Inspection on 16/04/09 for Camberwell Green Nursing Home

This inspection was carried out on 16th April 2009.

CQC 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

Camberwell Green Nursing Home 06/10/08

Camberwell Green Nursing Home 26/06/07

Camberwell Green Nursing Home 11/12/06

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 19/06/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Camberwell Green Nursing Home Camberwell Green Care Centre 54 Camberwell Green Camberwell London SE5 7AS Lead Inspector Michael Williams Unannounced Inspection 16th April 2009 10:00 DS0000007012.V375021.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Camberwell Green Nursing Home DS0000007012.V375021.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Camberwell Green Nursing Home DS0000007012.V375021.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 camberweelgreen@schealthcare.co.uk www.southerncrosshealthcare.co.uk Apta Healthcare (UK) Ltd 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) Solomon Demba Care Home 55 Category(ies) of Old age, not falling within any other category registration, with number (55), Physical disability (55) of places Camberwell Green Nursing Home DS0000007012.V375021.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 55) 2. Physical disability - Code PD (maximum number of places: 55) The maximum number of service users who can be accommodated is: 55 6th October 2008 Date of last inspection Brief Description of the Service: Camberwell Green Care Centre is run by ‘Southern Cross Health Care Ltd’. It is registered to provide nursing care, and care for people with physical disabilities, for up to 55 older people. It is not registered for any other groups such as people with dementia or mental health problems. The home is purpose built but it is a very plain, unornamented brick-built block; it is not an attractive building and would benefit by further architectural refinement to enhance its appearance and to set a standard for any visitor or resident entering the property. The home is located in the centre of Camberwell close to public transport, shopping and leisure facilities. Accommodation is provided on four floors. There are two passenger lifts. All bedrooms have ensuite toilets and are single rooms. There are 3 lounges and 2 dining areas but this not enough so activities take place in a wide corridor on one floor. The home also lacks sufficient space for storage and this compromises areas intended to be used by residents. The home has the usual facilities for a nursing home including offices, visitor room, laundry, kitchen, sluice rooms, clinic room – but the clinic room is poorly ventilated. We are advised that there have been no changes to the ownership of this home except changes to the Responsible Individual and the Registered Manager, who have both changed in 2008. We are advised that the fees for this home range from £582 to £800 in April 2009. Camberwell Green Nursing Home DS0000007012.V375021.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. This unannounced key inspection of ‘Camberwell’ was conducted on 16th of April 2009 and is the second visit since our key inspection on 6th October 2008. On both occasions the inspection was conducted by Mr Williams and Mr Peerbux. On 4th April we visited to check compliance with two statutory notices, about medication and kitchen hygiene. In April we toured the building, meet people who use this service, their visitors and staff and we checked documentation. We also took account of information provided to us including the home’s AQAA [Annual Quality Assurance Assessment] and other information from, for example, the local social service department. We also received a number of written representations in the form of questionnaires. The ‘people who use the service’ in this care home are referred to as residents. Camberwell Green Care Centre will be referred to as ‘Camberwell’ in this report. What the service does well: This year we received very few written reply to our questionnaires and two were rather critical of the service. Two were more positive and said they had no complaints or confirmed residents’ needs were being met. However, visitors we met on site were more positive and were happy with the service and in 2008 the responses we received then were also positive such as, “The care my relative receives is excellent” and “I’ve always been happy with this home”. So opinions vary widely as to how well this care home meets residents’ needs. Residents once again said the meals were “very nice”, or lovely”. What has improved since the last inspection? What they could do better: We received some very detailed comments in the feedback we were sent Such as “staff are not following (resident’s) care plans” and “Staff, when dealing with residents, can be very harsh at times!”. One respondent spoke of Camberwell Green Nursing Home DS0000007012.V375021.R01.S.doc Version 5.2 Page 6 an unpleasant odour pervading the home, they described it as “intense and unpleasant”. Residents also reflect on the many changes of manager and ask, “Why do the managers never stay?”. One reply tells us about the response to complaints, “At head office there is not much concern…”. In this case suggesting a resident is not finding Southern Cross a very responsive organisation. We found that care planning was very detailed and up to date but lacked much detail about social care planning. In respect of catering, whilst residents said the meals were very nice we found that the temporary cook was not very clear about the preparation (and separation) of meals for minority ethnic groups. We also found lots of problems with the environment. We found a number of matters of concern about the environment including damaged to fire doors and insects in shower rooms. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Camberwell Green Nursing Home DS0000007012.V375021.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 Camberwell Green Nursing Home DS0000007012.V375021.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1, 3 and 4: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be assured the home will provide relevant information, they will be offered a trial stay and will be suitably assessed so as to ensure their needs can be met. EVIDENCE: We checked the information provided to new residents and we find it commendable that each resident has a combined Statement of Purpose and Guide in their bedroom. In 2008 we found some vital pieces of information were missing from these documents. The first issue was the need for a better description of the criteria for admission to make clear the conditions of registration and the category of residents that can, and cannot be admitted. In the past this led to some inappropriate admissions of people with dementia. The latest manager is much clearer about complying with the home’s registration – older people and people with physical disabilities. Secondly, the information packs were generalised and not specific to the resident, the bedroom and the fees payable. The manager has advised us that Camberwell Green Nursing Home DS0000007012.V375021.R01.S.doc Version 5.2 Page 9 this was easily rectified by having contracts and agreements in place for each resident at the time of admission, giving details of their allocated bedroom and the fees they will be paying or have paid on their behalf. As before, we checked the procedures for admitting new residents so we examined a range of residents’ case files. The home uses standardised assessment forms - which staff use to assess a wide range of potential needs including physical, mental, social and cultural needs. Each resident and/or their representative is given information about the service and is involved in the assessment process. Staff visit prospective residents and invite them to visit the service so the processes for assessing prospective residents is very good. The home also makes sure it gets assessments from suitably qualified professionals such as care managers and we saw these in place in the residents’ files. Camberwell Green Nursing Home DS0000007012.V375021.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7 to 11: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Since the home has been admitting people who have advanced stage dementia, (a condition for which it is not registered), it cannot assure that all residents’ needs can be at all times. EVIDENCE: At the time of compiling this report we had received very few written comments this year. We did receive did verbal feedback from residents and visitors whilst on site. This is a fairly large care home, accommodating 55 residents so we would expect of range of experiences and this was the case. One resident told us that care plans were not being followed, making this quite plain by telling us that “Requests fall on deaf ears”. Conversely the people we spoke to said they were happy with the service and one visitor told us, “I have always been happy with Camberwell, the staff are very good here”. So overall there was very mixed and contrasting opinions about this care home. Camberwell Green Nursing Home DS0000007012.V375021.R01.S.doc Version 5.2 Page 11 Care planning is at the heart of the delivery of good care and so the home tells us that it aims to take a ‘person centred’ approach to this. We find that this home uses standardised, “Roper”, care-plan forms to ensure all aspects of care can be assessed and recorded. We checked a number of these to confirm that they are being used appropriately. We were advised that all care plans are being revised and updated and this is commendable since they should be reflecting the current needs of residents. This year we found them very detailed with lots of examples of health care and risk assessments but they were very limited on aspects of social care. In many instances the documentation includes information about residents previous interests and expectations, often quite simple such as “likes to read books” or “would like a newspaper each day”. This information, gathered at the time of admission, was not being translated into action plans and seemed to be largely ignored in day to day practice, for example there was no newspaper on the floor we made these observations. The plans were very much based upon health and hygiene with little reference to social or recreational activity. It is noted however that activities are available in the home. The care plans need to reflect the promised ‘person centred approach’ for each resident and how they might pass the time. We saw several large signs on bedrooms which appeared undignified for residents and suggested staff were not familiar with the current needs of residents. In respect of diversity, we discussed with the manager how well she deals with disability and diversity and we note that the home is well adapted for residents with physical disabilities, such as those who use a wheelchair or need a hoist to manoeuvre, however the range of adaptations for residents with sight or hearing impairment seemed limited. We demonstrated the use of a portable hearing device, available from RNID (Royal National Institute for Deaf), and the manager agreed it would be a useful piece of equipment when interviewing the hard of hearing. In 2008 we issued two statutory notices one of which was requiring the home to address serious shortcomings in the handling of medication. We visited in February to check that the notice had been complied and found medication practices much improved and so they were not inspected on this occasion. Camberwell Green Nursing Home DS0000007012.V375021.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12 to 15: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot be assured that they will be able to lead a lifestyle that suites them. EVIDENCE: The acting manager advised us that the home has recently employed an activities coordinator although absent on the day of inspection. Once again, it was disappointing to see very little social or recreational activity taking place during our visit. We did see staff sitting with residents engaged in social interaction but we saw much more frequently residents either sitting in their bedroom or in groups in the lounges with little to occupy them except the ubiquitous television showing programmes of little interest it seemed. Although assessments and care plans give some information about each resident, their history, occupation and interests, it is pre-eminently about health and little about social, emotional and spiritual aspects. Even so there seemed to be little evidence that what little information there was about the personal life of the resident was being used to inform staff about care planning and what residents might like to do to pass the time. Not surprisingly therefore Camberwell Green Nursing Home DS0000007012.V375021.R01.S.doc Version 5.2 Page 13 many residents were seen to be dozing in their chair at various points in the day. We spoke to a few visitors who confirmed that they are made to feel very welcome in this care home; the home has a well organised entrance lobby with the administrator based near the front door and so ensuring prompt attention when people arrive. Whilst residents can make choices, within the constraints of their mental and physical capacity, there seemed little they can actually choose from; it might be presumed that residents could choose when they get up in the morning but an anonymous caller in 2008 suggested otherwise and told us residents were required to get up early for the convenience of staff; we were not able to verify this issue. We did observe that residents have a choice about meals, two main choices for each midday meal and a third was for example special ‘ethnic’ meals. The cook was a little uncertain about the proper separation and preparation of meals for minority ethnic foods, Halal or Kosher for example. Meals are plated in the kitchen, under the direction of care staff we were told, and sent to each floor in a hot trolley. This does not seem to give residents much, if any choice at the point of service. On the day of inspection the meals were a meat stew, a vegetable or meat ‘burger. As before residents once again told us that meals were, ‘lovely’, ‘very good’ or ‘nice’. Because the home has no safe, enclosed and private garden few residents can or would choose to sit outside – although residents do so if they choose to smoke. We anticipate that with the employment of staff to lead social and recreational activity this section will improve with time but it needs to start with information about residents, their past experiences and the future aspirations and more work is needed in preparing social care plans. Perhaps nursing staff need to be reminded that this is a home where people live and not a hospital. Camberwell Green Nursing Home DS0000007012.V375021.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16 and 18: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. We cannot assure residents that they will be fully protected by the home’s complaints and protection procedures. EVIDENCE: The two previous registered managers both peremptorily left Camberwell in 2008 - suggesting that this home was not being managed in the best interests of the residents. Whilst it is a matter of concern when matters of safety and protection of residents arise, as they did in 2008, the home does have in place the documentation, policies and procedures for dealing with complaints and ‘Safeguarding’ issues (safeguarding residents from abuse). One resident thought the service did not listen to or respond to concerns as they would wish. We interviewed a junior member of staff to check her awareness of the safeguarding procedures and she was a little uncertain about some aspects such as whistle-blowing (reporting to external agencies any matters of safety) but she was clearer about how she would deal with any suspicion of abuse or poor practice, by reporting it to senior staff within the organisation. All staff especially staff who are shift leaders must have refresher training in the prevention of residents from being harmed or suffering abuse. Staff knowledge and understanding in this area must also be constantly checked at team meetings and during supervision sessions. The manager was able to confirm Camberwell Green Nursing Home DS0000007012.V375021.R01.S.doc Version 5.2 Page 15 that she has arranged a training schedule for all staff that includes safeguarding training within the next month. We noted that the use the term ‘Care Manager’ for both the home’s manager and the local authority social workers would led to some confusion about reporting safeguarding incidents. Here we note that the newest manager has made clear that in-house managers are not to be referred to as ‘care managers since that refers usually to social service staff and confusion would arise if safeguarding procedures require referral to a ‘care manager’. This is very clear and sensible step is indicative of the clarity and leadership the latest manager is bringing to the running of the home and the training of staff. Because the refresher training has yet to be completed within the previous timescales and since there are still some concerns about how responsive this organisation is to residents’ and visitors’ concerns this section is assessed as improving from poor to adequate. Camberwell Green Nursing Home DS0000007012.V375021.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19, 20, 25 and 26: People using this service experience poor quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. We cannot assure residents that the premises are entirely safe and suitable to meet their needs in comfortable surroundings. EVIDENCE: Although a purpose built, and registered service, it now seems that the home does not have all the space and accommodation needed to care for the number of residents (55), and the staff team, for whom it is registered. As we outlined in the brief description of the service, the home lacks sufficient space for storage and this compromises areas intended to be used by residents. Hottrolleys (used to serve meals) are stored in a dining room with a sign on the dining room suggesting the dining area is ‘out of bounds’ between mealtimes; nurses stations, including desk, filing cabinets and chairs are located in corridors that are fire escape routes and are intended to be wide enough for wheelchairs and beds to manoeuvred in safety. As we have seen in the past and we observed again, visitors including inspectors are being interviewed by Camberwell Green Nursing Home DS0000007012.V375021.R01.S.doc Version 5.2 Page 17 nursing staff in a very public area. We were advised that because there are not lounges on each floor some social activities such as games take place in small groups in one of the corridors – whilst this seems a reasonable compromise, because there is insufficient communal space on each floor, this arrangement may cause an obstruction on evacuation routes. The manager accepts that there is no enclosed, safe and protected area for residents to wander; the front of the property, where patio windows from the lounge are located, opens onto the street and it would be somewhat unsafe to leave the doors open. The new manager is resolved to have suitable fencing installed so as to create a safe a private area for residents. Towards the rear of the property there are raised shrub/flower beds but again this is adjacent to the car park, through which the residents would need to walk if they chose to sit in this area. Our overall impression is therefore of a building that is accommodating more people than the building can properly cater for, it is not well designed internally or externally. In addition to our impression that there are some very poor aspects to the design of this care home, we also identified a number of specific problems that must be addressed. The vinyl floor covering in the kitchen has been replaced. Outside, the yellow, clinical waste bins are kept in compound but it is bolted where it should have a lock to prevent unauthorised access to clinical waste. As with our inspection visit in 2008 we again found numerous problems with the premises. Several doors (fire doors) were heavily damaged, possibly by wheelchairs; water temperatures at a shower was too hot suggesting fail safe thermostats had not been fitted; lights not working. The Water Regulations appear not to be complied with (such as shower hoses that could reach to the floor). Wiring near bath; bath hoist damaged; curtain of its hooks; door lock faulty. We also saw and photographed for identification purposes a number of small insects in shower/bathrooms. We conclude that junior staff are not observing and reporting maintenance problems quickly enough, for example in a bedroom where we interviewed a member of staff there were a number of maintenance problems which were corrected only after we drew the items to the attention of the maintenance person. Senior Southern Cross estates staff appear not to be auditing this property as effectively as they might. We acknowledge however that the on site maintenance person quickly attended to those matters were brought to his attention. This home is not providing a good environment for residents and in some areas is potentially unsafe so it is assessed as poor on this occasion. Camberwell Green Nursing Home DS0000007012.V375021.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27 to 30: People using this service experience adequate good outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. We cannot assure residents that the staff team is always well trained, managed, supervised and available in sufficient numbers to meet the needs of the residents. EVIDENCE: We spoke to staff and checked their staff files and met with the latest manager who informed us that more than 50 of staff have an NVQ level qualifications. As part of the inspection process three staff personnel files were checked for references, criminal record checks, application forms and copies of identification. It was noted in 2008 that not all of the staff files had all the correct documents in place. Since our last visit the manager has arranged for all the staff files to be audited and any gaps in paperwork sorted out. This process was well underway when we visited again in April 2009; the necessary papers were ready for filing in the manager’s office. As with recruitment records the staff training records, were also not always up to date and there were gaps in mandatory training. The manager has reviewed staff training and all staff have been or are undergoing training and refresher courses on a wide range of safety and care related subjects. The registered person must monitor staff competencies through regular supervision, as this will influence the need for updates with regards to training. Training and development is now linked to the homes’ service aims and to the residents’ need and individual plans (for Camberwell Green Nursing Home DS0000007012.V375021.R01.S.doc Version 5.2 Page 19 example training in end of life care). Formal supervision sessions are now be held with all care staff at least six times a year for the delivery of good quality services and staff we spoke to confirmed this to be the case. The AQAA [Annual Quality Assurance Assessment] the home sent us tells us about how diversity is addressed in this home. For example in 2008 the home was providing service to 48 Residents of whom 29 were female and 19 male; and the home has 43 female staff and 9 male staff. The home then had 38 ‘white European’ residents and 10 from ‘other ethnic groups’; conversely the home has 2 member of staff who are ‘white European’ and the remaining 37 were from ethnic minority groups, mainly Africa and Caribbean. From our observations the picture is much the same this year. Whilst the staff team does not reflect the ethnic background and culture of the resident group it seems to reflect the background of the local workforce available for recruitment. This section is assessed as adequate because the training for safeguarding and therefore staff knowledge in this area, such as whistle blowing, is still not to a good standard although we acknowledge that training is scheduled to be completed within a month. Camberwell Green Nursing Home DS0000007012.V375021.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31, 33, 37 and 38: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. We cannot assure residents this home is being run in their best interests with their safety and well being paramount. EVIDENCE: The key issue under this heading of management and administration is, as a resident has observed, the instability of the management team. Three managers within a year is very poor indeed. We assess this section as adequate not on the basis that the current manager Mrs Delany is less than good but because of the recent track record of management changes. The resident who commented tells us these changes have affected staff attitude and moral and therefore has had an adverse impact upon the delivery of care. The new manager has it seems brought clarity and leadership to the running of Camberwell Green Nursing Home DS0000007012.V375021.R01.S.doc Version 5.2 Page 21 Camberwell and the training and supervision of the staff team and is commended for her skills in turning the home from poor to adequate in a relatively short time. Mrs Delaney tells us that she will be submitting an application for registration shortly. The registration process will then formally assess her ‘fitness’, suitability and competence to run this home but at the time of this inspection, April 2009, the home is still without a registered manager. We note and commend the wide range of improvements made since our previous visits and this includes care planning, the introduction of activity coordinators, improvements to the environment such as the kitchen, employment and recruitment practices and record keeping. We are particularly impressed by the fact that this manager has paid attention to the Commission’s findings and has acted upon them with alacrity and robustness; this gives the Commission some confidence that life for residents will improve in this home - if some stability in management can be maintained. Camberwell Green Nursing Home DS0000007012.V375021.R01.S.doc Version 5.2 Page 22 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 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X X 3 2 Camberwell Green Nursing Home DS0000007012.V375021.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15 Timescale for action Care plans must reflect social as 30/07/09 well as health needs. This is so residents experience a lifestyle that suites their needs. Meals, it is required that choice 30/07/09 be offered at the time of service. So as to offer choice in a more meaningful way. Safeguarding residents: All staff 30/07/09 must have regular and updated refresher training in protecting residents from abuse. This is so that all staff know how to report allegations of abuse in a timely manner to the local care management team. Staff are to be reminded that ‘care manager’ in this context refers to social service staff and not the home’s manager. The timescale for this is extended as a training programme is in place. Water safety, the home must 30/07/09 ensure all water outlets comply with water regulations and (where residents will use the water supply such as baths and DS0000007012.V375021.R01.S.doc Version 5.2 Page 24 Requirement 2 OP14 16(2)i 3 OP16 OP18 13(6) 4 OP19 OP38 13(4) Camberwell Green Nursing Home 5 OP19 OP38 23(4)(4A) 6 OP26 16(2)j 7 OP31 OP33 OP37 8 showers) there must be suitable fail safe valves fitted. This is so as to protect residents from harm. Safety and maintenance: All fire 30/07/09 doors must be maintained in good working order. This is so as to protect residents from risks of spread of fire and smoke. This requirement is restated because different issues have arisen on this occasion. Hygiene, the home must 30/07/09 maintain cleanliness and hygiene and eliminate infestations of insects. This is so as to protect residents from harm. Manager: The home must 30/07/09 appoint and register a manager without delay (Section 11 of the Care Standards Act applies). This is so that residents will know the home is being run by a fit and competent person. 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 OP16 Good Practice Recommendations Complaints, it is recommended that the service review the way in which it responds to and gives feedback to residents and visitors who raise concerns with the organisation. This is so that residents will feel listened to. Hearing, it is recommended that portable hearing devices be provided, (available from RNID). This is to assist residents when being interviewed. Garden and boundary fences: It recommended the home review the external facilities available for residents including the provision of safe boundaries and an enclosed private garden. 2 3 OP22 OP19 Camberwell Green Nursing Home DS0000007012.V375021.R01.S.doc Version 5.2 Page 25 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Camberwell Green Nursing Home DS0000007012.V375021.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!