to the furnishings in the room. There was a chest of drawers that had old and faded labels stuck to Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 19 each drawer on which were written things like ‘jumpers’ or ‘underwear’. Staff explained that these had been used for someone who was becoming a little confused as to where things were kept but this person was no longer living in that room. These faded labels with tiny writing were difficult to read and would be unlikely to be useful to anyone who was confused. The effect was that they added to the institutional feel of the room. As at the last inspection, some health and safety issues were noted. One bedroom had a wall light next to the bed in the style of a pair of candles. One of the ‘candle bulbs’ was missing and could pose a risk for anyone placing their fingers near the exposed bayonet fitting. Another bedroom had a small lamp on a chest of drawers which also had no light bulb fitted but which was plugged in and switched on. The senior carer removed this immediately. These issues were discussed with the manager, who said they would be made safe as a matter of urgency. People’s individual bedrooms contained evidence of personal belongings, flowers, photographs and ornaments and some of the rooms were very homely. The manager stated in the AQAA, “Both bathrooms now have a whirlpool bath in order for the residents to feel relaxed and enjoy their baths. The lounge, dining room, kitchen, hallways and both bathrooms have been fully renovated”. It was noted on a tour of the premises that the bathrooms have had some improvements, but there are still areas for improvement as the rooms have not been fully re-furbished. Tiles remain cracked and dated, there is a tangled washing line hanging over the bath in one bathroom, which gives the room a neglected and tired atmosphere that would not enhance the bathing experience for people living in the home. Some improvements have been made in the kitchen area including replacing the doors of the kitchen cupboards. A new boiler has been fitted, which has made space to reorganise some of the cupboards. However, the corner of the kitchen where the old boiler was removed has not been repaired and the walls have not been made good, which has left an exposed area that could cause difficulties in maintaining good infection control in the kitchen. Although the manager stated in the AQAA, “Most of the building has been renovated and new furnishings have been provided”, observations during the inspection indicate that further improvements are necessary if people living in Camberley Lodge are to benefit from a well maintained home. The manager stated in the AQAA, “The home is always clean and tidy and there are never any unpleasant smells. Staff have attended infection control training and are aware of the policies and procedures. A domestic has been employed in order to keep a good standard of hygiene at Camberley Lodge”. On a tour of the premises it was noted that throughout the premises the Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 20 standard of cleanliness was good and there were no odours anywhere. Bathrooms and toilets were clean and had liquid soap and paper towels for hand washing. However, there were also terry towels in communal toilets, which could pose a risk to good infection control. The laundry was small but contained appropriate equipment for the size of the home. The walls do not have a surface that is easily washable and consideration needs to be given as to how this could be improved so that good infection control in this area is maintained. The senior carer said that there are plans to move the laundry to the converted garage and the manager later said they are considering this. Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in Camberley Lodge can be confident that they are cared for by an established staff team who have been recruited appropriately and can meet their needs. EVIDENCE: The manager stated in the AQAA, “We have a mixed skill of staff who work each shift and a senior carer is always on duty. At peak times we have an extra staff on duty”. Staff rotas were examined and confirmed that levels of staffing on each shift are two carers, one senior carer, a cook and a domestic. The manager explained that she also likes to take a ‘hands on’ role. On the day of the inspection staffing levels were seen to be appropriate and people’s needs were being attended to promptly. In a discussion with the manager we were told that most care staff in the home have a National Vocational Qualification (NVQ) or are working towards the award. At the time of the inspection, out of a total of eighteen care staff, six had completed NVQ at level 2, a further two were due to start the award and six were in the process of doing level 3. The sample of personnel records examined contained evidence of NVQ awards. Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 22 Personnel records examined contained all the documentation required by regulation, including an application form with no unexplained gaps in employment history, two written references and proofs of identity. When staff have been employed, the manager explained that they have a 12week induction period that is based on the Skills for Care common induction standards. During the induction process staff have to complete questionnaires and are given a certificate when their induction is complete. There have been improvements in staff training since the last inspection. The manager said she is in the process of updating the training planner. Personnel records examined show evidence of training in medication, dementia, moving and handling and safeguarding (previously referred to as Protection of Vulnerable Adults or POVA), which was delivered by the Essex Vulnerable Adults protection Committee (EVAPC). There was also evidence of the induction process that is in place for new staff. A member of staff spoken with said they get the training they need to do their jobs. Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall Camberley Lodge is adequately managed, although the manager needs to develop the skills and competencies needed in the day-to-day running of the home to show that the home is run in the best interests of the people who live there. EVIDENCE: The manager has now completed and received her certificates for the Registered Managers Award and NVQ level 4 in care. In the time she has been in post, she been made progress in developing management skills and has complied with requirements left at previous inspections. However, there are some areas relating to the management of the home that need to be more robust. Under regulation 37 of the Care Standards Act 2001, the registered person has a responsibility to inform us at the Commission of death, illness or Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 24 any other significant event that occurs in the home. It was noted in one of the care plans examined that the person had recently been discharged from hospital. Also, whilst being shown round the home we were informed that one of the people living in the home was currently in hospital. We had not been informed under Regulation 37 of either of these events. The manager stated in the AQAA, “We have a monthly residents’ meeting whereby all the residents have the opportunity to express their opinions or their likes and dislikes and we aim to take their views into consideration and make appropriate changes where necessary”. We discussed the home’s process for assessing the quality of the service they provide, which we refer to as their Quality Assurance system. It was evident from records examined such as minutes of Residents’ Meetings and completed surveys, that staff and the management team seek the opinions of people living in the home. However, the Quality Assurance process could continue to be developed so that all the information sought from people living in the home and other interested parties is pulled together into the home’s development plan. This would demonstrate how people’s views and wishes are taken into account and acted upon. As at the previous inspection, people living in the home either manage their own finances or are supported by their next of kin or an advocate. There are appropriate records maintained relating to health and safety, including checks that are carried out on water temperatures. A sample of health and safety records that were examined on the day of the inspection were in order and up to date. Records examined confirm that fire drills are carried out and the fire alarms are tested weekly. The manager said that they were pleased that a recent test of their fire evacuation process was carried out in three minutes. All rooms and bathrooms have thermostatic valves fitted to the hot water supply and records examined of water temperatures were found to be in order. Records were also examined of regular checks that are carried out on fridge and freezer temperatures and the kitchen cleaning programme. The manager stated in the AQAA, “The whole building has been rewired. The home is kept safe by putting all health and safety policies and procedures into practice”. Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? no 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 OP9 Regulation 13(2) Requirement The registered manager must ensure that systems for the storage and recording of medication are sufficiently robust to safeguard people using the service. Specifically: 1. there must be appropriate facilities for the storage of all medication, including controlled drugs, and 2. there must be a clear record of the instructions given by healthcare professionals who prescribe any medication on an ‘as directed’ or ‘as required’ basis. The record should include the date and state who gave the instructions. Staff must not enter people’s private rooms without permission to ensure their privacy and dignity is upheld. Timescale for action 31/10/08 2. OP10 12(4)(a) 25/07/08 3. OP26 23(2)(b) The manager and proprietor 31/10/08 must ensure that the kitchen and laundry walls have a finish that is readily cleanable so that staff and people living in the home are protected by good infection DS0000063329.V369005.R01.S.doc Version 5.2 Page 27 Camberley Lodge control. 4. OP31 37 (1) (ag) (2) The manager must inform us at the Commission of any event affecting the wellbeing of people living in the home. This information must be given in writing. 25/07/08 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. Refer to Standard OP7 Good Practice Recommendations The process for updating and improving care plans should continue until everyone living in Camberley Lodge has a care plan that contains sufficient detail to ensure their needs are met as they would wish. Practices around maintaining records relating to healthcare need to be improved to provide evidence that all people’s healthcare needs are addressed and followed up. The manager and staff team should ensure that people living in the home have access to a range of social and recreational activities that will provide stimulation and improve their lifestyle. The management team should carry out an audit of furnishings, fixtures and fittings around the home and repair or replace anything that is broken. This would ensure that people living in the home are not put at risk of harm from damaged furnishings such as broken drawers or lamps without light bulbs fitted. The manager should continue to support staff working towards obtaining an NVQ award so that a minimum of 50 of care staff have the qualification. The Quality Assurance system should be developed further so that people living in the home can be confident their DS0000063329.V369005.R01.S.doc Version 5.2 Page 28 2. OP8 3. OP12 4. OP19 5. OP28 6. OP33 Camberley Lodge views are taken into account. Specifically greater efforts should be made to document how people’s wishes are being sought, collate this information into a report and make an action plan for the home taking these views into consideration. Camberley Lodge DS0000063329.V369005.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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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