Inspection on 06/10/08 for Camberwell Green Nursing Home

This inspection was carried out on 6th October 2008.

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

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 26/06/07

Camberwell Green Nursing Home 11/12/06

Camberwell Green Nursing Home 21/08/06

Camberwell Green Nursing Home 24/11/05

Camberwell Green Nursing Home 12/08/05

Camberwell Green Nursing Home 17/02/05

Camberwell Green Nursing Home 13/07/04

Camberwell Green Nursing Home 31/12/03

Extracts from inspection reports are licensed from CQC, this page was updated on 19/12/2008.

CARE HOMES FOR OLDER PEOPLE Camberwell Green Nursing Home Camberwell Green Care Centre 54 Camberwell Green Camberwell London SE5 7AS Lead Inspector Michael Williams Key Unannounced Inspection 6th October 2008 10:15 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.V372656.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.V372656.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Camberwell Green Nursing Home Address Camberwell Green Care Centre 54 Camberwell Green Camberwell London SE5 7AS 020 7708 0026 020 7708 0027 camberweelgreen@schealthcare.co.uk www.southerncrosshealthcare.co.uk Apta Healthcare (UK) Ltd Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Care Home 55 Category(ies) of Old age, not falling within any other category registration, with number (55), Physical disability (55) of places Camberwell Green Nursing Home DS0000007012.V372656.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing :Code RCH N To service users of the following gender:Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category:-Code OP Maximum number of places:55 and Physical disability:Code PD Maximum number of places:55 The maximum number of service users who can be accommodated is: 55 26/6/2007 2. Date of last inspection Brief Description of the Service: Camberwell Green Care Centre is run by a national company, ‘Southern Cross Health Care Ltd’. ‘Camberwell’ is registered to provide personal care, including nursing care, for up to 55 older people; it is also registered to provide care for people with physical disabilities. It is not registered for any other groups such as people with dementia or mental health problems. The home is purpose built but it is a very plain, unornamented brick-built block; it is not an attractive building and would benefit by further architectural refinement to enhance its appearance and to set a standard for any visitor or resident entering the property. The home is located in the centre of Camberwell and is close to public transport, shopping and leisure facilities. Accommodation for residents is provided on four floors. There are two passenger lifts. All bedrooms have ensuite toilets and all are single rooms. There are 3 lounges and 2 dining areas; this not enough so activities take place in a wide corridor on one floor. The home also lacks sufficient space for storage and this compromises areas intended to be used by residents such as wheelchairs in a shower room, hot-trolleys stored in a dining room, nurse station in a corridor and chef’s desk is in a dry-store cupboard. The home has the usual facilities for a nursing home including offices, visitor room, laundry, kitchen, sluice rooms, clinic room – but the clinic room is poorly ventilated. We are advised that there have been no changes to the ownership of this home except changes to the Responsible Individual and the Registered Manager, who have both changed in 2008. We are also advised that the fees for this home range from £582 to £800 in October 2008. Camberwell Green Nursing Home DS0000007012.V372656.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This unannounced key inspection of ‘Camberwell’ was conducted on 6th October 2008 by Mr Williams and Mr Peerbux. We toured the building, meeting residents, visitors and staff and checking documentation. We also took account of information provided to us including the home’s AQAA [Annual Quality Assurance Assessment] and other information from, for example, the local social service department. We also received a number of written representations in the form of questionnaires. The ‘people who use the service’ in this care home are referred to as residents. Camberwell Green Care Centre will be referred to as ‘Camberwell’ in this report. What the service does well: What has improved since the last inspection? What they could do better: We are told that staff moral seems low; care we are told is sometimes rather mechanistic; “lunch is a chore”, for some staff rather than a opportunity to engage with residents and make it a pleasant experience. Another commentator said that nurses were not as attentive as they should be in monitoring, recording and reporting to families any health care incidents such as falls. Others commented upon lost clothing and on the poor décor. We also identified a number of areas that need to be reviewed and improved including the initial assessments to avoid admitting residents ‘out of category’; medication procedures; activities; staff numbers and staff training in reporting abuse and the registration of the new manager. The premises need to be reviewed to make better use of the limited space; this may mean reducing the number of beds. Enforcement action being considered. Camberwell Green Nursing Home DS0000007012.V372656.R01.S.doc Version 5.2 Page 6 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.V372656.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Camberwell Green Nursing Home DS0000007012.V372656.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1, 3 and 4: People using this service experience poor quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has very detailed formulae for assessing prospective residents but is not adhering to its registration when making decisions about admissions and so residents cannot be assured this home is going to be able to meet their needs. EVIDENCE: We checked the information provided to new residents and we find it commendable that each resident has a combined Statement of Purpose and Guide in their bedroom. However some vital pieces of information were missing from these documents. The first was a clear description of the criteria for admission to make clear the conditions of registration and therefore the category of residents that can, and cannot be admitted. This appears to have lead to some inappropriate admissions of people with dementia. Secondly, the information packs are generalised and not specific to the resident, the bedroom and the fees payable. This could be easily rectified by having inserts to the guide that are specific to the particular resident, their allocated bedroom and the fees they will be paying or have paid on their Camberwell Green Nursing Home DS0000007012.V372656.R01.S.doc Version 5.2 Page 9 behalf. These documents also needed to be kept up to date with managers of the organisation and the new London contact centre for the Commission. On this occasion we also checked the procedures for admitting new residents so we examined a range of residents’ case files. The home uses standardised assessment forms - which staff use to assess a wide range of potential needs including physical, mental, social and cultural needs. Each resident and/or their representative is given information about the service and is involved in the assessment process. Staff visit prospective residents and invite them to visit the service so the processes for assessing prospective residents is very good. The home also makes sure it gets assessments from suitably qualified professionals such as care managers and we saw these in place in the residents’ files. Despite all the very detailed assessments we observed that residents are being admitted with a diagnosis of dementia; for example in one instance the assessment is that a resident has “Dementia – end stage”. It would be more appropriate for an older person with dementia and who has secondary healthcare needs to be admitted to a care home that caters for people with dementia and one that can also provide the nursing care for their physical health care needs as well. In another instance a resident’s challenging behaviour indicates that the placement was not appropriate. The AQAA [Annual Quality Assurance assessment] the home sent us tells us about how diversity is addressed in this home. The home is currently catering for 48 Residents of whom 29 are female and 19 male; and the home has 43 female staff and 9 male staff. The home has 38 ‘white European’ residents and 10 from other ethnic groups; conversely the home has 2 member of staff who are ‘white European’ and the remaining 37 are from ethnic minority groups, mainly Africa and Caribbean. Whilst the staff team does not reflect the ethnic background and culture of the current resident group it probably does reflect the background of the local workforce available for recruitment. Areas of strength include the information provided to residents and the detailed assessment formats available for staff to use when assessing residents but matters requiring improvement include the need to ensure that, having identified the needs of a resident, the manager is mindful of the home’s conditions of registration before preceding with admissions that might be ‘out of category’. Since this is a fundamental issue, because inappropriate admissions would be a breach of the Care Standards Act, this section about choice is assessed as poor. Camberwell Green Nursing Home DS0000007012.V372656.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7 to 11: People using this service experience poor quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Since the home is admitting people who have advanced stage dementia, (a condition for which it is not registered), it cannot assure that all residents’ needs can be and are being met at all times. The system for administration of medication is inadequate and potentially places residents at risk. EVIDENCE: We received very few written commentaries from relatives, none from residents and only one from a professional visitor. We did receive did verbal feedback from residents and visitors whilst on site including comments from a GP [General Practitioner] and a Nurse Practitioner [one who can prescribe certain medicines, examinations and treatments] and an Optician. This is a fairly large care home, accommodating 55 residents so we would expect of range of experiences and this was the case. One person thought the care here was “Excellent”, another said, “It’s pretty good here” whilst several thought care was ‘alright’, ‘not bad’ or ‘no complaints’. So overall there was not a lot of enthusiasm for Camberwell. Care planning is at the heart of the delivery of good care and so the home tells us that it aims to take a ‘person centred’ approach to this. We find that this home uses standardised, colour-coded, care-plan forms to ensure all aspects of Camberwell Green Nursing Home DS0000007012.V372656.R01.S.doc Version 5.2 Page 11 care can be assessed and recorded. We checked a number of these to confirm that they are being used in a sensible manner. We were advised that all care plans are being revised and updated and this is commendable since they should be reflecting the current needs of residents. However, we identified during the inspection that the daily records were sometimes brief and did not give enough information on the changes in residents’ needs. Daily records should be a good source of evidence to show that care is actually being provided, in accordance with the care plan. When well written they help to ensure a consistent approach and good quality of care for residents but we saw that a resident had recently been prescribed antibiotics however the reason for this was not recorded on their file. Changes in people individual health care needs must be made aware to all staff and recorded to ensure they receive support and care as needed. One example of an alleged failure to record and then address individual needs was a relative who told us she had paid for a daily newspaper but it was never provided for her husband – an apparent failure in the ‘person centred’ approach the home is aiming for. In respect of diversity, we discussed with the manager how well she deals with disability and we note that the home is well adapted for residents with physical disabilities, such as those who use a wheelchair or need a hoist to manoeuvre, however the range of adaptations for residents with sight or hearing impairment seemed limited. Several comments lead us to conclude that care in this home is not always to the highest standard. One visitor thought staff gave the impression meal times were a ‘chore’, lacking any joy or homeliness. More specifically one visitor thought a nurse was in her opinion not very skilled because she had failed to act upon signs and symptoms of a serious injury. Our observations tended to confirm this in so far we found a record of a “fractured neck of femur” dated Saturday 31st May but no assertive action was taken until a Nurse Practitioner advised, on 2nd June, referral to hospital for X-ray and further examination. This resident was finally diagnosed and treated for a fracture on 4th June. We advised the manager to check what happened in this case and if necessary report this incident as possible neglect to the local social service department. We have also received anonymous and unverified information about residents ‘made to get up early in the morning’. We have also asked the providers to investigate this issue - but whether it is true or not this anonymous form of contact with the Commission suggests a lack of confidence in the management of the home. Other commentators also thought the home “rudderless” and another “inefficient” at meeting care needs. We examined the policies, procedures and practice in respect of the administration of medicines, in particular we audited medication records and administration charts and we identified a number of serious shortcomings. There were several instances where prescribed medication had been omitted or administered but not signed for. While it transpired that there might have been acceptable explanations for this, these had not been recorded. In all cases where medication is not given as prescribed, staff must ensure that they record the reason for this. The administration/non-administration of all medication must be recorded accurately at all times to ensure that the Camberwell Green Nursing Home DS0000007012.V372656.R01.S.doc Version 5.2 Page 12 residents are having/not having their medication for their health and wellbeing. This service is a care home that provides nursing care, and so nurses are employed here. The Nursing and Midwifery Council (NMC) Code of Professional Conduct requires each nurse to be individually accountable for making sure that all medicines are administered correctly. All staff must be reminded that they must make an accurate record, immediately after observing a resident taking or refusing their medicines. Some items of medication were prescribed, “use as directed”. No other directions were seen for administration. There must be clear direction for all items of medication to ensure that residents are receiving their medication as intended by the prescriber. There is a record for medication being received in the home however it was noted that there was no record of antibiotics being received in the home. All medication being received in the home must be recorded accurately to ensure that there is no mishandling and to ensure that managers can audit all medicines including their receipt, use or disposal. We noted that the system for disposal of medication was not entirely safe. We saw a clear plastic bag with a high number of tablets in it but the staff on duty were not able to identify whose they were as no records were available on the contents of the bag. The home must keep an accurate record of medication being disposed to ensure that there is no mishandling. Another issue of disposal was the clinical waste; although the yellow bins are in an enclosure neither the enclosure nor the bins were locked – a matter we deal with under the environmental section. The temperature of the room where medications were stored was 28oC,this is above recommended level. Medications must be stored at the recommended level i.e. not above 25oC for the safety of residents. Enforcement action being considered is being considered in respect of the unsafe practices in this area. During the inspection it was also noted that some items of medication were out of date suggesting poor auditing by nurses and managers. All items of medication must be within their use by date so that residents are not put at risk. The home is reminded that medicines in the custody of the home must be handled according to regulation and best practice. On the day of the inspection one of the visiting doctors we spoke to raised concerns that since the home has changed from a local chemist to a more distant one there is a lack of communication between the new chemist which supply medication to the home and himself. In the opinion of the doctor this tended to reduce good communications between the home, the surgery and the chemist leading to possible complications in prescribing and changing drugs, particularly those changed at short notice or between the monthly cycles of prescriptions. It is strongly recommended that the home consider changing their chemist to a local one. The Commission would continue to monitor the medication standard and if there is any further concern this might lead to enforcement action being taken against the home. In respect of ‘end of life care’ we saw that the local Hospice has been advising the staff upon good practice and we note that care plans include a section on this in the form of the ‘Gold Standard’ format for assessing and recording last wishes and planned care for the dying. Camberwell Green Nursing Home DS0000007012.V372656.R01.S.doc Version 5.2 Page 13 Areas of strength include the updating of care plans, their comprehensive nature covering all aspects of care including social, cultural and terminal, palliative care. Matters requiring improvement include the need to ensure staff are delivering care in visibly respectful, caring and kindly manner; care plans must include sudden changes in the health or well being of residents so as to maintain good communication between staff teams and ensure residents’ needs are known to the whole care team; the procedures for dealing with medicines also needs considerable improvement, better management and auditing. This section, about health and care, is assessed as poor. Requirements or Statutory Notices will be issued in respect of the poor management of medication. Requirements or enforcement action may be taken in respect if the shortcomings identified in this section. Camberwell Green Nursing Home DS0000007012.V372656.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): NMS 12 to 15: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot be assured that they will be able to lead a lifestyle that suites them. EVIDENCE: The acting manager advised us that the home is currently without an activities coordinator and it was disappointing to see very little social or recreational activity taking place during our visit. One aspect of concern to us was the range of residents’ needs in this care home; many residents have dementia and therefore little capacity to express themselves and make known their wishes whilst others are compos mentis, sound of mind but neither group seemed to have much to engage them day by day. We frequently saw residents either sitting in their bedroom and in groups in the lounges with little to occupy them except the ubiquitous television showing a programme no-one was taking any notice of. Although assessments and care plans give a great deal of information about each resident, their history, occupation and interests, there seemed to be little evidence this information was being used to inform staff about what residents might like to do to pass the time. Visitors confirm that they are made to feel very welcome in this care home; the home has a well organised entrance lobby with the administrator based near the front door and so ensuring prompt attention when people arrive. As Camberwell Green Nursing Home DS0000007012.V372656.R01.S.doc Version 5.2 Page 15 we left there was a group of residents and visitors in this area and again this indicated how welcoming the entrance is and this gives a good first impression of the home. Several visitors told us that they like to visit very regularly each week and this demonstrates that the home welcomes visitors. Whilst residents can make choices, within the constraints of their mental and physical capacity, there seemed little they can choose from; they can supposed that residents could choose when they get up by anonymous callers suggested otherwise; we observe that residents have a choice about meals, two main choices for each midday meal – although a third was also offered when we were there. Because the home has no safe, enclosed and private garden few residents can or would choose to sit outside – although residents are doing so if they choose to smoke. The chef was commended for his cooking; he was described by residents as “very good and very funny”, although he concedes that he has limited skills in cooking certain ‘ethnic’ meals such as Halal or Kosher. The choice of meals on the day of our visit included cottage pie or pasty, both with vegetables, or spicy chicken on rice. Residents said the meals were, ‘lovely’, ‘very good’ or ‘alright’. We checked the catering arrangements in this home; the staffing issues are discussed under staffing section and environmental issues under that section. Areas of strength include the welcoming atmosphere of the home, and the freedom residents have to spend the day as they wish. Matters requiring improvement include the need to employ a person to lead activities and support and encourage care staff to consider social aspects of care as well as physical, health care needs. This section, about lifestyle, is assessed as adequate. Camberwell Green Nursing Home DS0000007012.V372656.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16 and 18: People using this service experience poor quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. We cannot assure residents that they will be fully protected by the home’s complaints and protection procedures. EVIDENCE: The previous registered manager of Camberwell has left following a report of unprofessional conduct and since we inspected Camberwell in 2007 there have been other reports of untoward incidents - such as the ones reported to us during the course of the inspection (referred to in the health and personal care section of this report) this home is evidently not protecting all its residents from harm as they might expect. Whilst it is matter of concern when matters of safety and protection of residents arise the home does have in place the documentation, policies and procedures for dealing with complaints and ‘Safeguarding’ (safeguarding residents from abuse). Despite the information and guidance available for staff we found that senior staff, that is, the nurses were not clear about their responsibilities to report untoward incidents to the correct authorities. As part of the inspection process two qualified nurses, who are in charge of different floors, were interviewed on their knowledge for reporting alleged abuse. Both of them stated that they would investigate any incident of alleged abuse. This is very concerning to the Commission as this would ‘contaminate’ evidence that might be needed in any investigation that would be carried out by the Social Services’ Care Management Team or indeed any police investigation. All staff especially staff who are shift leaders must have refresher training in the prevention of Camberwell Green Nursing Home DS0000007012.V372656.R01.S.doc Version 5.2 Page 17 residents from being harmed or suffering abuse or being placed at risk of harm or abuse. Their knowledge and understanding in this area must also be constantly checked at team meetings and during supervision sessions. Since we are receiving information about concerns directly into the Commission – rather than through the home’s management team – all staff residents and visitors need to be assured that any concerns raised directly with the company, Southern Cross, will be dealt with appropriately – including referral to Social Services Department. Staff need to be reminded about the ‘whistle-blowing’ policy; in particular staff should have the confidence to deal with concerns in-house and only use external reporting when the management team of the home is failing to respond to their concerns. It is to be noted that the use the term ‘Care Manager’ for both the home’s manager and the local authority social workers may lead to some confusion about reporting incidents. Areas of strength include the information given to residents and the information and guidance available for staff (about how the service will deal with complaints and concerns); however the number and range of concerns arising in the service indicates that the home is not protecting residents as it should and is not giving staff, visitors and professional bodies confidence that it is dealing with complaints and protection effectively. This section, about complaints and protection, is therefore assessed as poor. Camberwell Green Nursing Home DS0000007012.V372656.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19, 20, 25 and 26: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. We cannot assure residents that the premises are entirely safe and suitable to meet their needs in comfortable surroundings. EVIDENCE: Although a purpose built, and registered service, it now seems that the home does not have all the space and accommodation needed to care for the number of residents (55), and the staff team, it is registered. As we outlined in the brief description of the service, the home lacks sufficient space for storage and this compromises areas intended to be used by residents. Wheelchairs are being stored in a shower room; several hot-trolleys (used to serve meals) are stored in a dining room with a sign on the dining room suggesting it is ‘out of bounds’ between mealtimes; nurses stations, including desk, filing cabinets and chairs are located in corridors that are fire escape routes and are intended to be wide enough for wheelchairs and beds to manoeuvred in safety. As we saw, it also means visitors are being interviewed by nursing staff in a very public area. We were advised that because there are not lounges on each floor some social activities such as games take place in small groups in one of the Camberwell Green Nursing Home DS0000007012.V372656.R01.S.doc Version 5.2 Page 19 corridors – whilst this seems a reasonable compromise, because there is insufficient communal space on each floor, this arrangement causes an obstruction in evacuation routes. In the kitchen the chef’s desk is located in the corner of a dry-store cupboard. Externally we identified that this is not an attractive building and there is no enclosed, safe and protected area for residents to wander; the front of the property, where patio windows from the lounge are located, opens onto the street and it would be somewhat unsafe to leave the doors open. One resident was using this are to smoke and commented upon the unkempt area with weeds and rubbish detracting from what is clearly intended to be a pleasant outlook for residents. Towards the rear of the property there are raised shrub/flower beds but again this is behind a car park, through which the residents would need to walk if they chose to sit in this area. Our overall impression is therefore of a building that is accommodating more people than the building can properly cater for. In addition to our impression that there are some very poor aspects to the design of this care home, we also identified a number of specific problems that must be addressed. For example, the kitchen is need of regular deep cleaning, the floor was very dirty in some areas (near the junction of walls and floor), the cooker hoods appeared dusty and grimy and the walls were rather greasy in some areas – suggesting that not enough hours are allocated for kitchen assistants to do this work. The vinyl floor covering appears to be in need of thorough cleaning and sealing with a suitable impervious, non-slip finish if it is not to be replaced. We also noted that some crockery was chipped and odd sizes of plates were in use. Outside, the yellow, clinical waste bins are within an (unlocked) enclosure and the bins were overloaded and unlocked. Some fire doors are not closing fully, for example in the ground floor dining area. Some bedroom doors (which are fire doors) do not have self-closing devices and we saw a self-closing arm (on a linen cupboard) that was detached. There are other details that need attention such stained carpet near dining area, knobs missing on light switches, lights not working, call bell units broken and so forth. We noted that many of these problems have been logged in the maintenance book, and that is commendable, but as the entries are dated 21st September there has been a delay of two weeks in dealing with these matters. We are told the maintenance person is absent and no locum has been employed. We also found that a clinic room, in which medicines are stored, poorly ventilated and was excessively hot at 28oC when the recommended maximum is 25oC. Areas of strength include the provision of single, ensuite bedrooms; otherwise matters requiring improvement are numerous and are listed above. This section, about the environment, is assessed as poor. Requirements or Statutory Notices will be issued in respect of failure to maintain adequate standards of hygiene and safety in this home. Requirements or enforcement action will be considered in respect if the shortcomings identified in this section. Camberwell Green Nursing Home DS0000007012.V372656.R01.S.doc Version 5.2 Page 20 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): NMS 27 to 30: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. We cannot assure residents that the staff team is always well trained, managed, supervised and available in sufficient numbers to meet the needs of the residents. EVIDENCE: We observed several matters that indicate staffing numbers and their deployment needs to be reviewed. We noted that there was a delay in responding to call bells; staff work over two floors (ground and first) and this means sometimes there is only one member of staff on the ground floor as we saw at one point; there was limited activity opportunities offered during the afternoon. We also saw how dirty some areas of the kitchen were and how many minor issues of maintenance were overdue repair. Visitors tell us that staff moral seems at a low ebb and attitude and motivation, for example at meal times, seems poor. A point we noted for ourselves during the day. We spoke to staff and checked their staff files and made several observations. The acting manager informed us that more than 50 of staff have an NVQ level qualification of at least level 2. As part of the inspection process three staff personnel files were sampled for references, criminal record checks, application forms and copies of identification. It was noted that two of the files did not have all the relevant documents. Staff files must contain all relevant documentations as per schedules 2 and 4:6 of the revised Care Homes Regulations for the delivery of good quality services and for the protection of residents. Camberwell Green Nursing Home DS0000007012.V372656.R01.S.doc Version 5.2 Page 21 From the staff training records, it was noted that they were not always up to date and there are gaps in mandatory training. All staff must be up to date with their mandatory training to ensure residents continue to receive care as is reasonable to meet their needs. There must be a staff training and development programme in place, which meets Sector Skills Council workforce training targets to ensure staff fulfil the aims of the home and meet the changing needs of residents. A training needs assessment must also be carried out for the staff team as a whole, and an impact assessment of all staff development must be undertaken to identify the benefits for residents and to inform future planning. The registered person must monitor staff competencies through regular supervision, as this will influence the need for updates with regards to training. Training and development must be linked to the homes’ service aims and to the residents’ need and individual plans (for example training in Diabetes). We note that staff are not having regular supervision. Formal supervision sessions must be held with all care staff at least six times a year for the delivery of good quality services. Areas of strength include the positive comments made by residents and relatives about care; a few said care is ‘excellent’, ‘pretty good’ or more specifically about the staff team, “They are very good to us, when we are ill they look after us”. Matters requiring improvement include the number of staff, including ancillary staff, staff training and supervision. This section, about staffing, is assessed as adequate. Camberwell Green Nursing Home DS0000007012.V372656.R01.S.doc Version 5.2 Page 22 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): NMS 31, 33, 37 and 38: People using this service experience poor quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. We cannot assure residents this home is being run in their best interests with their safety and well being paramount. EVIDENCE: Since our last inspection, in 2007, the registered manager was obliged to leave the services of Southern Cross following investigations into unprofessional practice; this indicates that, residents had not been protected by good leadership and sound management. The replacement manager, referred to in this report as the ‘acting manager’, tells us that she will be submitting an application for registration and the registration process will assess her ‘fitness’, suitability and competence to run this home but at the time of registration the home is without a registered manager. We therefore conclude that at least for a period this home was not being run in the best interests of the residents. Some of comments we received tend to indicate a need for an improvement in management and leadership; one commentator said the home seems to be Camberwell Green Nursing Home DS0000007012.V372656.R01.S.doc Version 5.2 Page 23 “rudderless” and another said the home was “inefficient” and this person wanted their relative “to move to a better home”, others have said staff moral is not high. The home has a new manager and clearly she needs to improve standards in all areas if the home is to offer a good, ‘person centred’ service to all its residents. Record keeping in this home is varies in quality; some records are well presented, well organised such as the updated care plans and the kitchen records. However there have been lapses, for example in records relating to medicines. Similarly, the three staff supervision records were checked and we find that the staff are not having regular supervision. Formal supervision sessions must be held with all care staff at least six times a year for the delivery of good quality services. In other sections of this report we have also highlighted areas were resident safety is at some risk including medication records, fire doors, kitchen hygiene, unexplained discrepancies in recording a fracture, staffing levels that may not be fully meeting the needs of the residents and the service. Areas of strength include the good intentions of the new manager, with the support of the new Operations Manager for Southern Cross, to improve the running of the home; the positive comments of those who did have give us feedback also augers well for the future but there are numerous areas that must be tackled with vigour if this home is to improve to a ‘good’ rated service for residents from the current poor rating. Camberwell Green Nursing Home DS0000007012.V372656.R01.S.doc Version 5.2 Page 24 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 Poor 1 2 3 4 5 6 ENVIRONMENT Standard No Score Ad’qt 19 20 21 22 23 24 25 26 2 X 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score Poor 7 2 8 1 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score Ad’qt 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score Poor 16 2 17 X 18 1 1 1 X X X X 1 2 STAFFING Standard No Score Ad’qt 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Poor 1 X 2 X X 2 1 1 Camberwell Green Nursing Home DS0000007012.V372656.R01.S.doc Version 5.2 Page 25 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. Standard 1 OP1 OP3 OP4 Regulation 6 Timescale for action Statement of Purpose must be 30/12/08 revised to make clear the criteria for admission in accordance with the home’s registration (and Section 24 of the Care Standards Act). This is so that prospective residents know the home is only admitting residents who are within the conditions of registration. Fees: Each resident must be 30/12/08 provided with (as part of the Service User Guide) a statement of fees payable no later than the day he or she is admitted. This is so residents will know from the outset what fees are payable. Medication records: The 02/12/08 administration/non-administration of all medication must be recorded accurately at all times. This is to ensure that residents are having their medication as prescribed. Enforcement action being considered is being considered in respect of the unsafe practices in this area. Medication prescriptions: There 02/12/08 must be clear directions, (not just ‘as directed’) for all items of DS0000007012.V372656.R01.S.doc Version 5.2 Page 26 Requirement 2 OP1 5A 3 OP9 OP7 OP8 13(2) 4 OP9 OP7 OP8 13(2) Camberwell Green Nursing Home 5 OP9 OP7 OP8 13(2) 6 OP9 OP7 OP8 13(2) 7 OP16 OP18 13(6) 8 OP19 23 (2) (b) 9 OP19 OP38 23(4)(4A) medication. This is to ensure that residents are receiving their medication as prescribed and advised by the prescriber. Enforcement action being considered is being considered in respect of the unsafe practices in this area. Medication stock records: All medication being received, or disposed of, in the home must be recorded accurately so as to ensure that there is no mishandling. Enforcement action being considered is being considered in respect of the unsafe practices in this area. Medicines must be stored at the recommended level i.e. not above 25 degrees. This is so residents will know their medication is being stored safely. Enforcement action being considered is being considered in respect of the unsafe practices in this area. Safeguarding residents: All staff must have regular and updated refresher training in protecting residents from abuse. This is so that all staff know how to report allegations of abuse in a timely manner to the local care management team. Staff are to be reminded that ‘care manager’ in this context refers to social service staff and not the home’s manager. Kitchen hygiene: The registered person must ensure that the kitchen floor is sealed so as to be non-permeable and kept clean. Outstanding from 30/09/07. Enforcement action being considered is being considered in respect of the unsafe practices in this area. Safety and maintenance: All fire doors must be maintained in good working order. This is so as to DS0000007012.V372656.R01.S.doc 02/12/08 02/12/08 30/12/08 02/12/08 30/12/08 Camberwell Green Nursing Home Version 5.2 Page 27 10 OP19 23 (2) (b) 11 OP29 19 12 OP27 18(1)a 13 OP31 OP33 OP37 8 protect residents from risks of spread of fire and smoke. The Registered Manager must ensure that all repairs are carried out in a timely manner so residents are safe. Staff files must contain all relevant documentation in accordance with Schedules 2 and 4:6 of the Care Homes Regulations 2001. This is so that residents will know that recruitment practices are safe. Staffing numbers: it is recommended that the registered persons review staffing levels and the deployment of staff in all areas including nursing and care staff on each floor, and domestic and support staff. This is to ensure there are enough staff to meet the needs of residents and maintain the home to an acceptable standard. Manager: The home must appoint and register a manager without delay (Section 11 of the Care Standards Act applies). This is so that residents will know the home is being run by a fit and competent person. 30/12/08 30/12/08 30/12/08 30/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations Registration: It is recommended that the registered person review all residents so as to ensure that they were admitted within the home’s conditions of registration and that none are ‘out of category’ by reason of dementia, DS0000007012.V372656.R01.S.doc Version 5.2 Page 28 Camberwell Green Nursing Home 2 OP12 OP14 3 OP9 4 OP19 5 OP38 6 OP19 7 OP19 mental illness or other conditions not part of the home’s registration. Social Care: It is recommended that the home employ an activity coordinator so as to ensure that residents can lead a fulfilling life in accordance with their wishes and chosen lifestyle. Medicines: It is recommended that the home consider changing their chemist to a local one. This is so that the prescribing Doctors and Nurse Practitioners will know and have good communication with the dispensing pharmacist. Garden and boundary fences: It recommended the home review the external facilities available for residents including the provision of safe boundaries and an enclosed private garden. Clinical Waste: It is recommend that the home review its procedures for handling clinical waste including drugs and other clinical waste; in particular that receptacles, both within and outside the building, are suitable for the purpose and kept secure. This is so as to comply with waste management and for safety of residents. Storage space: It is recommended that the home review the use space including storage spaces, nurse stations, activity areas and so forth. This is so as to ensure all areas are kept safe and that areas used by residents are not used inappropriately. Décor and maintenance: It is recommended that the registered persons review the procedures for monitoring the standards of decoration and maintenance in this home. This is to ensure residents are provided with accommodation that remains safe, comfortable and reasonably decorated all times and repairs and undertaken without delay. A staff training and development programme should be put in place, which meets Sector Skills Council workforce training targets and all staff must be up to date with their mandatory training. This is to ensure staff are competent in delivering care that meet residents’ needs. Staff supervision: The Registered Manager must ensure that all staff receive supervision as per the organisation’s policy (that is, meetings six times). 8 OP30 9 OP36 Camberwell Green Nursing Home DS0000007012.V372656.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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.V372656.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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