Inspection on 21/08/06 for Camberwell Green Nursing Home

This inspection was carried out on 21st August 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 11/12/06

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 11:00 21 , 22 & 31 August 2006 st nd st 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.V309605.R02.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.V309605.R02.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.V309605.R02.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 24th November 2005 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 four vacancies. 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.V309605.R02.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 three days in August 2006. The inspector spent the first two days at the home talking with service users and relatives, managers and staff, going through records and touring the building. The inspector spent the third day telephoning relatives. Service users spoken to were not specific about many things but generally said they had no problems at the home. In general terms, of the twelve relatives spoken to, three thought this was a good home, six thought it was bad and three were more neutral. Relatives’ specific comments are included in the main body of the report. The inspector was concerned about the number of issues that arose during this inspection and a meeting with the provider was arranged following the writing of the draft report. What the service does well: What has improved since the last inspection? • • Care plans are clearer and more consistent. Staff at the home are receiving training and input from external professionals in order to improve how they care for someone when they are dieing. Staff have worked hard to try and offer more meaningful activities to service users. DS0000007012.V309605.R02.S.doc Version 5.2 Page 6 • Camberwell Green Nursing Home • • There is now a manager in place who has been registered with the Commission. Work has been done to train staff in the area of protection of vulnerable adults which will improve staff’s understanding of the issues. What they could do better: Standards assessed at this inspection showed that the home must do more work: • • • • Assessments of prospective service users must be written down for selffunding service users. Care plans must always be reviewed every month. Care plans must be drawn up with the involvement of the service user or their representative. 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. 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. 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. DS0000007012.V309605.R02.S.doc Version 5.2 Page 7 • • • • • • • • • Camberwell Green Nursing Home • • • • • • Staff must have annual assessments of their training needs and 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. Staff must be supervised and appraised regularly by senior staff who have been trained to do so. Record keeping must be accurate and effective. Appropriate procedures for infection control, specifically the availability of hot water, must be in operation. 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. Camberwell Green Nursing Home DS0000007012.V309605.R02.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.V309605.R02.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 at least once during a 12 month period. 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. Usually senior staff visits a prospective service user before they move to the home to make sure that the home can meet their needs. These assessments are not always written down for self funding service users which means that staff may not always have the information they need to draw up the first care plans for service users. Standard 6 is not applicable as the home does not provide intermediate care. EVIDENCE: There is new legislation in place that will come into force on 01/09/06 and 01/10/06 which will require homes to state exactly what fees each service user is paying and how it breaks down into different areas, in the service user guide. (See Recommendation 1) The Registered Manager said that the assessment procedure was the same as at the last inspection. At the last inspection the manager said that senior staff Camberwell Green Nursing Home DS0000007012.V309605.R02.S.doc Version 5.2 Page 10 will visit a prospective service user to make their assessment prior to them coming to the home. None of the files examined during this inspection showed a written assessment by the home of someone’s needs, only some files had Community Care Assessments on file. The assessment of the one self-funding service user was given to the Commission following the inspection but the issue of not being able to access the information during the information was still the same. (See Requirement 1) Camberwell Green Nursing Home DS0000007012.V309605.R02.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 at least once during a 12 month period. 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. Plans for staff to meet service users’ needs are drawn up and written down using the same format throughout the home. Care plans are not always reviewed every month as required which means that service users may not have their changing needs met by staff. Not all care plans are drawn up with the involvement of the service user or their representative, which means that staff do not know if they are really meeting all the needs of service users. Records of health care monitoring are not consistent or effective which means that either health care needs are not being met as required by care plans and external professionals’ advice or staff are not recording that they are meeting these needs effectively. Not all medication procedures are being followed consistently by staff which means that medication may not be being stored and administered as required. Camberwell Green Nursing Home DS0000007012.V309605.R02.S.doc Version 5.2 Page 12 Staff at the home are receiving training and input from external professionals in order to improve how they care for someone when they are dieing. EVIDENCE: There was a previous requirement that the Registered Manager must ensure that all care plans are consistent, written with the involvement of the service user and reviewed monthly as required. The new organisation has introduced new forms for care plans to be written on and staff have worked hard getting used to these new forms. All care plans had been rewritten in April 2006. The inspector examined eight service user files from the four floors. Care plans are now written for all service users and cover all areas of need and risk. Care plans are clear and the daily notes shows that nurses are referencing some of those care plans in their daily work. However, some but not all care plans had been reviewed every month as required. One service user had guidelines in place around swallowing from the borough’s Speech and Language therapists from February 2006 but these had not been transferred to a care plan format so they had not been reviewed monthly. Some but not all care plans had been signed by the service user or their representative. (See Requirement 2) A general problem seemed to be that the new forms in use include a section of many forms to record all health monitoring such as weight, blood pressure, turning and food/fluid intake or output. Sometimes staff were using the forms but sometimes they were using their own forms held elsewhere i.e. there was no consistency. One member of staff said that they did not understand all the forms they had to use. The Registered Manager said that someone from the head office will be visiting the home soon to train staff in how to use the forms. (See Requirement 3) Records of dressings changes and wound assessments were occurring regularly and as stated in care plans. One dependency assessment stated that the service user was at no risk of pressure sores but they in fact did have a pressure sore. Two body maps did not include full details of the service users’ sores or discoloured areas. One care plan stated that due to rapid weight loss a service user had to be weighed weekly and then later twice a week. Records showed that this service user was only being weighed monthly and they had lost six kilograms between July and August. Camberwell Green Nursing Home DS0000007012.V309605.R02.S.doc Version 5.2 Page 13 Some service users had care plans stating that their food intake must be monitored but the records showed that the amount of food taken was not recorded, just what type of food. Some service users had care plans stating that their fluid input and output must be recorded but records showed that totals were not being recorded of the input and output so no monitoring of daily amounts was taking place. One care plan stated that a service user must be turned or moved regularly but no records were maintained of turning at night. There were records being maintained of that service user being checked every two hours but not of being turned or moved. (See Requirement 4) There was a previous requirement that the Registered Manager must ensure that service users are consulted about their preferred times of getting up and going to bed, that this is recorded in their care plan and that in practice this is carried out by staff. There are night care plans in place now and some of these state which times a service users wants to get up and go to bed. The inspector was not able to judge if people are getting up and going to bed at those times. Risk assessments for service users who needed cot sides at night were not always being completed and although care plans stated the need for consent, this was not being sought. (See Requirement 5) There had been two complaints recorded since the last inspection about clothes going missing, which had later been found. One recent adult protection investigation had in part focussed on clothes going missing and one service user reported during the inspection that some of their clothes had gone missing, some of which had been found and some which hadn’t. They also reported that they had found some jewellery in their drawer that was not theirs. One relative said that they now do all the laundry for their service user as their clothes keep going missing even though their name is written in them. One relative said that clothes keep going missing or getting torn. Following the inspection the Operations Director told the inspector that there are statements in the Service User Guide telling service users that they cannot be responsible for laundry that is damaged during normal laundry procedures but this still leaves the problem of clothes going missing.(See Requirement 6) One relative said that their service user regularly didn’t get shaved as they wished. The inspector noticed some men during the inspection who looked unshaven. (See Requirement 7) The inspector checked the medication stocks and records on all floors. There was a previous requirement that the Registered Manager must ensure that stock checking procedures ensure that accurate records are maintained of Camberwell Green Nursing Home DS0000007012.V309605.R02.S.doc Version 5.2 Page 14 all medication held in the home at any time. Some of the stocks of medication checked did not tally with the records. (See Requirement 8) There were some gaps on the medication records where medication had not been signed for. (See Requirement 9) There were some records that stated that medication had to be taken “as directed” as opposed to stating specifically when it had to be administered. (See Requirement 10) Some medication was only to be taken when required by the service user but staff were signing for this when it was not taken as opposed to only when it was taken. (One nurse said that she had been told to do this by the community pharmacist but the Commission’s advice is that this should not be done. Given the difference in advice, the inspector said they would raise this issue again with the Commission’s pharmacist inspectors and get back to the home at a later date). (See Requirement 11) There was a previous requirement that the Registered Manager must ensure that staff respect service users’ privacy and dignity at all times particularly in the areas of knocking on doors before they enter and not speaking about other service users’ issues in front of people. The inspector saw staff knocking on doors and waiting for an answer before they entered. 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. Staff on one floor said that they had a written care plan in place for someone who had died recently but that file was not available. There was one service user who was being visited by the St Christopher’s nurse because they were close to dying and they did not have a death and dieing care plan in place on file. The St Christopher’s nurse told the inspector that they are currently working on developing relationships with staff at the home so that they feel comfortable calling them out when they need help with someone who is dying. The St Christopher’s Hospice will be offering more training to staff in this area. The home has started working with the Gold Standard Framework which is a protocol from the GP which can prevents someone being sent to hospital if they do not wish to be and if there is nothing that can be done for them. The St Christopher’s Nurse felt that it would be useful for the home to use the Liverpool Care Pathway which would provide a checklist for staff to use when someone is reaching the end of their life. Although the Registered Manager and deputy were aware of this pathway they were not yet ready to operate it in the home. The Operations Director later told the inspector that the Care Home Support Team (CHST), who offer training and support to all nursing homes have not been recommending the Liverpool Care Pathway. The Commission will check with the CHST to make sure that they are offering the same advice and training as the palliative nurses. Although the home is working on this Camberwell Green Nursing Home DS0000007012.V309605.R02.S.doc Version 5.2 Page 15 area, the standard is not yet met however further training is in place and the St Christopher’s Nurse said that things are improving so this will be further assessed at the next inspection. The previous requirement is not met though and has to be repeated. (See Requirement 12) Camberwell Green Nursing Home DS0000007012.V309605.R02.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff have worked hard to try and offer more meaningful activities to service users but more work must be done to make sure that service users have an individual programme of activity that is interesting and useful to them. Service users can have visitors to the home as they choose but they are not supported to go out into the local community regularly. Generally service users are happy with the food that is on offer although some service users would want some improvements. As the caterer is about to change in the next few weeks this issue was not fully assessed during this inspection. EVIDENCE: There was a previous requirement that the Registered Manager must ensure that a consultation is carried out with all service users as to what activities they would choose to engage with on a day-to-day basis. The results of this survey must then lead to an individual programme of activities support being drawn up in the care plan and offered to each service user. Files showed that service users do now have assessments on file of what they like to do. Camberwell Green Nursing Home DS0000007012.V309605.R02.S.doc Version 5.2 Page 17 However, although everyone also has one or two care plans in place around social activities these plans are the same typed care plan saying that they will do the same things with just a space left to insert the name of the service user. One of these plans was in place at the last inspection, the other has been drawn up since the last inspection. Relatives and friends can visit the home when they choose and some relatives said that staff are very friendly when they visit. The activities file shows that the activities co-ordinator spends a lot of time with service users on a 1:1 basis but there is little evidence from these records of service users doing things that they have specifically said they liked to do e.g. one service user likes playing dominoes but has not played dominoes according to the records. It appeared from the records that some reminiscence work has begun on a 1:1 basis but it was not clear if all the people offering this have been trained in reminiscence work and no group is offered in the home. Further evidence was provided to the Commission following the inspection that showed that reminiscence groups have been offered by someone trained to do so. While it is obvious that attempts have been made to do work in this area, further attention is needed to the service users’ needs other than their health care and personal care requirements. (See Requirement 13) There was a previous requirement that the Registered Manager must ensure that a consultation takes place around the issue of food at the home that includes reference to cultural, ethnic and other preferences and that the results of this consultation are acted upon. There had been a consultation in April 2006 and the Registered Manager said that the menus had been revised in response to this survey, although the previous menus were not available so the inspector could not assess how the menus had changed. One service user said that generally the food was ok but that they would like to be able to have egg and bacon for breakfast sometimes instead of porridge all the time as the cooked breakfast option. On the second day of the inspection the evening meal was not was what stated it should be on the menu. The provider of the meals at this home is changing in the next two weeks so no requirements are yet being made and this standard will be more fully assessed at the next inspection but the inspector will expect these issues to be addressed in the interim. Camberwell Green Nursing Home DS0000007012.V309605.R02.S.doc Version 5.2 Page 18 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 inspected at least once during a 12 month period. 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 relatives say that they often make complaints and things do not change or they change for a while and then they have to complain about the same issue again. 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. 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. The home has a comments book in the front entrance, which contained some comments that had been followed up by the Registered Manager but several relatives told the inspector that they had complained to staff and to the managers about several issues over the past few months, none of which were recorded in the complaints book. Three relatives said they had complained about issues a few times but nothing seemed to be done about it. One relative said they had complained about a very serious issue about a member of staff, one which should have been investigated as an adult protection issue but they did not know what had Camberwell Green Nursing Home DS0000007012.V309605.R02.S.doc Version 5.2 Page 19 happened. The Commission had not been informed of this complaint or allegation. (See Requirements 14, 15 & 17) There was a previous requirement that the Responsible Individuals must ensure that all staff attend training around protection of vulnerable adults. Training records showed that sixteen staff have attended this training with a senior manager in the organisation since the last inspection. A full up-to-date staff list was not available for the inspector but the Registered Manager said that he currently had around twenty-two staff working in the home. Work has therefore been done to meet the previous requirement but a few more staff have to attend the training before it is met. (See Requirement 17) Camberwell Green Nursing Home DS0000007012.V309605.R02.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 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. 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. The home is generally clean but on one day of the inspection one area of the home smelled offensive. Camberwell Green Nursing Home DS0000007012.V309605.R02.S.doc Version 5.2 Page 21 EVIDENCE: There was a previous requirement that the Registered Manager must arrange for service users to be provided with keys to their rooms unless their risk assessment suggests otherwise or they choose not have them. Files showed that service users have been consulted and some now hold their own keys. 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. It appeared that two bathrooms had been painted since the last inspection and there now a picture in one of the large bathrooms but in general the bathrooms were still the same as at the last inspection with some of them now needing decoration because of chipped paintwork. The Operations stated that all bathrooms had been decorated since the last inspection but as the work would have been done by the organisation’s handyperson there are no records to evidence this and the inspector did not agree that the bathrooms were of an acceptable standard yet. (See Requirement 18) 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. The registered manager had contacted the inspector before the inspection to say that the organisation had not yet organised this assessment. (See Requirement 19) On the tours of the building the shared areas of the home were clean but during the first day of the inspection at the home the first floor smelled very strongly of urine. One relative said that the home often smells of toilets when they visit, particularly at the weekend. (See Requirement 20) Camberwell Green Nursing Home DS0000007012.V309605.R02.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 at least once during a 12 month period. 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. There are not enough staff on duty to fully meet the needs of service users at all times. While some relatives spoke about staff being caring and warm other comments from relatives raised concerns about the ability of some staff to care for service users effectively and appropriately. 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 do not have annual assessments of their training needs and do not have training plans in place which means that they may not be getting the training the need to do their jobs. The organisation’s recruitment procedures are not robust which means that the organisation does not know or cannot show that the staff they are employing are fit to do the job and service users may be receiving support and care from people who are not competent to do so. EVIDENCE: Camberwell Green Nursing Home DS0000007012.V309605.R02.S.doc Version 5.2 Page 23 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 and there was a previous requirement that the Registered Individuals must ensure that a staffing review takes place that establishes how many hours of care and support service users require (to include social and recreational support) and how those hours are being met by the numbers of staff currently on duty. This review must be sent to the Commission. The Registered Manager said that he had conducted a review of service users by finding out which were low, medium or high dependency but he had not attached the number of required hours to each of these three categories so there was no way to review how many hours were needed on each floor. Further evidence was provided to the Commission following the inspection showing that another review had been carried out. On one day of the inspection one nurse was on one floor with fourteen service users. She said that other staff had gone downstairs with service users who were in the lounge and that they could come back up if they were needed. Relatives talked of their service users remaining in their rooms all day and seeming like no one was with them. One relative was very concerned that their service user was not getting enough to drink because they were in their room and they could not lift their cup and staff did not go in to help them drink. One relative said that staff did not put away laundry, they left it in the laundry bag and the relatives had to put it away. One relative said that their service user had their incontinence pad changed in the morning but then they had to wait until the evening until it was changed again. Another relative said that they regularly had to ask staff to change their service user’s pads as they had defecated in them in their room while in bed and no one was around to change them. Another relative said that their service user has to call out for staff to take them to the toilet and had to wait a long time and often has to mess themselves because staff don’t come in time. One relative said that their service user did not get shaved regularly and he could not do it himself. One relative said that their service user wants to bathe at the weekend but has not been allowed to because there are not enough staff around to do it then. (See Requirements 21 & 22) 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 said that because of the change of organisation, the NVQ provider has changed which has led to people stopping their previous NVQ programme while the new provider took over. He said that two staff hold the NVQ and another nine are registered to begin it again soon. Work is being done to meet this requirement but it is not yet met. (See Requirement 23) The inspector examined nine files of staff who had been recruited since the last inspection. Camberwell Green Nursing Home DS0000007012.V309605.R02.S.doc Version 5.2 Page 24 The home’s managing organisation has changed recently and it appeared that the recruitment procedures of the new organisation are more effective than the last however some problems were noted. Generally two references were being received back for all staff but these were not always stamped or on headed notepaper or no note had been made of how else the reference had been verified. (See Requirement 24) Gaps in an applicant’s employment or educational history were not being investigated. (See Requirement 25) The Registered Manager said that POVAFirst check has been used as a matter of course to start staff without a Criminal Records Bureau check being received back. This is only supposed to be used as an emergency and there are specific additional requirements that have to be met when this is used. (See Requirement 26) Two interview records were not always maintained for each staff member and there were no comments made on how they answered the questions, just tick boxes in some cases. One of the questions being asked in the health care assistant interview was how they would facilitate team building, when there is no expectation on that role of any facilitation of team building. (See Requirement 27) One member of staff had an interview record that showed they had given an unsatisfactory interview. They had no previous experience of care and had only undertaken some training courses in first aid and care. They had two references of file but neither made any reference to their ability to do the job. They had no record of any supervision on file. There was no note on record as to why this person had been hired in spite of their unsatisfactory interview. The Registered Manager said that staff can be hired with no experience because they can be trained and supervised to do the job but appropriate training and supervision was not being evidenced by the records. (See Requirement 28) There was a previous requirement that the Responsible Individuals must ensure that there is an Induction and Foundation programme in place that covers the requirements of the Skills For Care (previously TOPSS) standards. There is an Induction and Foundation programme now in place so this requirement is met although the inspector had concerns about how the programme was being operated. There is a checklist in place that is to be completed within two days of starting at the home and then the Induction programme, which is supposed to be completed within six weeks of starting. Some staff had no six-week induction record. Some of the records had not been completed for staff who had been working longer than six weeks and none had any comments on them as to what evidence had been used or how the staff member had been assessed, they were just signed and dated. Some Camberwell Green Nursing Home DS0000007012.V309605.R02.S.doc Version 5.2 Page 25 of the records had the same date for all areas of the form, which were supposed to be covered over the six-week period. No staff had a six-month foundation programme on file or a six-month assessment of their probationary period. (See Requirements 29 & 30) There was a previous requirement that the Responsible Individuals must ensure that staff attend training around Care Planning and End of Life Care. Three staff have attended care-planning training and five staff have attended end of life training with seven attending palliative care awareness. Training records showed that some areas have been focussed on in the past year such as manual handling, health and safety and fire training whereas there are some areas that need attention such as fall awareness and infection control. Because staff have not had annual appraisals they do not have individual training and development plans on file which show what training they need to meet the needs of service users. These plans have not been brought together into an overall annual training plan for the home. (See Requirement 31) Some relatives said that some staff were lovely, warm and caring. They noted some particular individuals who they said they couldn’t praise enough. Some relatives said that some staff were “rough” with their service users with two relatives saying that their service users had been scared of staff. Some had concerns about the ability of some staff to understand and communicate with service users. Two relatives said that staff needed more patience and more training. One relative said that staff talked to each other in languages other than English in front of English service users. One visiting professional said that they had seen different groups of staff shouting at each other in front of service users. The inspector spoke with the Registered Manager about issues of diversity and difference within the care home. (See Requirement 32 and Recommendation 2) Camberwell Green Nursing Home DS0000007012.V309605.R02.S.doc Version 5.2 Page 26 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 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. Procedures to manage service users’ money are not being operated effectively which means that the home is not safeguarding service users’ money as required. Staff are not supervised or appraised regularly by senior staff who have been trained to do so which means that service users are receiving care from staff who are not getting enough advice and support. Record keeping, as mentioned throughout the report, is not accurate which means that the home is not protecting service users interests by effective holding of information. Health and safety procedures are generally operated as required which means that service users are protected from harm but some significant lapses have meant that service users have been put at risk recently. Camberwell Green Nursing Home DS0000007012.V309605.R02.S.doc Version 5.2 Page 27 EVIDENCE: There was a previous requirement that the Registered Individual must ensure that the new manager puts in an application with the Commission to become Registered Manager as soon as they commence employment. This has now been done and the manager has been registered with the Commission. 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 other issues raised during this inspection, the inspector decided that these issues would be more usefully assessed at the next inspection. (See Requirement 33) The inspector noted two significant issues during this inspection that had not been reported to the Commission as required. (See Requirement 34) There was a previous requirement that the Registered Manager must ensure that the cabinets containing service users files are kept locked at all times. The cabinets checked during the inspection were locked. The inspector examined the financial recording of service users money and found that sometimes only one member of staff signed for certain items not two. There were items recorded as “shopping” on the record but no receipts were available. The Registered Manager said that this was because the service user took the money away to spend themselves but had not signed for it. Receipts were not all attached to the home’s finance dockets for each item recorded which made it very difficult to audit the accounts. (See Requirement 35) Service users do not get a monthly statement for the home of their account with the organisation. (See Requirement 36) One some records service users’ personal allowance was not being recorded weekly as going into their account. The Registered Manager said that this was because the family managed their finances. Three relatives were uncertain whether their relatives were getting their personal allowance from the home as they should be each week and one relative talked of how they had turned up at the home and their service user had looked grubby and in tattered clothes and staff had told them that they did not have enough money to buy clothes. (See Requirement 37) Of the nine files examined only two staff had any records of supervision sessions. Some staff had only been working at the home for one or two months but the inspector would expect new staff to receive supervision within their first month and two members of staff had started at home in January Camberwell Green Nursing Home DS0000007012.V309605.R02.S.doc Version 5.2 Page 28 2006 and received no supervision as yet. The organisation’s policy is that staff have six supervision sessions a year. Staff who offer supervision have not had training in how to conduct supervision and appraisals. (See Requirements 38 & 39) Staff have not had annual appraisals. The Registered Manager said that they had been due in December 2005. Most of the health and safety documentation and checks were in place and in order. During the inspection, the inspector noted that there was no hot water on the ground or first floors of the home, including bathrooms, toilets and the kitchen (the shower on the first floor did have hot water). Different staff said that this had been ongoing for different periods of time but they all said that it had been difficult to manage. The Registered Manager said that an engineer had visited thirteen days before the inspection and said that the boiler was unfixable. The Registered Manager said he was not aware of any problems on the first floor, believing it only to be the ground floor affected. The water temperature tests in the home had not been taken in June or July on the ground and first floors. This issue had not been reported to the Commission. An immediate requirement was left to replace the boiler within forty-eight hours. The engineers said they had to order a new boiler and wouldn’t be able to fit it until the 29th August. The Registered Manager was told to conduct emergency risk assessments for all service users regarding any health and personal care issues they had, along with risk assessments for the toilets, kitchen and home infection control. (See Requirements 40 & 41) Camberwell Green Nursing Home DS0000007012.V309605.R02.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 2 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 2 2 3 X 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 2 2 2 2 Camberwell Green Nursing Home DS0000007012.V309605.R02.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 OP3 Regulation 14 (1) Requirement The Registered Manager must ensure that there is a written assessment on file of all service users who are self funding at the home, that has been undertaken by qualified staff from the home and which meets the requirements of the standard. 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. Part of unmet requirement: Previous timescales 30/11/05 & 31/03/06 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. 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. DS0000007012.V309605.R02.S.doc Timescale for action 30/11/06 2. OP7 12 (2) (3) 15 30/11/06 3. OP7 18 (1) (c) (i) 30/11/06 4. OP7 OP37 12 (1) & 17 (1) 30/09/06 Camberwell Green Nursing Home Version 5.2 Page 31 5. OP8 OP7 12 (1) & 15 (1) 6. OP8 12 (1) 7. OP8 12 (1) 8. OP9 13 (2) 9. OP9 13 (2) 10. OP9 13 (2) 11. OP9 13 (2) 12. OP11 12 (1) & 15 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. The Registered Manager must ensure that service users do not have clothes and other possessions go missing. The Registered Manager must ensure that all service users are shaved or receive other personal grooming regularly and as they choose. 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. Previous requirement: Unmet timescale 31/12/05 The Registered Manager must ensure that all medication is signed for at the point of administration. 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. The Registered Manager must ensure that medication to be taken “as required” is only signed for when it is taken. (This requirement has been referred back to the Commission’s pharmacist inspectors as they give this advice but it is conflict with community pharmacist advice that the home has received). The Registered Manager must ensure that all agreed guidelines and procedures in the event of someone’s dying and death are DS0000007012.V309605.R02.S.doc 30/09/06 31/10/06 30/09/06 31/08/06 31/08/06 31/08/06 31/08/06 30/09/06 Camberwell Green Nursing Home Version 5.2 Page 32 13. OP12 16 (2) (m) & (n) 14. OP16 22 15. OP16 22 16. OP18 13 (6) 17. OP18 13 (6) & 18 (1) (c) (i) 18. OP21 12 (3) & 23 (2) (d) clearly recorded in the service users’ files/care plans. Previous requirement: Unmet timescale 31/01/06 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. 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 timescale 31/03/06 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. The Registered Manager must ensure that all allegations are recorded and appropriately investigated and that the appropriate authorities are informed. The Responsible Individuals must ensure that all staff attend training around protection of vulnerable adults. Previous requirement: Unmet timescale 31/03/06 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 DS0000007012.V309605.R02.S.doc 31/10/06 31/08/06 31/08/06 31/08/06 30/11/06 30/11/06 Camberwell Green Nursing Home Version 5.2 Page 33 19. OP25 23 (2) (n) 20. OP26 16 (2) (k) 21. OP27 18 (1) (a) 23. OP28 13 (6) & 18 (1) (c) (i) 24. OP29 19 (1) (4) & (5) 25. OP29 19 (1) (4) & (5) 26. OP29 19 (1) (4) & (5) requirement: Previous timescales 31/12/05 & 31/03/06 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. Unmet requirement: Previous timescales 31/12/05 & 31/03/06 The Registered Manager must ensure that the home is free from offensive odours at all times. The Registered Manager must ensure that there are sufficient staff on duty at all times to ensure that all service users needs are met. Unmet requirement: Previous timescales 31/12/05 & 31/03/06 The Registered Individuals must ensure that 50 of non-nursing care staff hold the NVQ Level 2 in Care. Unmet requirement: Previous timescales 31/12/05 & 31/03/05 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. The Registered Individuals must ensure that all gaps in employment or education are investigated and a record made of the investigation. The Registered Individuals must ensure that the POVAFirst check is not used as a matter of course to start staff at the home without DS0000007012.V309605.R02.S.doc 30/11/06 31/08/06 31/08/06 30/11/06 31/08/06 31/08/06 31/08/06 Camberwell Green Nursing Home Version 5.2 Page 34 27. OP29 19 (1) (4) & (5) 28. OP29 19 (1) (4) & (5) 29. OP30 18 (1) (c) (i) & (2) 30. OP30 18 (1) (c) (i) & (2) 31. OP30 OP36 18 (1) (c) (i) 32. OP30 12 (1) & receiving back a full enhanced Criminal Records Bureau check. 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 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. 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. 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. 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. The Registered Individuals must DS0000007012.V309605.R02.S.doc 31/08/06 31/08/06 31/08/06 30/11/06 30/11/06 30/11/06 Page 35 Camberwell Green Nursing Home Version 5.2 18 (1) (c) (i) 33. OP33 12 (3) & 24 34. OP33 26 35. OP35 12 (1) & 13 (6) 36. OP35 12 (1) & 13 (6) 37. OP35 12 (1) & 13 (6) 18 (1) (c) (i) & (2) 38. OP36 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. 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. 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. 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. The Registered Individuals must ensure that all service users whose money is managed by the organisation, receive individual monthly statements of their accounts. The Registered Individuals must ensure that all service users receive their weekly personal allowance as required. The Registered Manager must ensure that all staff who offer supervision and appraisals have DS0000007012.V309605.R02.S.doc 30/11/06 31/08/06 31/08/06 30/11/06 31/08/06 30/11/06 Camberwell Green Nursing Home Version 5.2 Page 36 39. OP36 18 (2) 40. OP38 13 (4) (a) & (c) 41. OP38 13 (4) (a) & (c) received training in how to do so and have been judged as competent to do so. The Registered Manager must ensure that all staff receive supervision regularly and as per the organisation’s policy i.e. six times a year. The Registered Individuals must ensure that there is hot water in all parts of the care home. (This had been met by the time the final report was written) The Registered Individuals must ensure that emergency risk assessments are undertaken to establish appropriate measures to be taken to protect the health and welfare of service users while the boiler is being fixed. (This had been met by the time the final report was written) 30/09/06 23/08/06 22/08/06 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. Refer to Standard OP1 Good Practice Recommendations The Registered Individuals should begin work on establishing exactly how each service users’ fees break down and put these in their service user guide. (This will become a legal requirement on 01/09/06 for current service users and 01/10/06 for new service users). 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. 2. OP30 Camberwell Green Nursing Home DS0000007012.V309605.R02.S.doc Version 5.2 Page 37 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 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.V309605.R02.S.doc Version 5.2 Page 38 - 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!