Inspection on 11/12/06 for Camberwell Green Nursing Home

This inspection was carried out on 11th December 2006.

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 but made no statutory requirements on the home.

Other inspections for this house

Camberwell Green Nursing Home 16/04/09

Camberwell Green Nursing Home 06/10/08

Camberwell Green Nursing Home 26/06/07

Camberwell Green Nursing Home 21/08/06

Camberwell Green Nursing Home 24/11/05

Camberwell Green Nursing Home 12/08/05

Camberwell Green Nursing Home 17/02/05

Camberwell Green Nursing Home 13/07/04

Camberwell Green Nursing Home 31/12/03

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

CARE HOMES FOR OLDER PEOPLE Camberwell Green Nursing Home Camberwell Green Care Centre 54 Camberwell Green Camberwell London SE5 7AS Lead Inspector Lisa Wilde Unannounced Inspection 10:00 11 & 12 December 2006 th th 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 Camberwell Green Nursing Home DS0000007012.V323850.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. Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Camberwell Green Nursing Home Address Camberwell Green Care Centre 54 Camberwell Green Camberwell London SE5 7AS 020 7708 0026 020 7708 0027 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) Apta Healthcare (UK) Ltd Solomon Demba Care Home 55 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This home will accommodate 55 nursing care service users aged 60 years and above (female) and 65 years and above (male) and chronic sick and disabled persons aged 40 years and above Date of last inspection 21st August 2006 Brief Description of the Service: Camberwell Green Care Centre Care Centre is run by the organisation Southern Cross. Services include residential and nursing care for older people, people with mental health needs, younger people with physical disabilities and intermediate care services. Camberwell Green Nursing Home is able to provide care with nursing for up to 55 people. The home is purpose built and located in the centre of Camberwell close to public transport routes, shopping and leisure facilities. The home has four floors and there are two lifts available. At the time of this inspection there were two vacancies. The current fees for a place at this home are £567 if paid for by the local authority and £667 if paid for privately. The home makes the reports of the Commission’s inspections available in the reception area of the home (although during this inspection the last report was not in the reception area). Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day at the home with further information being sent to the inspector the day after. Two inspectors attended the home for this inspection. This inspection focussed on the large number of requirements made at previous inspections and because of this the inspector did not contact any relatives afterwards (as she had done at the last inspection) or spend much time talking with service users. At the next inspection the inspector will focus on service users’ and relatives’ experience of the home. The inspectors examined records, talked with staff, the Registered Manager and the Operations Manager, toured the building and examined medication stocks. The inspectors found that staff have been working very hard to improve standards at this home and although there had been improvements in some areas such as care planning, staff supervision and medication, there were still serious concerns and a large number of additional requirements had to be made during this inspection. Two immediate requirements had to be made around health and safety. An improvement plan is required of the provider following this inspection and when this is received by the Commission the provider will be called for a meeting with the Commission for them to explain how they are going to ensure that this home improves significantly over the next few months. A Commission internal management review was called following the inspection to decide if enforcement action to ensure compliance with the national minimum standards, is necessary at this point. What the service does well: Standards assessed during this inspection showed that: • • • • Senior staff visit a prospective service user before they move to the home to make sure that the home can meet their needs. Plans for staff to meet service users’ needs are drawn up and written down using the same format throughout the home. Service users can have visitors to the home as they choose. All service users have single rooms with en-suite bathrooms. Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? • Care plans are clearer and more consistent, are drawn up with the involvement of the service user or their representative and are reviewed monthly. Staff have worked hard to try and offer more meaningful activities to service users. Work has been done to train staff in the area of protection of vulnerable adults. Staff now receive regular supervision from their line manager. Staff now have annual assessments of their training needs • • • • What they could do better: Standards assessed at the home showed that the home must make sure that: • Records of health care monitoring must be consistent and effective and health care must be offered as required by care plans and external professionals’ advice. Medication procedures must be followed consistently by staff. Service users must have an individual programme of activity that is interesting and useful to them and must be allowed to go out as they choose. All complaints or allegations must be recorded and action taken to make sure that the service improves. The communal toilets and bathrooms in the home must be decorated in a homely manner. Facilities and equipment in the home must be checked as required by an appropriately qualified professional. All areas of the home must be free of offensive odours. There must always be enough staff on duty to fully meet the needs of service users. • • • • • • • Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 7 • • • • • • • All staff must be able to care for service users effectively and appropriately. Staff must receive the supervision and training they need when they first start work at the home. Staff must have annual training plans in place. The organisation’s recruitment procedures must be more effective. All procedures to manage service users’ money must be operated effectively. Record keeping must be accurate and effective. All health and safety procedures must be operated effectively. 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. Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 8 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 Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 9 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&6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Senior staff assess prospective service users’ needs before they move to the home so that no one is offered a place without the staff team believing they can support someone. Standard 6 is not applicable as this home does not provide intermediate care. EVIDENCE: There is new legislation in place now that came into force on 01/09/06 and other changes come into force on 01/10/06 which will require services to state exactly what fees each service user is paying and how it breaks down into different areas, in the service user guide. (See Requirement 1) There was a previous requirement that the Registered Manager must ensure that there is a written assessment on file of all service users who are self Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 10 funding at the home, that has been undertaken by qualified staff from the home and which meets the requirements of the standard. This has now been don and pre-admission assessments were seen for all new service users. Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 11 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, 10 & 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A lot of work has been done around care planning and the plans are better than at the last inspection but they still do not fully describe all areas of support that a service user needs, are not being reviewed as required and they are not always being followed consistently by staff. This means that service users are not getting all the care they need from all staff at all times. Service users and relatives are now more involved in the care plans and have had more opportunity to comment on and change them if they wish. Service users’ healthcare and personal care needs are not being fully met which means that service users may be unhappy or uncomfortable with the support they get from staff or in the worst cases may be being put at risk of harm by the actions or lack of action of staff. Service users do not get enough exercise (or the exercise is not being recorded properly) so the home is not showing that it is meeting service user needs in this area. Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 12 All medication procedures are not effective which means that medication may not be being administered properly. Service users are cared for when they are dying but as care is not being offered according to current best practice the home may not be doing all it can to effectively offer the most effective end of life care. EVIDENCE: There was a previous requirement that the Registered Manager must ensure that all care plans are written with the involvement of the service user or their representative and reviewed monthly as required. The home now conducts care reviews and invites relatives to take part. A lot of files showed that service users or their relatives are signing care plans and while there is still further work to do this requirement can now be set to be met. Records should be kept on file of all efforts that have been made to involve families who have not yet signed care plans. (See Recommendation 1) There was a previous requirement that the Registered Individual must ensure that all service users’ weight, nutrition, pressure sore and other health care monitoring and records are maintained as required by care plans and external professionals advice, in detail and are accurate. Files showed some improvement in this area but there were still significant concerns with turning charts showing that some days recording had been missed ad service users who need to be turned two hourly are being turned sometimes three hourly. No recordings of night turning were available. Weight is not being taken weekly as required for some service users. Some blood monitoring has been missed. Care plans are not being changed in response to developments in service users’ health needs. (See Requirements 2 & 3) There was a previous requirement that the Registered Manager must ensure that all risk assessments for service users requiring cot sides are completed and that written consent for cot sides is sought from the service user or their representatives. This now being done. There was a previous requirement that the Registered Individuals must ensure that all staff are trained to understand the purpose of all forms and records that they use within the home. Files showed improvement in this area and staff said that the recent care planning training has helped them use the records. One service user, confined to bed was observed to be unable to reach beakers of drinks on the bedside trolley. Staff advised that it is likely to be domestics not repositioning the trolley to within the reach of the service user, who cannot speak English. The service user was noted to drink thirstily when the inspector alerted a member of staff and the trolley was repositioned. Staff are unable to Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 13 communicate effectively with this service user but were observed to be taking time to try and interact to some degree. (See Requirements 4 & 5) The medication stocks and records on the ground and first floor were examined. Boots pharmacy has recently started to supply MAR and stock but have not yet inspected the service. Medication storage was adequate. Photographs of each user available and drug info sheets retained for reference Staff advised that there is no covert administration currently and demonstrated a clear understanding of the right to refuse medication and action to take if non-compliance is an issue. There was a previous requirement that the Registered Manager must ensure that specific instruction as to how and when medication is to be given are recorded on the medication administration charts. This is now being done. There was a previous requirement that the Registered Manager must ensure that stock checking procedures ensure that accurate records are maintained of all medication held in the home at any time. Monthly stock checks have started however, topical items such as creams are stored in bedrooms and are not checked or recorded. Only trained staff sign for medication, although care assistants may be using topical creams etc without recording. (See Requirements 6 & 7) There was a previous requirement that the Registered Manager must ensure that all medication is signed for at the point of administration. MAR charts showed no gaps in recording and full administration instructions were available. There was a previous requirement that the Registered Manager must ensure that medication to be taken as required is only signed for when it is taken. This is now being done. There was a previous requirement that the Registered Manager must ensure that all agreed guidelines and procedures in the event of someone’s dying and death are clearly recorded in the service users’ files/care plans. This is now occurring more regularly and files showed when relatives have been asked about this but do not wish to talk about it. The home does not yet work within the Gold Standard Framework or the Liverpool Care Pathway systems, which would assist with ensuring that all needs in the event of serious illness and death are met. The home is starting to access training and is working with the local St Christopher’s nurses to develop in this area. (See Requirements 8 & 9) Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 14 There was a previous requirement that the Registered Manager must ensure that service users do not have clothes and other possessions go missing. Domestic hours have increased to help with laundry and there are missing property books on each floor. These records and the complaints registered showed that clothes are still going missing. (See Requirement 10) There was a previous requirement that the Registered Manager must ensure that all service users are shaved or receive other personal grooming regularly and as they choose. This issue had been caused by there not being enough staff to meet these needs an as staff had not increased since the last inspection it could be assumed that the issue is still ongoing. As the inspector did not contact relatives during this inspection, this issue will be assessed at the next inspection. (See Requirement 11) Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 15 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 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Work has been done in the area of activities since the last inspection and there has been an increase in the amount of group activities that take place so service users have more chances to take part in daily activities. Service users are not however having their individual needs met by the activities that are on offer as there is little opportunity for them to take part in things that are not group based and they do not have individual programmes of activity based on what they like to do. Relatives can visit the home when they choose and are made welcome by staff. Generally service users are only part of the local community if they can get out of the home by themselves; there are occasional trips out of the home but there are not enough staff to support service users to go out by themselves regularly. Daily routines are determined by how many staff are on duty and not by service user choice. Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 16 EVIDENCE: There was a previous requirement that the Registered Manager must ensure that individualised care plans are drawn up for service users to ensure that social and recreational activities are offered that are meaningful to them. Some care plans have been drawn up but some of the files still contain the old forms which are the same plan with each service user’s name inserted. (See Requirement 12) The TV reception is poor in the main lounge and in some bedrooms. (See Requirement 13) The activities co-ordinator was noted to be enthusiastic and engaging in reminiscence with small group of service users in the ground floor communal lounge then singing to music with them later in the day. The activities co-ordinator has worked hard to improve the standard of activities in this home and records showed that group activities take place through the week and some one to one sessions occur. Care plans on some files stated that some service users need to have daily one- to one contact as they were confined to bed. There were no records maintained of monitoring of this contact. The activities co-ordinator offers gentle exercise in a group but has not been trained to do so. There are not many reminiscence materials available and more board games could be provided. There are occasional trips into the local community but there are no regular outings as the home has no transport of its own. (See Requirements 14 – 16 and Recommendation 2) There is a new chef at the home who has not yet had time to make an impact on the menus on offer. He discussed some areas where he felt he could access train to improve the quality of pureed meal for service users and the choices on offer for African and Caribbean service users. Some service users were happy with the food and some weren’t. The area of food will be assessed fully at the next inspection when the new chef has had more time to settle in. (See Recommendations 3 & 4) Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 17 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 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are complaints procedures in place but not all complaints or allegations are recorded and one relative said that they still make complaints and do not hear anything about it. This means that service users and their relatives do not feel that they are listened to and taken seriously. Work has been done to train staff in the area of protection of vulnerable adults which will improve staff’s understanding of the issues but there still aren’t robust procedures in place for reacting to and addressing allegations of abuse or bad practice. EVIDENCE: There was a previous requirement that the Registered Manager must ensure that a record is maintained of all informal complaints and concerns in order that patterns of concerns can be audited and action can be taken and recorded in response to any issues. This is not yet being done as the inspector was made aware of some verbal and informal complaints that have been made which were not recorded or monitored centrally. (See Requirement 17) There was a previous requirement that the Registered Manager must ensure that all complaints (including verbal complaints) from service users or their relatives are investigated and actioned and the complainant is made aware of Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 18 the outcome. One relative on the day of the inspection was there to meet with the Registered Manager as they had made a complaint about the service a month prior and had still not heard what had been done about it. (See Requirement 18) There was a previous requirement that the Responsible Individuals must ensure that all staff attend training around protection of vulnerable adults. More staff have attended this training since the last inspection but still about half the staff team need the training. (See Requirement 19) There was a previous requirement that the Registered Manager must ensure that all allegations are recorded and appropriately investigated and that the appropriate authorities are informed. There was no evidence that there have been allegations made since the last inspection although an issue raised at the last inspection had been treated as a complaint and was noted in the complaints folder, not held separately as an allegation and the inspector was not satisfied that the Registered Manager was aware of the difference between complaints and allegations and the need for them to be investigated differently. All details of how this allegation had been notified to the Registered Manager i.e. by the inspector following discussion with a relative, were not included in the notes of this allegation. (See Requirement 20) Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 19 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, 20, 21, 23, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are lounges and dining rooms on the ground floor and third floor of the home but service users on the first and second floor have to move onto those floors if they wish to sit in space other than their own rooms or if they wish to use a dining room. All service users have single rooms with en-suite bathrooms many of which have been personalised in ways they have chosen. The communal toilets and bathrooms in the home are not decorated in a homely manner. Facilities and equipment in the home have not been checked as required by an appropriately qualified professional which means that service users may not be using the most effective equipment to safely meet their needs. Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 20 The home is generally clean but on one day of the inspection some areas of the home smelled offensive. EVIDENCE: There is a redecoration plan for bathrooms and bedrooms but a cyclical decoration programme of communal areas is not available. The kitchen requires a deep clean and certain areas require retiling and some maintenance. (See Requirements 21 & 22) There was a previous requirement that the Registered Manager must ensure that work is carried out on all the toilets and shower/bathrooms to decorate them in a manner that is non-institutional, chosen by the service users and as homely as possible given the equipment that may need to be kept in some of them. Bathrooms and toilets are being redecorated and have improved but still need more attention to make them less institutional. In addition there was no privacy lock on ground floor shower room door. (See Requirements 23 & 24) There was a previous requirement that the Registered Individuals must ensure that an occupational therapists assessment (or equivalent) of the building and all equipment and adaptations within it is carried out to ensure that service users are safe and receiving the most appropriate specialist support. Any recommendations made in the report must be addressed. This has not yet been done but has been booked for 20/12/06. The assessor is not an occupational therapist and the inspector was concerned that their qualification did not enable them to conduct an equivalent assessment but for the sake of moving this issue on, the assessment will be conducted and the report sent to the Commission as a priority, if this report does not look like a full OT assessment, the requirement will be repeated. (See Requirement 25) There are a few problems that extend to many areas of the home which would be picked up by a thorough occupational therapist assessment including many door handles are breaking and should be replaced, patches of damp damage reception ceiling tile and ground floor staircase walls, lighting in some bathrooms and WCs is poor and may need brighter bulbs, some sealed lighting units are without lampshades and there was a leaking hand wash basin in a ground floor bedroom and the service user had positioned a bowl to catch drips and prevent a slippery floor. (See Requirements 26 & 27) Many bedrooms are personalised and homely and a new service user and her son said that they had been welcomed and able/encouraged to bring personal items into the home. There was a previous requirement that the Registered Manager must ensure that the home is free from offensive odours at all times. The home was Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 21 generally clean, but some rooms had a bad odour of urine. (See Requirement 28) Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 22 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 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels are not adequate on the ground and first floor and service users are not having their needs met because of this. There are problems with some staff not being able to communicate effectively with service users. Recruitment procedures have improved significantly but there are still a few issues to address to make sure that effective checks are in place to make sure staff are who they say they are and can do the job they are hired to do. Staff are not having their training needs fully assessed or if they are assessed, training is not identified to meet areas of poor performance which means that service users are not being cared for by staff who are fully trained to do their jobs properly. EVIDENCE: There was a previous requirement that the Registered Manager must ensure that there are sufficient staff on duty at all times to ensure that all service users needs are met. Evidence gathered during this inspection showed that there are not enough staff on the ground and first floors to meet the needs of Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 23 service users. The Registered Manager and Operations Manager have acknowledged this and put in a request for 84 more staff hours per week on these floors. Given the number of requirements and problems with standards of care, an urgent requirement is made to increase staffing to these levels. (See Requirements 29 & 30) One service user told the inspector I am looked after very well, too good really, they spoil me! There was a previous requirement that the Registered Individuals must ensure that 50 of non-nursing care staff hold the NVQ Level 2 in Care. The Registered Manager has not included bank staff in the calculation of NVQ attendance so it was not possible to fully assess this area. If this information is provided to the Commission prior to the final draft of this report the requirement can be assessed. (See Requirement 31) The personnel files of the two staff recruited since the last inspection were examined. There was a previous requirement that the Registered Individuals must ensure that all references are stamped, on headed notepaper or some other method is used and recorded to verify the identify of the person providing the reference. This is not yet being done consistently. (See Requirement 32) There was a previous requirement that the Registered Individuals must ensure that all gaps in employment or education are investigated and a record made of the investigation. There were no gaps in the files examined. There was a previous requirement that the Registered Individuals must ensure that the POVAFirst check is not used as a matter of course to start staff at the home without receiving back a full enhanced Criminal Records Bureau check. One staff member had moved over from another home within the organisation so didn’t need a new CRB but the other CRB was not available. (See Requirement 33) There was a previous requirement that the Registered Individuals must ensure that all interview questions are appropriate to the post being applied for and that full records are kept of the interviewers notes. The Registered Manager said that they do not use the old questions any more. There was a previous requirement that the Registered Individuals must ensure that all staff are fit to do the job for which they are employed and if staff are employed with little or no care experience or following an unsatisfactory interview, a full record is made as to why the interviewers believe they should be employed. Records showed that this recording has improved although there was only one interview record for each staff member. (See Requirement 34) Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 24 Health and equalities monitoring forms are not held anonymously. (See Recommendation 5) There was a previous requirement that the Registered Individuals must ensure that all staff offering support and assessment to staff during their induction and foundation period have received sufficient guidance and been judged as competent to offer such support and assessment. This training has been booked for this year but has not been offered yet. (See Requirement 35) There was a previous requirement that the Registered Manager must ensure that all staff undergo a full induction and foundation programme during the first six weeks and then six months of their employment. Records of this induction and foundation must be maintained to include comments as to how the member of staff has progressed. This is not yet being done. The Registered Manager said that this was because the new organisation’s paperwork is not in place yet but there is still a need for a full induction to be carried out. (See Requirement 36) There was a previous requirement that the Registered Individuals must ensure that all staff have an at least annual appraisal of their work performance and training needs and that then an individual training and development plan is drawn up. These individual plans must then be brought together into an overall annual training and development plan for the home. Appraisals have been carried out for most staff although the quality of the appraisal was questionable in some cases, possibly due to staff not having had this training yet. Individual training plans have not been drawn up and an overall annual training plan is not in place. (See Requirement 37) There was a previous requirement that the Registered Individuals must ensure that all staff understand the needs of service users and the expectations of staff while working at the home and that all staff can communicate effectively with service users. No evidence was provided to the inspectors to show that this had been done and the previously mentioned example of staff not being able to speak to service users for whom English is not their first language is further evidence of this not being met. (See Requirement 38) There was a previous recommendation that the Registered Individuals should consider what additional input is needed within the home to ensure that all staff can understand and work effectively around issues of diversity and difference and how these may impact on the provision of care at the home. This has not been done. (See Recommendation 7) Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 25 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, 36, 37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users’ money is not fully protected by the financial procedures in the home. Staff do not receive the supervision and training they need when they first start work at the home which means that relatively inexperienced and untrained staff may be working with vulnerable service users and not know what they are doing wrong. Staff now receive regular supervision from their line manager. Staff now have annual assessments of their training needs but do not yet have training plans in place which means that they may not be getting the training the need to do their jobs. Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 26 Record keeping throughout the home is not effective. Service users are put at risk by the environment and by how staff operate the health and safety procedures. EVIDENCE: The Registered Manager has not yet begun the Registered Managers Award. (See Requirement 39) There was a previous requirement that the Registered Manager must ensure that service users and their families are consulted about their satisfaction with all aspects of life at the home and that a development plan is drawn up (to be reviewed at least annually) that addresses any issues raised. Given the number of areas of concern noted during this inspection, the area of quality assurance will be assessed at the next inspection so the home can focus on priority areas of care and health and safety. (See Requirement 40) There was a previous requirement that the Registered Individuals must ensure that all significant events that affect the welfare of service users are reported as required to the Commission. Minutes of a recent meeting between the provider and social services show that discussions took place of vulnerable adult issues that had not been reported to the Commission as required. (See Requirement 41) There was a previous requirement that the Registered Manager must ensure that all receipts are kept for all money taken out of service users’ accounts or that the service user signs for all money they take. If the service user is not the one taking the money, that two members of must staff sign each entry. This is now done. There was a previous requirement that the Registered Individuals must ensure that all service users whose money is managed by the organisation, receive individual monthly statements of their accounts. This is not yet done. (See Requirement 42) There was a previous requirement that the Registered Individuals must ensure that all service users receive their weekly personal allowance as required. Practice in this area has not changed and it is still not possible to see from the records that this is being done. (See Requirement 43) There was a previous requirement that the Registered Manager must ensure that all staff who offer supervision and appraisals have received training in how to do so and have been judged as competent to do so. This training has been booked but has not yet been carried out. (See Requirement 44) Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 27 There was a previous requirement that the Registered Manager must ensure that all staff receive supervision regularly and as per the organisation’s policy i.e. six times a year. Records show that generally this is being done now. Records maintained throughout the home show that the record keeping standard is not met and a further recommendation is made about filing systems. (See Recommendation 6) Fire drills are conducted with required frequency and outcomes are recorded. Professional testing of detection equipment and extinguishers is happening regularly and evidence is available. Call point testing is conducted each week by the maintenance manager. Wheelchairs are being checked by maintenance man, and all parts labeled with a number each chair having a number). Lift maintenance check records wee available. Hoists are being checked, and evidence of checks and repairs (professional) are available, however there did not appear to be enough available as staff have to go between floors to get hoists meaning that service users are delayed in getting out of bed or going to the toilet. The Registered Manager agreed that he had already acknowledged that increased number of hoists will be a priority for 07 budget. (See Requirement 45) The recent gas boiler certificate was available. There was no LFEPA report available and staff had put items of furniture in a fire exit hallway, essentially blocking it. These items were removed during the inspection but staff must not use these areas for storage pending dumping. (See Requirements 46 & 47) Three sluice rooms were all unlocked. The ground floor sluice room door had a hazardous chemical sign on it and all sluice rooms have posters warning of very hot water. This issue has been the subject of requirements several times previously and had been taken out of the last report due to the home stating that there were no risks in the sluice room. Given that there are risks these doors need to be locked. (See Requirement 48) One bathroom radiator had exposed parts which were very hot. This was repaired during the inspection but needs to be checked regularly as bumping of wheelchairs and other equipment may cause damage in high use areas such as bathrooms. (See Requirement 49) Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 28 There was no alcohol hand rub available in the home and no hand towels available in the kitchen and many bathrooms/toilets. (See Requirement 50) Staff dispose of clinical waste in the three yellow bins located in the car park to the rear of the building. Bins were overflowing and surgical gloves etc were on the floor at the base of the bins. This was cleared by maintenance during the inspection but was reported to be regularly caused by staff not checking to see if another bin is empty. (See Requirement 51) The food hygiene inspection report was available and satisfactory but it was for 2005 and related to a previous catering team. Hot water temperatures are checked each week and results are recorded, all temperatures were within the required ranges. There is a pest control contract in place, but there is an ongoing issue with ants and mice. (See Requirement 52) Window restrictors are slowly being replaced with stronger ones as the maintenance manager recognises that the older ones are not strong enough. This replacement should be prioritized. (See Requirement 53) Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 29 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 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 2 X 3 X 2 2 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 2 2 2 1 Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES 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 OP1 Regulation 4&5 Requirement The Registered Individuals must ensure that the breakdown of each service users’ fees is put these in the service user guide/statement of purpose as required by the new legislation. Previous recommendation The Registered Individuals must ensure that all service users’ weight, nutrition, pressure sore and other health care monitoring and records are maintained as required by care plans and external professionals advice, in detail and are accurate. Previous requirement: Unmet timescale 30/09/06 The Registered Individuals must ensure that care plans are changed when service users health or personal care needs change. The Registered Manager must ensure that all service users (particularly those confined to their rooms) have access to drinks throughout the day. The Registered Individuals must ensure that additional efforts are DS0000007012.V323850.R01.S.doc Timescale for action 31/01/07 2. OP7 OP8 12 (1) & 17 (1) 28/02/07 3. OP7 OP8 12 (1) & 17 (1) 28/02/07 4. OP8 12 (1) 15/12/06 5. OP8 12 (1) 28/02/07 Camberwell Green Nursing Home Version 5.2 Page 31 6. OP9 13 (2) 7. OP9 13 (2) 8. OP11 12 (1) & 15 9. OP11 12 (1) & 18 (1) (c) (i) 10. OP8 12 (1) 11. OP12 16 (2) (m) & (n) 12. OP8 12 (1) made to ensure that staff are able to communicate with service users who do not speak English. The Registered Manager must ensure that stock checking procedures ensure that accurate records are maintained of all medication held in the home at any time (including topical preparations). Previous requirement: Unmet timescales 31/12/05 & 31/08/06 The Registered Manager must ensure that all prescribed creams and topical preparations are signed for at the point of administration. The Registered Individuals must ensure that staff are trained in and the home operates such systems as the Gold Standard Framework and the Liverpool Care Pathway to fully support someone according to best practice when dying. The Registered Individuals must ensure that there is an organisational policy drawn up describing the current best practice the home will operate to ensure all service users’ needs are met when they are dieing. The Registered Manager must ensure that service users do not have clothes and other possessions go missing. Previous requirement: Unmet timescale 31/10/06 The Registered Manager must ensure that individualised care plans are drawn up for service users to ensure that social and recreational activities are offered that are meaningful to them. Previous requirement: Unmet timescale 31/10/06 The Registered Manager must DS0000007012.V323850.R01.S.doc 11/12/06 11/12/06 31/03/07 31/03/07 28/02/07 28/02/07 28/02/07 Page 32 Camberwell Green Nursing Home Version 5.2 13. OP12 16 (2) (m) & (n) 15 & 16 (2) (m) & (n) 14. OP12 15. OP12 15 & 16 (2) (m) & (n) 15 & 16 (2) (m) & (n) 22 16. OP13 17. OP16 18. OP16 22 19. OP18 13 (6) & 18 (1) (c) (i) ensure that all service users are shaved or receive other personal grooming regularly and as they choose. Previous requirement with timescale 30/09/06, not assessed at this inspection. The Registered Manager must ensure that the TV reception is acceptable in all areas of the home. The Registered Manager must ensure that exercise is offered in accordance with care plans and is recorded and monitored effectively. All exercise must be offered by staff trained in how to do so safely. The Registered Manager must ensure that activities are offered in accordance with all care plans in this area. The Registered Individuals must ensure that service users are able to access the local community regularly, for instance by providing transport. The Registered Manager must ensure that a record is maintained of all informal complaints and concerns in order that patterns of concerns can be audited and action can be taken and recorded in response to any issues. Previous requirement: Unmet timescales 31/03/06 & 31/08/06 The Registered Manager must ensure that all complaints (including verbal complaints) from service users or their relatives are investigated and actioned and the complainant is made aware of the outcome. Previous requirement: Unmet timescale 31/08/06 The Responsible Individuals must ensure that all staff attend training around protection of DS0000007012.V323850.R01.S.doc 22/12/06 28/02/07 28/02/07 28/02/07 28/02/07 28/02/07 31/03/07 Camberwell Green Nursing Home Version 5.2 Page 33 20. OP18 13 (6) 21. OP20 13 (4) (a) & (c) 22. OP20 23 (2) (d) 23. OP21 12 (3) & 23 (2) (d) 24. OP21 12 (4) (a) 25. OP25 23 (2) (n) vulnerable adults. Previous requirement: Unmet timescales 31/03/06 & 30/11/06 The Registered Manager must ensure that all allegations are recorded and appropriately investigated and that the appropriate authorities are informed. Previous requirement: Unmet timescale 31/08/06 The Registered Individuals must ensure that the kitchen is deep cleaned and all necessary tiling and other remedial work carried out. The Registered Individuals must ensure that there is a cyclical decoration and maintenance programme drawn up for all areas of the home. A copy of this must be sent to the Commission. The Registered Manager must ensure that work is carried out on all the toilets and shower/bathrooms to decorate them in a manner that is noninstitutional, chosen by the service users and as homely as possible given the equipment that may need to be kept in some of them. Unmet requirement: Previous timescales 31/12/05, 31/03/06 & 30/11/06 The Registered Individuals must ensure that the appropriate privacy locks are on bath/shower room and toilet doors. The Registered Individuals must ensure that an occupational therapists assessment (or equivalent) of the building and all equipment and adaptations within it is carried out to ensure that service users are safe and receiving the most appropriate specialist support. Any recommendations made in the report must be addressed. A DS0000007012.V323850.R01.S.doc 28/02/07 31/01/07 28/02/07 28/02/07 22/12/06 31/12/06 Camberwell Green Nursing Home Version 5.2 Page 34 26. OP25 23 (2) (p) 27. OP25 23 (2) (d) 28. OP26 16 (2) (k) 29. OP27 18 (1) (a) 30. OP27 18 (1) (a) 31. OP28 13 (6) & 18 (1) (c) (i) 32. OP29 19 (1) (4) & (5) copy of this report must be sent to the Commission. Previous requirement: Unmet timescales 31/12/05, 31/03/06 & 30/11/06 The Registered Individuals must ensure that lighting in all parts of the home is adequate. Evidence of this must be sent to the Commission by the stipulated timescale. The Registered Individuals must ensure that all required maintenance identified during this inspection is carried out. Evidence of this must be sent to the Commission by the stipulated timescale. The Registered Manager must ensure that the home is free from offensive odours at all times. Previous requirement: Unmet timescale 31/08/06 The Registered Individuals must ensure that the additional staff hours requested by the Registered Manager and the Operations Manager are in place. Evidence of this must be sent to the Commission by the stipulated timescale. The Registered Manager must ensure that there are sufficient staff on duty at all times to ensure that all service users needs are met. Previous requirement: Unmet timescales 31/12/05, 31/03/06 31/08/06 The Registered Individuals must ensure that 50 of non-nursing care staff hold the NVQ Level 2 in Care. Additional information is required to fully assess this requirement. Previous requirement: Unmet timescales 31/12/05, 31/03/05 & 30/11/06 The Registered Individuals must ensure that all references are stamped, on headed notepaper DS0000007012.V323850.R01.S.doc 31/12/06 28/02/07 11/12/06 22/12/07 22/12/07 28/02/07 11/12/06 Camberwell Green Nursing Home Version 5.2 Page 35 33. OP29 13 (6) 34. OP29 19 (1) (4) & (5) 35. OP30 18 (1) (c) (i) & (2) 36. OP30 18 (1) (c) (i) & (2) 37. OP30 18 (1) (c) (i) or some other method is used and recorded to verify the identify of the person providing the reference. Previous requirement: Unmet timescale 31/08/06 The Registered Individuals must ensure that CRB checks (or records of the number and dates of such checks) are on file for all staff and available for inspection. The Registered Individual must ensue that at least two staff interview all applicants and records are kept of each interviewer’s notes and judgement. The Registered Individuals must ensure that all staff offering support and assessment to staff during their induction and foundation period have received sufficient guidance and been judged as competent to offer such support and assessment. Previous requirement: Unmet timescale 30/11/06 The Registered Manager must ensure that all staff undergo a full induction and foundation programme during the first six weeks and then six months of their employment. Records of this induction and foundation must be maintained to include comments as to how the member of staff has progressed. Previous requirement: Unmet timescale 31/08/06 The Registered Individuals must ensure following an at least annual appraisal of their work performance and training needs individual training and development plans are drawn up. These individual plans must then be brought together into an overall annual training and DS0000007012.V323850.R01.S.doc 11/12/06 11/12/06 28/02/07 15/12/06 28/02/07 Camberwell Green Nursing Home Version 5.2 Page 36 38. OP30 12 (1) & 18 (1) (c) (i) 39. OP31 18 (1) (c) (i) 40. OP33 12 (3) & 24 41. OP33 26 42. OP35 12 (1) & 13 (6) development plan for the home. Previous requirement: Unmet timescale 30/11/06 The Registered Individuals must ensure that all staff understand the needs of service users and the expectations of staff while working at the home and that all staff can communicate effectively with service users. Previous requirement: Unmet timescale 30/11/06 The Registered Individuals must ensure that the Registered Manager begins the Registered Managers Award NVQ. Evidence of this must be sent to the Commission by the stipulated timescale. The Registered Manager must ensure that service users and their families are consulted about their satisfaction with all aspects of life at the home and that a development plan is drawn up (to be reviewed at least annually) that addresses any issues raised. Previous requirement with previous timescales of 31/12/05, 31/03/06 & 30/11/06. This requirement was not assessed during this inspection and will be carried over to the next. The Registered Individuals must ensure that all significant events that affect the welfare of service users are reported as required to the Commission. Previous requirement: Unmet timescale 31/08/06 The Registered Individuals must ensure that all service users whose money is managed by the organisation, receive individual monthly statements of their accounts. Previous requirement: Unmet timescale 30/11/06 DS0000007012.V323850.R01.S.doc 28/02/07 31/03/07 31/03/07 31/12/06 31/12/06 Camberwell Green Nursing Home Version 5.2 Page 37 43. OP35 12 (1) & 13 (6) 44. OP36 18 (1) (c) (i) & (2) 45. OP38 12 (1) 46. OP38 13 (4) (a) & (c) 47. OP38 13 (4) (a) & (c) & 23 (4) 48. OP38 13 (4) (a) & (c) 13 (4) (a) & (c) 49. OP38 The Registered Individuals must ensure that all service users receive their weekly personal allowance as required. Previous requirement: Unmet timescale 31/08/06 The Registered Manager must ensure that all staff who offer supervision and appraisals have received training in how to do so and have been judged as competent to do so. Previous requirement: Unmet timescale 30/11/06 The Registered Individuals must ensure that a study is undertaken of the number of service users who need to use a hoist, how long they take with it and at what times of the day to assess if there are sufficient hoists to get service users out of bed in a timely manner. This study must be sent through to the Commission. The Registered Individuals must ensure that staff are aware of the fire safety procedures in the home and that fire exits are not blocked. The Registered Individuals must contact the LFEPA to see if they will conduct an inspection or if the Registered Manager is expected to conduct his own assessment of fire risks within the home. The Registered Manager must ensure that all doors required to be locked to protect service users from harm are kept locked. The Registered Individuals must ensure that all radiators are kept effectively covered to protect service users from high temperatures. This requirement was met by the end of the inspection. DS0000007012.V323850.R01.S.doc 31/12/06 28/02/07 31/12/06 15/12/06 31/12/06 11/12/06 11/12/06 Camberwell Green Nursing Home Version 5.2 Page 38 50. OP38 13 (4) (a) & (c) 51. OP38 13 (4) (a) & (c) 52. OP38 13 (4) (a) & (c) 13 (4) (a) & (c) 53. OP38 The Registered Individuals must ensure that there is alcohol wash available in all toilet and bath/shower rooms and throughout the home along with adequate supplies of hand towels. The Registered Individuals must ensure that all staff operate effective clinical waste procedures and the clinical waste bins are used appropriately. The Registered Individuals must ensure that the ongoing problems with mice and ants in the home are resolved. The Registered Individuals must ensue that all ineffective window restrictors are replaced as a priority. Evidence of this must be sent to the Commission by the stipulated timescale. 15/12/06 11/12/06 31/01/07 31/12/06 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. Refer to Standard OP7 OP12 OP15 Good Practice Recommendations The Registered Manager should keep records on service users’ files of all efforts that have been made to get relatives to sign care plans. The Registered Individuals should ensure that more materials are nought for the reminiscence work and for general activities. The Registered Individuals should ensure the chef receives training around how to provide more varied meals for service users on soft and pureed diets and also how to provide more choices for people from different ethnic backgrounds. The Registered Individuals should ensure that options are offered more regularly for service users from different ethnic backgrounds. DS0000007012.V323850.R01.S.doc Version 5.2 Page 39 4. OP15 Camberwell Green Nursing Home 5. 6. 7. OP29 OP37 OP30 The Registered Individuals should ensure that health and equalities monitoring forms are held anonymously. The Registered Manager should ensure that filing systems throughout the home are improved. The Registered Individuals should consider what additional input is needed within the home to ensure that all staff can understand and work effectively around issues of diversity and difference and how these may impact on the provision of care at the home. Previous recommendation. Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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. Extracts may not be used or reproduced without the express permission of CSCI Camberwell Green Nursing Home DS0000007012.V323850.R01.S.doc Version 5.2 Page 41 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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