Inspection on 14/01/09 for Camborne Lodge

This inspection was carried out on 14th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Camborne Lodge 20/07/09

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Camborne Lodge 1 Camborne Place Gateshead Tyne & Wear NE8 4EU     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elaine Charlton     Date: 1 4 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: Camborne Lodge 1 Camborne Place Gateshead Tyne & Wear NE8 4EU 01914900901 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Aspire Healthcare Ltd care home 13 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 13 The maximum number of users who can be accommodated is : 13 The registered person may provide the following caegory of service only: Care home care home only - Code PC To service users of the following gender: Either Whose primary care needs on admisision to the home are within the following categories: Learning disability - Code LD, maximum number of places, 13 Date of last inspection Brief description of the care home Camborne Lodge is two houses know as 1 Camborne Place and Meadowfield House, that are located close to each other in a residential area of Gateshead. There is easy access to local amenities and transport systems. The houses provide single accommodation for people with a learning disability. Accommodation in both the terraced houses is split over three floors which means that people who might want to live there need to be reasonably mobile. There are some bedrooms at ground floor level. Nursing care is not provided. People are properly assessed before they move into the home to make sure their needs and wishes can be met, and they can have short stays in the home to decide whether it is the place for them. Fees are split into three categories low, medium and high. They range from £600 to £1200 a week. Information is available to help people decide about the home and tells them what they can expect, Care Homes for Adults (18-65 years) Page 4 of 37 Brief description of the care home what they can do, and a bit about the staff who will help them. Reports from the Commission for Social Care Inspection (CSCI) are available in both houses. Care Homes for Adults (18-65 years) Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced visit was made on the 14 January 2009, a total of five hours were spent in the service. The acting manager was present throughout the inspection. Before the visit we looked at Information we have received since the new provider took over the home. How the service has dealt with any complaints and concerns since our last visit. The providers view of how well they care for people, and the views of people who use the service, their relatives, staff and other professionals who visit the service. We sent out our Have your Say questionnaires to people who live in the home and staff. Ten people who use the service and five staff sent them back. Care Homes for Adults (18-65 years) Page 6 of 37 We have also reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. During the visit we Talked with people who use the service, staff and the manager. Looked at information about the people who use the service and how well their needs are met, other records which must be kept, and checked that staff had the knowledge, skills and training to meet the needs of the people they care for. We looked around the building/parts of the building to make sure it was clean, safe and comfortable and checked what improvements had been made since our last visit. An Expert by Experience joined us for the inspection. An Expert is someone who has experience of using social care services. Their comments are included throughout the report. We told the manager what we found. What the care home does well: What has improved since the last inspection? What they could do better: Provide the joint service user guide/statement of purpose and other information in Care Homes for Adults (18-65 years) Page 8 of 37 different format so that people can easily understand them. Continue with the introduction of new service user plans, including up to date and informative care plans that are person centred. Complete the re-assessment of residents needs to make sure that they are being met and have access to all the equipment they need. Make sure that staff follow proper guidance on the safe ordering, receipt, recording, administering, and disposing of medication. Look at the quality of furnishings and make sure that planned repairs/replacements are carried out. Make sure that the minimum of staff information required is kept in each house and that staff receive regular/recorded supervision to help them do their job. Complete the appointment of a person to act as registered manager of the homes. XAbout what could be done better: Listen to our concerns. Having our own transport- mini bus. Giving the service users the opportunity to have regular excursions/day trips. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 37 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home have been asssessed to make sure that their care and support needs can be met, but they may not always be provided with information in a way that they can easily understand. Evidence: The home has a joint statement of purpose and service user guide that people can look at and get information about what they can expect in the home. We were told that work has not yet been done to provide information in different formats that are easy for people, who live or might want to live in the home, to understand. Ten people who use the service returned our Have your Say questionnaires before we carried out the inspection. They all said that they had been given enough information to help them decide if this was where they wanted to live. An admission procedure is in place as well as care planning and assessment documents. There have been no new, recent, admissions to the homes that make up Care Homes for Adults (18-65 years) Page 11 of 37 Evidence: Camborne Lodge. When people were asked about introdutory visits to the home they said: I came to look around and stayed for a weekend. I met other clients before I moved in. I came to look around. I came for a visit before deciding to move in and I liked the home straight away, the staff were very friendly. Some people are in the process of having their needs re-assessed to make sure that they have all the equipment and support they need to live safely in the home. People who move into the home are provided with a contract. This should also be provided in a more user friendly format. Care Homes for Adults (18-65 years) Page 12 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are supported to make choices about how their needs are met and by whom. Important information about who information can and cannot be shared with may not always be recorded. Evidence: People living in the home who sent back our questionnaires said they could always do what they wanted, when they wanted. They also said: I ask my keyworker to take me out. I decide when I get up and go to bed. The consultant/acting manager who is currently overseeing the homes until a new manager is appointed, told us that she was in the process of reviewing how care plans are kept and evaluated. New, more user friendly formats are being introduced. All staff are to receive training in care planning early in February to help them Care Homes for Adults (18-65 years) Page 13 of 37 Evidence: understand what they need to do, what to write and how they should write it. The new service user plan we saw included the persons assessment, care plans, a pen picture and their personal details. There was evidence that the information had been put together by the resident and their key worker. A new form for recording visits by a GP has also been introduced. The staff we met know the residents and their routines well, but important information is not always recorded. Relationships were seen to be warm, friendly and helpful. There is a statement of confidentiality that staff sign to say they understand their responsibilities about sharing information. We discussed the need to talk to residents and record their wishes about who information can be shared with. Staff should also include who a resident would not want to be told about things they do or that happen to them. Care Homes for Adults (18-65 years) Page 14 of 37 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People tell us they live the life they choose and like their home. Activities that take place in the home seem to be limited and the choice of meals is not person centred. Evidence: All ten people who sent back our questionnaires told us that they could do what they wanted during the day, at night and at weekends. They also said: You can do what you want. I go to the shops and for a drink and to college. I go to college, shopping, hairdressers and out for meals. I can go for a walk to the park and the library. I like to watch tv. People have been living in both houses for quite a while, they are getting older and are not as able to do things as they have been in the past. Care Homes for Adults (18-65 years) Page 15 of 37 Evidence: Part of the re-assessment of their individual needs is to make sure they can be independent and mobile, although one person in particular is no longer able to access the local bus service. Some people have very regular routines, this includes what they do in the morning, how they spend their afternoon and when they like to relax. We met one lady who had a regular routine, she was able to get herself a drink when she wanted and as we left was settling down to put her feet up for the afternoon. Internet shopping has now been introduced to the homes for food and household supplies. This is a very recent change and people were still getting used to it. The main food order is done by central office fortnightly from checklists completed in each house. There is a space on the forms to include items that residents have asked for. On the form we saw a resident had requested crab sticks. There is also a fortnightly top-up order. Residents are still able to do their personal shopping, or go out for small items that might be needed in the home. There are policies and procedures in place that support people to understand relationships, sex and sexuality, equal opportunities and harrassment. These have all been recently introduced but were not dated. The Expert by Experience said: When I asked the residents about what they did during the day and on an evening, I found that apart from going to a day centre once a week the residents stay at the home and watch the television. Residents said that due to the number of staff on duty they were unable to go out. Residents did say that they enjoyed a holiday to Scarborough last year with the home, and that they travelled there by bus. I was asked to stay for lunch and was told that they were having hot dogs. I was offered soup if I did not like hot dogs. When I asked the residents and staff about choice of food at mealtimes they said that they say what they would like and that the majority wins. Staff told me that this was due to the small cooker and the number of staff on duty. I found that residents all ate their meals at the same time. When asked if residents could help themselves to food from the kitchen, one replied, no you cant do that. We were told that that they were currently waiting for updated paper work for the Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: home menu. I suggested that they should use pictures or photographs of food so residents will be able to understand it better. Care Homes for Adults (18-65 years) Page 17 of 37 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home get support with their personal and healthcare needs, in a way they want, when they want, and from a member of staff they are comfortable with. Evidence: The healthcare needs of people living in the home are being reviewed and re-assessed to make sure that they are getting the right care and support. We were told that for one person this had included the involvement of an occupational therapist. Arrangements were being made to support this person both inside and outside the home with equipment that will make life easier and safer. People are able to see a range of healthcare professionals as they need. We saw evidence of a medication audit being carried out. Issues that had been identified were recorded. We were told that these are to be done on a weekly basis for the forseeable future. Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: The medication policy includes information and guidance about homely remedies, selfmedication, recording, storage and administering. The use of oxygen, medication errors and incidents, arrangements for holidays and visits to family. Staff have received training in the safe handling of medication. Everyone is to get refresher training so that they are completely up to date if they are not able to provide a certificate for their original training. The acting manager is waiting for training dates for two new members of staff. Two people have also asked to attend training on Drug Awareness and this is being arranged. Medication is kept securely within the home. There were separate recording arrangements in place for the management of controlled drugs although none are currently in use. We carried out a random check of medication in Meadowfield House. We were told that the system is the same in Cambourne Place. We saw that the key to the medication cupboard was kept on a huge bunch of keys. This should be kept separately and under the control of the senior person on duty. It has been the practice in both homes to put everyones medication for the day out in separate, covered containers. These were signed out by the person putting them up but could be given to people by any member of staff on duty. This is not safe practice. A medication review sheet is also being introduced. This will be used to record a persons current medcines, with any changes being separately recorded as and when they occur. The home has a policy to support staff who may be dealing with issues of Death and Dying. The policy is comprehensive and includes religious beliefs and differences, making wills and beneficiaries, and how to support people to get access to a Solicitor and/or advocate as they need. Routines in the houses were seen to be flexible and very much led by each resident. One person we met came to tell the person on duty they were going to have a bath and hair wash. It was mid-afternoon and there was no problem with this. Care Homes for Adults (18-65 years) Page 19 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are kept safe through policies, procedures and staff training, and know that they will be listened to if they have a concern or are unhappy. Evidence: People told us that they knew who to speak to if they were unhappy or had a complaint and that they felt safe. They also said: The staff. I am always happy, but if I was not I would speak to a member of staff. Manager, owners, staff inspectors. The staff and the owner. Staff, owner and CSCI. Comprehensive policies and procedures are in place that support and encourage the receipt of complaints and suggestions. Information is included about how information should be received and recorded, who should be approached and when. There is separate guidance on Safeguarding Adult procedures. Staff are to receive refresher training in the Protection of Vulnerable Adults within the next few months. Staff have access to other policies and procedures to help keep people safe, and these include financial transactions, firearms, weapons, guns and replicas, gifts and hospitality. Guardianship, illegal drugs, lone working and missing persons. Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: No complaints had been received by the home or CSCI. Four out of the five staff who sent back our questionnaire said they knew what to do if a resident or relative raised a concern. The Expert by Experienc said: The residents said that they would speak with staff if they had any concerns, complaints or did not feel safe. Care Homes for Adults (18-65 years) Page 21 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that gives them private and communal space where they can move around freely. Repairs and adaptations need to be carried out to make sure that everywhere is safe. Hygiene routines do not always promote good infection control. Evidence: We looked around both Camborne Place and Meadowfield House. Camborne Place also provides accommodation split over three floors. The laundry is upstairs giving staff room to work. It was locked when we walked around the home. Bedrooms vary in size but were all very homely and decorated in a way the resident had chosen. The hallways and staircases were also decorated with pictures of residents past and present doing things they enjoyed, including their favourite football teams. One resident spent time looking the pictures with us. Communal areas on the ground floor appear cramped because people have to walk through the lounge into the dining room and then into the kitchen, this means that some of the space in both the lounge and dining room are a walk way. Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: There is a vacant bedroom on the ground floor which could be used as a quite room or the small room on the first floor leading to a bedroom. This is only used to store filing cabinets at the moment but could be a nice quite area, where people can look out and see what is going on. No one the inspector spoke to was unhappy with the home. Some people like to watch the television or listen to music in their own bedroom. Furnishings in the communal areas are a little dated and stained. We talked to the acting manager about how staff deal with odours in the home. One area in particular was unpleasant. Meadowfield is a spacious house where everyone has their own bedroom. There are separate bathroom and toilet facilities although these have not been adapted in any way. We were told that a recent visit by an occupational therapist (OT) had highlighted the need to lower the bannister on one side of the staircase, and that arrangements to do this were in hand. The OT has also suggested that it would be a good idea to provide some aids in the bathroom in readiness for when people might need them. There is an electric bath seat in place but this has not been used or serviced recently. The acting manager said this was going to be serviced so that it was available should anyone need it. The accommodation is split over three floors. The office being on the top floor. On the ground floor there is a spacious hallway, large homely and comfortable lounge, dining area and kitchen. The rear yard is enclosed and and secure. The kitchen is domestic and style and people can make themselves a drink as and when they want. There was only one person at home when we visited but she came through to make a drink twice during our visit. There is a step in the doorway between the hallway and the dining area. The OT has recommended that a handrail is fitted to make it safer for residents. This is being organised. The front door to Meadowfield House is not easy to close from the outside as the lock Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: does not properly engage if there is not someone inside to make sure this happens. Again, the acting manager said this was in hand. Everyone who sent back our questionnaires felt that their home was always clean and fresh. Three people also said: Yes it is always very clean. I do my own room. I help out and do some chores. Pull cords in both houses need to be replaced. Staff should regularly check to see that these are clean and in working order. Freezers were in need of defrosting as meat was frozen to the sides, it had also not been dated before it had been put in the freezer. The Expert by Experience said about Camborne Place: I found that the home was very small inside. All the rooms were small inside and there was not much room to walk around the furniture. I found that the wallpaper and carpets looked stained and old. I also thought a lot of the furniture looked old and the settee I sat on was stained and uncomfortable. There was also an unpleasant smell in the home. The home had a living room, dining room and a kitchen downstairs. There were also a couple of bedrooms and a toilet and bathroom downstairs. The rest of the bedrooms were upstairs and there was also a third floor. I found the residents bedrooms were decorated according to the residents own taste, and they were filled with the residents own belongings. I liked the way there were lots of photographs of the residents on the wall. This made the home look very homely and personal to the residents who live there. I did not like the fact that there was a step up to the living room, as I think people may trip over it. Care Homes for Adults (18-65 years) Page 24 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by recruitment and selection procedures that are usually followed, but staff do not always receive the support and supervison they need to help them do their job. Evidence: We were not able to look at staff records as these had been removed from the home to be kept centrally. There is an agreement that the proprietor can sign with CSCI if they wish to keep central records, and this includes a template for the information about staff that must be available in each house. We were told that two staff had been found to be working in the home with only a POVA first clearance. Full Criminal Records Bureau applications have been submitted to make sure that these people are able to work with vulnerable people. We saw the new staff handbook that had recently been introduced. Staff will be given the employment handbook when they start work and it will form part of their Induction. Policies and procedures include the phylosophy of the home, bullying, harrassment, key working, disciplinary, grievances and equal oppportunities. Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: The home is fully staffed but staff shifts between the two houses vary and are aimed at meeting the individual needs of the people who live in each house. We were told that new rotas have just been introduced and that additional staff are now on duty in Camborne Place, at busier times, giving people more opportunities to do things. The new providers are working to promote staff training and support which staff said they have lacked in the past. Training over the next few months includes fire safety (in-house), first aid, protection of vulnerable adults, National Vocational Qualification level 2, safe handling of medication. Two people have asked to do Drug Awareness training and this is being organised. All staff are to receive care planning and dementia awareness training and will later do challenging behaviour. Staff have also requested sign language and learning disability awareness sessions. We saw rotas for the Christmas and New Year period that showed some evidence of shifts being organised to suit staff. It appeared that some staff did not get their fair share of time off at bank holidays and important holidays. These issues are being addressed by the acting manager. Regular, recorded, monthly supervision has started, but this has not been carried out in the past. Five staff sent back our Have your Say questionnaires. Everyone said that their recruitment had been properly done, that they were always or usually given enough information to care for people and got training relevant to their role, that helped them understand differing needs (including equality and diversity) and that kept them up to date with new ways of working. When we asked them what the home did well they said: Has a dedicated staff team who know and interact well with clients. Empathy shown in approach. Provide a safe and happy environment for clients. Staff know the residents really well as the majority of the staff have been here for a lot of years. Supporting the residents in what ever they want to do. Meet individual needs of care and offers full support. Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: About what could be done better: Listen to our concerns. Having our own transport- mini bus. Giving the service users the opportunity to have regular excursions/day trips. The Expert by Experience said: Residents said they liked the staff, with one resident saying yeah they are ok. When asked if they felt there were enough staff, one resident replied No because there is not enough staff to go out on a night. I found the staff to be pleasant and they welcomed me into the home. I found that staff were very good with residents and they enjoyed a laugh and a joke together. One of the staff told me they worked long hours without a break. Care Homes for Adults (18-65 years) Page 27 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is run in their best interests but does not yet have a registered manager in place to ensure that everything runs smoothly. Evidence: The provider has not yet recruited a manager for the home. We were told that this appointment is being progressed. People who live in the home told us that they were able to make choices about what they want to do and when, and they can also make special requests for things to be included in the food shopping list. Residents knew who was coming on duty later in the day and who would be on duty over night. The provider has only recently taken over the home so we have not yet had evidence of their quality assurance systems, and what people have told them about the services Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: they provide. A new and very comprehensive range of policies and procedures have been introduced and are being discussed with staff at their team meetings. We looked at a selection of these documents which were seen to be very informative and well written. They had not however been dated. Policies and procedures we saw included health and safety, accidents, children and young people, clinical waste, Control Of Substances Hazardous to Health (COSHH), challenging and violent situations, risk assessment, fire safety, first aid, food safety, infection control, personal protective clothing, Regulation 37 notifications, and smoking. There is a separate file where accidents and incident reports are kept. This has also been recently introduced and was to be shown to staff at the next team meeting. There is a handover book and communication log in place which record what staff have done, what appointments are due and any support people living in the home might need. We were told that this system was under review. We saw a nice, sensitive, recent recording about new visitor to the home. Staff had signed or initialed to say that they had read the recording. Residents are able to manage their own finances if they wish or can have the support of staff. We were told one person goes to the bank on their own and gets out what money they need. Others tell staff how much money they want for the week, sign for it and then are able to spend it as and when they want. If a resident is unable to sign the finance record, two staff are required to verify all entries. We were told that a new form is being introduced for staff to record large one off and/or multiple purchases for, or with, residents. This is good practice even if the person is in control of their own money. There had been a recent visit from the Fire Service and they were due to return the day after the inspection to check that the recommendations they had made were being followed up. The manager was working on a new fire risk assessment for the premises to make sure it meets the latest Fire Authority legislation. Staff good at seeing risk and dealing with it but not good at documenting it. Monthly health and safety audits are being carried out and any faults/issues identified are being recorded. This is followed up by what needs to be done and the form is not Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: signed off until the repair is carried out or issue dealt with. This is very good practice and provides an excellent audit trail. Purchase requests are also being dealt with in the same way and are not signed off until items needed are received. A new Fire log and file has just been introduced. Staff were only one week into the new process. All the staff who returned our questionnaires said that communication always or usually worked well. Everyone who took part in the inspection was very helpful and approachable. The Expert by Experience said: After visiting the home and speaking with staff and residents I have concluded that I would not like to live at Camborne Place because the home seems to be too small for the number of residents. I also would not live there because I like to have a choice of food at meal times and I like to choose when I eat. I also would get very bored watching television all day and night as I like to go out and do activities in the home. I think that Camborne Place is a poor place for residents to live. Care Homes for Adults (18-65 years) Page 30 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 The provider must sent CSCI 13/02/2009 a copy of the service user guide and statement of purpose. This will mean that CSCI are sure that these documents provide people with all the information they need to make decisions about moving into the home. THIS REQUIREMENT MET IMMEDIATELY. 2 6 15 Service user plans must be provided in a more person centred way, be regularly reviewed and evaluated. This will mean that the needs and wishes of people who live in the home are properly recorded so that staff know how to provide the care and support a person needs. 09/04/2009 Care Homes for Adults (18-65 years) Page 32 of 37 3 9 13 The re-assessment of residents needs and risks must be completed. This will mean that people have access to the equipment they need to keep them safe. 09/03/2009 4 19 12 Care plans supporting areas of health and personal care must be clear and up to date. This will mean that people living in the home know that staff have the information they need to give them the care and support they want, in the way they want. 09/04/2009 5 20 13 Staff must follow current best practice guidance for the safe ordering, receipt, dispensing, disposing and recording of medication. This will mean that people who live in the home are kept safe. 09/02/2009 6 26 23 Furniture in the communal lounge in Camborne Place must be clean or replaced. This will mean that people enjoy a comfortable environment. 14/04/2009 7 29 23 The lock on the front door at 14/02/2009 Meadowfield must be repaired. This will mean that people are kept safe and know their home is secure. Care Homes for Adults (18-65 years) Page 33 of 37 8 29 13 The adaptations and changes to premises identified by the occupational therapist must be carried out. This will mean that people who live in the home can be independent and are kept safe. 14/04/2009 9 30 13 The systems and measures in place for odour management must be improved. This will mean that people live in a home that is pleasant and odour free. 14/02/2009 10 34 19 Arrangements must be made to make sure that the staff information that must be kept in the care home is available. This will provide the evidence that people have been properly recruited and trained helping to keep people who live in the home safe. 14/03/2009 11 35 18 Staff must receive regular, 14/01/2010 recorded supervison that meets the National Minimum Standard. This will mean that staff get the right support to do their job and will help to keep people who live in the home safe. 12 37 9 The appointment of a person 14/06/2009 to act as registered manager must be progressed. Care Homes for Adults (18-65 years) Page 34 of 37 This will mean that the staff team has direction and their is a registered person in place who is responsible for the daily organisation of the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The provider should consider how else information should be provided so that everyone who lives in the home or might want to move in is able to understand what is given to them. This will help people to make the right choices. People should receive their contract in a way that it is easy for them to understand. This will mean that they know what to expect and what is expected of them. Consider including in care plans who residents do not wish staff to share information with, and to include pictures/large print in these documents to make them easier for people who use the service to understand. Activities and events in the home should be promoted and recorded so that it is clear people have choice and say what they want to do. This will help people to live interesting and stimulating lives. The choice of meals and mealtimes should be promoted so that people can eat what they want when they want. Consider the introduction of pictorial menus, or photographs in menus so that people are clear about the choices they are making. The key to the medication cupboard/storage facilities should be kept separately and securely from all keys. This will mean that only the most senior person in charge is in control of access to medication helping to keep people safe. Consideration should be given to how additional communal space could be provided for the people who live in Cambourne Place. This will mean that they have a choice of areas where they can spend time in private or with other residents. 2 5 3 6 4 14 5 6 16 17 7 20 8 28 Care Homes for Adults (18-65 years) Page 35 of 37 9 30 Pull cords in bathrooms and toilets should be replaced and kept clean to promote infection control. This will help to keep people well. Freezers in the home should be regularly defrosted so that food can be easily removed, and meat or home produced food should be dated before it is frozen to promote good stock rotation and safe use of frozen products. This will help to keep people who live in the home well. Consider dating policies and procedures so that it is evident when they were introduced or last reviewed. This will mean that people know information is up to date. Work should continue to make sure that all records are kept in a standard way and that staff know what they need to record and how it should be recorded. This will mean that information about people and the care and support they receive is properly kept, up to date and helps to keep them safe and well. 10 30 11 40 12 41 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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