Inspection on 26/06/07 for Camberwell Green Nursing Home

This inspection was carried out on 26th June 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report 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 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 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 09:30 26 June & 3rd July 2007 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Camberwell Green Nursing Home Address Camberwell Green Care Centre 54 Camberwell Green Camberwell London SE5 7AS 020 7708 0026 020 7708 0027 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.southerncrosshealthcare.co.uk 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.V341959.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This home will accommodate 55 nursing care service users aged 60 years and above (female) and 65 years and above (male) and chronic sick and disabled persons aged 40 years and above Date of last inspection 11th December 2006 Brief Description of the Service: Camberwell Green Care Centre Care Centre is run by the organisation Southern Cross. 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 three vacancies. The current fees for a place at this home are £500-£671. 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.V341959.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two days in June 2007 with two inspectors visiting the home on the first day and the lead inspector visiting again a few days later. The inspectors spoke with residents, relatives, staff, the Registered Manager and the Operations Manager, toured the building and checked records. Surveys were sent out to residents and relatives before the inspection and the lead inspector telephoned some relatives afterwards. Residents and relatives feedback was mixed with some being happy with the home and others less so but in general the feedback was better than at the last inspection. The inspector found that the majority of the requirements made at previous inspections had been met by this inspection but there were several more made at this inspection. This home has improved significantly since the last inspection but there is still considerable work to do to ensure that the home meets the National Minimum Standards. What the service does well: Standards assessed during this inspection showed that: • • • Senior staff visit a prospective resident before they move to the home to make sure that the home can meet their needs. Plans for staff to meet residents’ needs are drawn up and written down using the same format throughout the home. Care plans are clearer and more consistent, are drawn up with the involvement of the resident or their representative and are reviewed monthly. Residents can have visitors to the home as they choose. All residents have single rooms with en-suite bathrooms. Residents are protected from abuse by staff being trained and by effective policies and procedures. • • • Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Standards assessed at the home showed that the home must make sure that: • • • People who want to move to the home must be given all the information they need in order to make an informed choice about where to live. The food offered must be varied and hot meals must be served hot on all floors. Input must be gained into the activities programmes to make sure that the needs of isolated residents or those with sensory impairments are met. DS0000007012.V341959.R01.S.doc Version 5.2 Page 7 Camberwell Green Nursing Home • • • • • All complaints or allegations must be recorded and action taken to make sure that the service improves. All recommendations following the occupational therapist’s assessment of the home must be addressed. All areas of the home must be free of offensive odours. Staff must receive regular supervision from their line manager. Staff must receive the supervision and training they need when they first start work at the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who want to move to the home are not given all the information they need in order to make an informed choice about where to live. People who want to move to the home have their needs assessed before they are offered a place. Standard 6 does not apply as the home does not offer intermediate care. EVIDENCE: There was a previous requirement that the Registered Individuals must ensure that the breakdown of each service users’ fees is put these in the service user guide/statement of purpose as required by the new legislation. There have been statements put in the service user guide describing how the fees are broken down but no actual amounts have been included. The service user Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 10 guide and statement of purpose need to be reviewed as several personnel have changed and certain other details are now incorrect. (See Requirement 1) All residents have their needs assessed before they move to the home by a senior member of staff. These were seen on files. Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Generally all areas of care are written in a care plan that has been agreed by residents and care is offered in accordance with these plans but there are still some areas where healthcare must be improved. Residents have their needs assessed and are offered sensitive support when they are dieing. EVIDENCE: There was a previous requirement that the Registered Individuals must ensure that all service users’ weight, nutrition, pressure sore and other health care monitoring and records are maintained as required by care plans and external professionals advice, in detail and are accurate. Several care files were examined and although there were still a few errors in recording there had been sufficient improvement for this requirement to be deemed met. Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 12 Some files had bed rail assessments on file but these had not been signed by the resident or their next of kin. (See Requirement 2) There was a previous requirement that the Registered Individuals must ensure that care plans are changed when service users health or personal care needs change. Of the files examined, one was not changed when care needs had changed and some care plans were on file that had been completed but generally again there had been sufficient improvement for this requirement to be deemed met. There was a previous requirement that the Registered Manager must ensure that all service users (particularly those confined to their rooms) have access to drinks throughout the day. Drinks were seen in several service users rooms. There was a previous requirement that the Registered Individuals must ensure that additional efforts are made to ensure that staff are able to communicate with service users who do not speak English. The Registered Manager showed a tool that had been acquired that showed pictures that could be used if someone could not speak English but this is not being used yet in the home. Staff talked about how the local Speech and Language department will assist if someone’s speech needs to be developed or if there are problems with swallowing but there are some people in the home who cannot speak at all and staff just have to get to know them or what they want. Some care plans stated that photographs were required of wounds but these were not on file. Staff reported that they often have long delays in getting photographs developed. (See Requirement 3) There was a previous requirement that the Registered Manager must ensure that service users do not have clothes and other possessions go missing. There have been several occasions when clothes and items have gone missing in the past few months but there have been improvement in how this is monitored and most items are found. However property lists on some files had not been updated since the resident moved to the home. (See Requirement 4) On the first day of the inspection staff were offering personal care to residents in the communal lounge. (See Requirement 5) There was a previous requirement that the Registered Manager must ensure that stock checking procedures ensure that accurate records are maintained of all medication held in the home at any time (including topical preparations). There was a previous requirement that the Registered Manager must ensure that all prescribed creams and topical preparations are signed for at the point of administration. This is now being done. There was a previous requirement that the Registered Individuals must ensure that staff are trained in and the home operates such systems as the Gold Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 13 Standard Framework and the Liverpool Care Pathway to fully support someone according to best practice when dying. The home has worked with the Care Homes Support Team and St Christophers’ nurses over the past few months to improve the service in this area. Staff talked about how they would offer care and how they would involve families and GPs. Advance care plans were seen that described how staff would care for someone in the last days. There are some problems when families do not agree with he resident’s wishes to not be resuscitated or not to be taken to hospital. Staff said that they would often support the families wishes in this case although this will be against what the resident wants and may lead to problems with regard to the new Mental Capacity Act. (See Requirement 6) There was a previous requirement that the Registered Individuals must ensure that there is an organisational policy drawn up describing the current best practice the home will operate to ensure all service users’ needs are met when they are dieing. This has not yet been done. (See Requirement 7) Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Activities have improved in the home but there are still some people who are isolated and unable to maintain or develop skills. Residents can have visitors as they choose. The food meets some residents’ needs but sometimes it is not good enough or there is not enough choice. EVIDENCE: There were previous requirements that the Registered Manager must ensure that individualised care plans are drawn up for service users to ensure that social and recreational activities are offered that are meaningful to them and that activities are offered in accordance with all care plans in this area. Residents have such care plans and records of activities are maintained separately in an activities folder. There is one activities co-ordinator who works 36 hours per week and who works hard to try and conduct activities with all residents. There are groups offered most days and some trips have Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 15 started to happen. The activities co-ordinator said that she has to fund raise for funds for a day trip planned later in the year. On the first day of the inspection some residents were trying to watch tennis in the lounge while karaoke was going on and a game was being played. (See Requirement 8) Some residents do not want to or are not able to come down to the lounge to join in and they often spend a lot of time on their own in tier rooms. Some are happy to do this and some are not. Some service users are blind or deaf and would not get as much out of the activities as those who do not have sensory impairments. (See Requirement 9) Some reminiscence activities have been bought since the last inspection but there are still not many materials available and there is no reminiscence area. (See Requirement 10) There was a previous requirement that the Registered Manager must ensure that the TV reception is acceptable in all areas of the home. This is now the case. There was a previous requirement that the Registered Manager must ensure that all service users are shaved or receive other personal grooming regularly and as they choose. Residents appeared groomed and some records are kept of when residents want to have personal care done. There was a previous requirement that the Registered Manager must ensure that exercise is offered in accordance with care plans and is recorded and monitored effectively. All exercise must be offered by staff trained in how to do so safely. The activities co-ordinator is responsible for exercise but she has not had the time to do a lot of this and generally offers some individual passive exercise to people in their own rooms. There are no established programmes of exercise in place to ensure that residents maintain their physical abilities as much as possible. (See Requirement 11) There was a previous requirement that the Registered Individuals must ensure that service users are able to access the local community regularly, for instance by providing transport. Residents have been registered with the local Dial-a-ride service and access this when they wish to individually or when a large group activity is organised. Some residents or relatives said that food on the top floors is often cold but the time it gets to them. The cook said that this has been identified as a problem and he has asked for more food trolleys to be bought so that food doesn’t have to be plated up on the ground floor kitchen. Food menus still do not show a lot of variety for people wanting African or Caribbean food although the cook may be making different meals and not recording them as records are not maintained of what was actually made, only the menu of what was planned. Residents said that in the evening there are usually only sandwiches on offer and so if they do not want this then they have to have more of what they had for lunch that day. This is a particularly an issue for residents on Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 16 pureed meals who cannot eat sandwiches. (See Requirement 12 & Recommendations 1 & 2) Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate 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 some relatives say that they still voice concerns and do not hear anything about it. This means that residents and their relatives do not feel that they are listened to and taken seriously. Residents are protected from abuse by staff being trained and by effective policies and procedures. EVIDENCE: There were previous requirements 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 and that that the Registered Manager must ensure that all complaints (including verbal complaints) from service users or their relatives are investigated and actioned and the complainant is made aware of the outcome. Recording of formal complaints has improved and an audit is recorded every month. There had been one verbal complaint made to the senior manager in the past few weeks that had not been recorded and one complaint that was given to the inspector in a pre-inspection survey, which the Registered Manager said he was aware of from a relatives meeting, that had not been recorded. Relatives during the inspection told one inspector that they Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 18 often told staff or the manager about things they were not happy about but they weren’t often made aware of what happened about their concern. (See Requirements 13 & 14) There was a previous requirement that the Responsible Individuals must ensure that all staff attend training around protection of vulnerable adults. Most staff have now attended the training. There was a previous requirement that the Registered Manager must ensure that all allegations are recorded and appropriately investigated and that the appropriate authorities are informed. This now happens. Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There have been some improvements in the physical environment but there is still a long way to go and a thorough assessment has now been undertaken so the home does now know what it needs to do to make sure the environment meets the needs of residents. All service users have single rooms with en-suite bathrooms many of which have been personalised in ways they have chosen. Decoration in the toilets and bathrooms has improved and they are now more homely and less institutional. EVIDENCE: Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 20 There was a previous requirement that the Registered Individuals must ensure that the kitchen is deep cleaned and all necessary tiling and other remedial work carried out. The tiling had been done although a deep clean had not taken place. The floor of the kitchen has many indents so that it is no longer non-permeable and the fly screens are very dirty and some cannot be sealed. (See Requirement 15) There was a previous requirement that the Registered Individuals must ensure that there is a cyclical decoration and maintenance programme drawn up for all areas of the home. A copy of this must be sent to the Commission. This had been done. 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. This has now been done. There was a previous requirement that the Registered Individuals must ensure that the appropriate privacy locks are on bath/shower room and toilet doors. This has now been done. The fence around the front of the home is broken and ineffective as a security measure when the doors to the lounge are opened. (See Requirement 16) 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. A copy of this report must be sent to the Commission. The assessment has been done and the report makes many urgent, high and medium priority recommendations. (See Requirement 17) There was a previous requirement that the Registered Individuals must ensure that lighting in all parts of the home is adequate. Evidence of this must be sent to the Commission by the stipulated timescale. Lighting had been replaced by the OT assessment had been conducted after this and makes recommendations around lighting. This requirement is now included in the requirement to carry out the OT report recommendations. There was a previous requirement that the Registered Individuals must ensure that all required maintenance identified during this inspection is carried out. Evidence of this must be sent to the Commission by the stipulated timescale. This had been mostly done although there were still several door handles that needed fixing however again this has been included in the requirement to carry out the OT report recommendations. Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 21 One resident’s hot tap had been constantly running for several days. On the first day of the inspection two toilets on the ground floor were locked and staff reported that one was blocked and the other was broken. Neither of these issues were recorded in the maintenance book. (See Requirement 18) There were some staff notices in resident communal areas and on the top floor training materials had been left out. (See Requirement 19) There was a previous requirement that the Registered Manager must ensure that the home is free from offensive odours at all times. The ground and first floor of the home smelled of urine at the start of the inspection in the morning. (See Requirement 20) Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Induction, training and supervision have improved so generally residents are offered care by staff who are better able to do their jobs. Recruitment procedures are now effective so residents are protected by the organisation doing all the required checks on potential staff before they start work at the home. EVIDENCE: There was a previous requirement that the Registered Individuals must ensure that the additional staff hours requested by the Registered Manager and the Operations Manager are in place. Evidence of this must be sent to the Commission by the stipulated timescale. The hours had been increased on the ground and first floors. Presently day shifts finish at 8pm with the night staff starting at 8pm and night shifts end at 8am with day shifts starting at 8am i.e. there are no rota’d handover period for staff to discuss issues that need to be consistently managed. (See Requirement 21) Camberwell Green Nursing Home DS0000007012.V341959.R01.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. Some staff reported that they believed the need more staff and that they have to rush to do everything they need to do. Some service users said that it takes a long time for the call bell to be answered when they press it. Staffing has been increased on the first floor but the home had stated that the third floor may have been previously overstaffed. (See Requirement 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. 50 of staff have now registered for the NVQ. Residents said that staff were good. There was a previous requirement that the Registered Individuals must ensure that all references are stamped, on headed notepaper or some other method is used and recorded to verify the identify of the person providing the reference. This is now being done although the verification check isn’t always made with person who has written the reference (See Recommendation 3 & 4) There was a previous requirement that the Registered Individuals must ensure that CRB checks (or records of the number and dates of such checks) are on file for all staff and available for inspection. This is now being done. There was a previous requirement that the Registered Individual must ensure that at least two staff interview all applicants and records are kept of each interviewer’s notes and judgement. This is now being done. There was a previous requirement that the Registered Individuals must ensure that all staff offering support and assessment to staff during their induction and foundation period have received sufficient guidance and been judged as competent to offer such support and assessment. The training required by some staff has been cancelled a few times and so in the interim the Registered Manager or deputy offers support and supervision to new staff during the induction period. There was a previous requirement that the Registered Manager must ensure that all staff undergo a full induction and foundation programme during the first six weeks and then six months of their employment (Skills for Care have now changed this period to a twelve week induction period). Records of this induction and foundation must be maintained to include comments as to how the member of staff has progressed. Records of inductions are maintained however some of them show that an induction that is intended to take at least six weeks involving observations, assessments and pieces of work to evidence skills and understanding has been signed off as completed within a few days. (See Requirement 23) Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 24 There was a previous requirement that the Registered Individuals must ensure following an at least annual appraisal of their work performance and training needs individual training and development plans are drawn up. These individual plans must then be brought together into an overall annual training and development plan for the home. These are now in place. There was a previous requirement that the Registered Individuals must ensure that all staff understand the needs of service users and the expectations of staff while working at the home and that all staff can communicate effectively with service users. As far as could be assessed, this has improved. Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents’ money is now protected by the financial procedures in the home. Consultation with residents and relatives has improved and the home is doing more to respond to resident’s comments. Not all staff receive the training they need when they first start work at the home which means that relatively inexperienced and untrained staff may be working with residents and not know what they are doing. Staff now receive regular supervision from their line manager. Residents are protected by how staff operate the health and safety procedures. Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 26 EVIDENCE: There was a previous requirement that the Registered Individuals must ensure that the Registered Manager begins the Registered Managers Award NVQ. This has now been done. 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. Relatives meetings take place although attendance is low. Consultation had taken place earlier in the year and individual issues raised had been addressed. There is no ongoing annual development plan in place that links all quality monitoring together and establishes how standards will be raised continually. (See Requirement 24) There was a previous requirement that the Registered Individuals must ensure that all significant events that affect the welfare of service users are reported as required to the Commission. This is now done. There was a previous requirement that the Registered Individuals must ensure that all service users whose money is managed by the organisation, receive individual monthly statements of their accounts. The financial systems have been computerised and are generally much more robust than previously however service users have not yet been sent monthly statements of their account. (See Requirement 25) There was a previous requirement that the Registered Individuals must ensure that all service users receive their weekly personal allowance as required. This is now done. There was a previous requirement that the Registered Manager must ensure that all staff who offer supervision and appraisals have received training in how to do so and have been judged as competent to do so. This has now been done. Supervision sessions are supposed to be carried out every two months according to the home’s policy but the supervision record showed that ten staff had not had supervision since January or February 07. Some supervision records had been competed with the same phrases for all staff which did not show that individual supervision was being carried out and did not identify what issues had been discussed or what action was to be taken. (See Requirement 26 & Recommendation) There was a previous requirement that the Registered Individuals must ensure that a study is undertaken of the number of service users who need to use a Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 27 hoist, how long they take with it and at what times of the day to assess if there are sufficient hoists to get service users out of bed in a timely manner. This study must be sent through to the Commission. New hoists have been bought and staff reported that they have enough now. There was a previous requirement that the Registered Individuals must ensure that staff are aware of the fire safety procedures in the home and that fire exits are not blocked. No fire exits were blocked during this inspection. There was a previous requirement that the Registered Individuals must contact the LFEPA to see if they will conduct an inspection or if the Registered Manager is expected to conduct his own assessment of fire risks within the home. Staff re currently updating the fire risk assessments and evacuation plans. There was a previous requirement that the Registered Manager must ensure that all doors required to be locked to protect service users from harm are kept locked. This was being done during the inspection. There was a previous requirement that the Registered Individuals must ensure that all radiators are kept effectively covered to protect service users from high temperatures. This is now done. There was a previous requirement that the Registered Individuals must ensure that there is alcohol wash available in all toilet and bath/shower rooms and throughout the home along with adequate supplies of hand towels. This is now done. There was a previous requirement that the Registered Individuals must ensure that all staff operate effective clinical waste procedures and the clinical waste bins are used appropriately. This is now done. There was a previous requirement that the Registered Individuals must ensure that the ongoing problems with mice and ants in the home are resolved. There is a contract in place and pest control measures are taken as soon as vermin are seen in the home. There was a previous requirement that the Registered Individuals must ensure that all ineffective window restrictors are replaced as a priority. Evidence of this must be sent to the Commission by the stipulated timescale. This has now been done. Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 28 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 2 2 2 3 3 2 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 2 2 X 3 Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 6 Requirement The Registered Individuals must ensure that the service user guide and statement of purpose are revised so that all details are correct and that the potential range of fees is included. The Registered Manager must ensure that the service user or their representative consent to and sign bed rail assessments. The Registered Manager must ensure that when photographs of wounds are required they are on file as a priority. The Registered Manager must ensure that inventories of possessions are regularly updated. The Registered Manager must ensure that staff respect residents’ privacy and dignity when offering personal care. The Registered Individuals must ensure that there is an organisational policy in place and staff are trained and made aware of their obligations of the Mental Capacity Act, particularly DS0000007012.V341959.R01.S.doc Timescale for action 30/09/07 2. OP7 12 (1) & 17 (1) 12 (1) & 17 (1) 12 (1) & 17 (1) 12 (4) (a) 31/08/07 3. OP7 31/08/07 4. OP7 31/08/07 5. OP8 OP10 31/07/07 6. OP10 OP30 18 (1) (c) (i) 31/08/07 Camberwell Green Nursing Home Version 5.2 Page 30 7. OP11 12 (1) & 18 (1) (c) (i) 8. OP12 16 (2) (m) & (n) 9. OP12 16 (2) (m) & (n) 10. OP12 16 (2) (m) & (n) 11. OP12 15 & 16 (2) (m) & (n) 12. OP15 16 (2) (i) with regard to carrying out service users’ wishes about going to hospital. The Registered Individuals must ensure that there is an organisational policy drawn up describing the current best practice the home will operate to ensure all service users’ needs are met when they are dieing. Previous requirement: Unmet timescale 31/03/07 The Registered Manager must ensure that all areas of the home are used to offer activities in order that service users who want to watch television are not disturbed by noisy activities taking place in the same room. The Registered Manager must ensure that specialist advice and input is sought to offer individual and group activities to people who have sensory impairments and others who are isolated in their rooms. The Registered Manager must ensure that additional materials are bought to offer a fully effective programme of reminiscence and that thought is given to establishing reminiscence areas in the home. The Registered Manager must ensure that exercise is offered in accordance with care plans and is recorded and monitored effectively. All exercise must be offered by staff trained in how to do so safely. Previous requirement: Unmet timescale 28/02/07 The Registered Manager must ensure that hot meals are served hot on all floors and that evenings meals are varied and service users are not offered the same meal they had at DS0000007012.V341959.R01.S.doc 31/08/07 31/07/07 30/09/07 30/09/07 31/08/07 31/07/07 Camberwell Green Nursing Home Version 5.2 Page 31 13. OP16 22 14. OP16 22 15. OP19 23 (2) (b) 16. OP19 23 (2) (b) 17. OP19 OP20 OP21 OP22 OP25 23 (1) & (2) 18. 19. OP19 23 (2) (b) 23 (2) OP20 lunchtime. The Registered Manager must ensure that a record is maintained of all informal complaints and concerns in order that patterns of concerns can be audited and action can be taken and recorded in response to any issues. Previous requirement: Unmet timescales 31/03/06, 31/08/06 & 28/02/07 The Registered Manager must ensure that all complaints (including verbal complaints) from service users or their relatives are investigated and actioned and the complainant is made aware of the outcome. Previous requirement: Unmet timescales 31/08/06 & 28/02/07 The Registered Individuals must ensure that the kitchen floor is sealed and non-permeable and that the fly screens are clean and can be effectively closed/sealed. The Registered individual must ensure that the fence at the front of the home is made good and is effective as a security measure. The Registered Individuals must ensure that an action plan is drawn up and sent to the Commission that addresses all the recommendations following the Occupational Therapist’s assessment of the home. All urgent recommendations in the report must be actioned within six weeks. The Registered Manager must ensure that all repairs are carried out in a timely manner. The Registered Manager must ensure that all signs and notices that are for the benefit of staff DS0000007012.V341959.R01.S.doc 31/08/07 31/08/07 30/09/07 31/07/07 31/07/07 31/07/07 31/07/07 Camberwell Green Nursing Home Version 5.2 Page 32 20. OP26 16 (2) (k) 21. OP27 18 (1) ( a) 22. OP27 18 (1) (a) 23. OP30 18 (1) (c) (i) & (2) 24. OP33 12 (3) & 24 25. OP35 12 (1) & 13 (6) only are not placed in service users areas. The Registered Manager must ensure that the home is free from offensive odours at all times. Previous requirement: Unmet timescales 31/08/06 &11/12/06 The Registered Individuals must ensure that there is an effective handover in the morning and evening that is included in the staff rota. The Registered Individuals must conduct an assessment of how many daily hours care are needed on an individual basis for all service users and send this through to the Commission. 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 (now changed to 12 weeks by Skills for Care). Records of this induction and foundation must be maintained to include comments as to how the member of staff has progressed. Previous requirement: Unmet timescale 31/08/06 & 15/12/06 The Registered Individuals must ensure that there is in a place an annual development that establishes how the home will continually improve and increase levels of service user satisfaction with all areas of the service provided. The Registered Individuals must ensure that all service users whose money is managed by the organisation, receive individual monthly statements of their accounts. Previous requirement: Unmet timescales DS0000007012.V341959.R01.S.doc 31/07/07 31/07/07 31/07/07 31/07/07 30/09/07 31/07/07 Camberwell Green Nursing Home Version 5.2 Page 33 26. OP36 18 (2) 30/11/06 & 31/12/06 The Registered Manager must ensure that all staff receive supervision as per the organisation’s policy. 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP15 Good Practice Recommendations The Registered Individuals should ensure the chef receives training around how to provide more varied meals for service users on soft and pureed diets and also how to provide more choices for people from different ethnic backgrounds. Previous recommendation The Registered Individuals should ensure that options are offered more regularly for service users from different ethnic backgrounds. The Registered Individuals should ensure that staff health and equalities monitoring forms are held anonymously. Previous recommendation. The Registered Individuals should ensure that checks made to verify the authenticity of staff references are made with the person who has written the reference. The Registered Individuals should consider what additional input is needed within the home to ensure that all staff can understand and work effectively around issues of diversity and difference and how these may impact on the provision of care at the home. Previous recommendation. 2. 3. 4. 5. OP15 OP29 OP29 OP30 Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Camberwell Green Nursing Home DS0000007012.V341959.R01.S.doc Version 5.2 Page 35 - 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!