CARE HOME ADULTS 18-65
Cambria House 24 St Peter`s Street Winchester Hampshire SO23 8BP Lead Inspector
Marilyn Lewis Unannounced Inspection 10th July 2007 09:30 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 Cambria House DS0000047346.V341121.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 Adults 18-65. 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. Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Cambria House Address 24 St Peter`s Street Winchester Hampshire SO23 8BP 01962 865226 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) cambriahouse@choiceltd.co.uk Choice Limited Andrew James Key Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th November 2006 Brief Description of the Service: Cambria House provides a service to eight younger adults with a learning disability. The home has been developed to work with service users with complex needs including service users who challenge the services provided for them. The home is owned and managed by C.H.O.I.C.E Ltd. Links are established with the community team, specialist services and the support of the company’s psychologist services. Accommodation is provided on three floors in a large house that has been refurbished and redeveloped to provide this service. All residents are accommodated in single rooms and there is a lounge with dining area. A garden with seating and decking areas is provided to the rear of the property. The house is situated in the heart of Winchester and is close to all local services. Fees range from £1700-£2400 per week. This includes use of the homes transport. Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Information from past reports, the Annual Quality Assurance Assessment provided by the registered manager and a visit to the home was taken into account when writing this report. A visit to the home was made on the 10th July 2007. The inspector met with residents and staff and joined them for lunch. Three residents accompanied the inspector to see their rooms and the communal areas. Care plans were seen for three residents including one resident who has moved into the home since the last inspection. Records were also seen including those for staff recruitment and training. All the residents of the home are male. A staff member said that there have always only been male residents at the home and it was felt that to admit female residents would disturb ‘life at the home’. One resident said that he liked the home to have only male residents. Male and female staff are employed at the home. What the service does well:
Residents said they liked living at the home and there was a relaxed and friendly atmosphere in the home. Staff interacted well with the residents and spoke to them in a friendly and sensitive manner, encouraging them to make their own decisions and supporting them to meet their goals and aspirations. Good systems are in place for the assessment and admission of new residents who are able to visit the home and meet staff and residents before moving in. The assessments are reviewed following admission to ensure the needs and aspirations of the resident are being met. Staff said that they received very good support from the registered manager and were encouraged to attend training sessions and gain qualifications such as National Vocational Qualification (NVQ) level 2 or above in care. Residents are supported to participate in a wide range of social and leisure activities both in the home and the local community. The residents make frequent visits to the shops to gain confidence and skill in using money and to local leisure centres and facilities such as the library and theatre. Support is given for residents to maintain contact with their friends and family, who are able to visit the home at any time provided the resident was in agreement.
Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 7 The registered manager has worked with staff to improve the quality of care provided at the home and is pro active in addressing areas requiring improvement as they arise. The registered manager has implemented systems to further improve the recording of how the goals of residents are being met and to minimise the risk of error when administering medication. Care plans seen for one resident stated that he required a healthy diet so that he could reduce his weight and minimise the risks to his health. Records seen indicated that some of the meals provided were not healthy with chips and fried egg or cheese pasty served. The weights of some residents were not being monitored and recorded monthly as stipulated in the key worker responsibilities. Although residents liked their rooms and the communal rooms some areas of the home still required redecoration and refurbishment. A resident said that hot water came out of some of the cold water taps at hand basins and he felt this was a nuisance. The registered manager showed the inspector maintenance requests going back a number of months asking for this issue to be resolved. Some areas of the home were not clean particularly the woodwork and skirting boards. The registered manager was addressing this and had recruited a staff member for domestic duties who was due to start when the CRB and POVA had been obtained. Records for the attendance at fire drills did not always document the name of staff attending and it was therefore not possible to confirm that all staff had attended fire drills. Following the visit the registered manager notified the inspector that two night staff members, who sometimes work the same shift and there were no records for their attendance at a drill, had attended a drill that included evacuation of the home. The registered manager stated that he would ensure all staff attended fire drills and records of their attendance would be kept. 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. Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good assessments are undertaken and the person is able to visit and meet with staff and residents, before being admitted to the home as a new resident, ensuring the home can meet their care needs and aspirations. EVIDENCE: One resident had moved into the home earlier in the year. The registered manager visited the prospective resident and met with his key workers to discuss his care needs and to assess whether Cambria House would be a suitable home for the person. The prospective resident then visited Cambria House with his parents and met with the residents and staff. During a period of transition the care needs of the prospective resident were assessed and information was gathered from the care manager and health professionals, including the psychologist. The assessment had been completed by the registered manager and was very detailed. A support worker knew the care needs of the resident and said that they had read the assessment and information received from previous carers. Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 10 The assessment was reviewed in six weeks and involved the resident, care manager, a parent and the registered manager. An action plan was drawn up following the review when changes to the care needs were identified. An issue regarding a medical complaint had been investigated and found to be a past problem and no longer an issue. A resident said that he had been asked for his views on the person moving into the home. The registered manager said that all the residents were asked for their opinion on the person living at the home and had indicated that they agreed. Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are involved in their care planning and staff support them to achieve their goals, but how this is achieved is not always clearly documented. Residents feel they are involved in all aspects of life at the home and are supported to take risks to maintain an independent lifestyle. EVIDENCE: A resident said that he knew what was in his care plans and agreed that his wishes had been recorded. Care plans seen for three of the residents were detailed and contained the residents’ goals for the next six months and long term. Staff knew the goals of the residents and how they were supporting the residents to achieve them but records did not clearly document how this was being achieved. The registered manager said that the format for documenting goals would be changed to provide staff with an opportunity to update the records as work towards the goals had been completed, for example a check that the resident
Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 12 who wanted to go on holiday with his parents, had a current passport, had discussed the holiday destination with parents and staff and when tickets had been purchased. The resident had spoken with staff about the holiday and the plans had been completed but not documented. Improvements to the documentation of the residents’ goals and aspirations have been implemented since the last inspection and the registered manager is aware of the need for further improvement and is implementing a system to ensure this takes place. A requirement was issued at the last inspection for all physical intervention strategies to be supported by clear guidelines. Care plans seen contained guidelines for staff including the triggers for challenging behaviour, the signs of agitation and the appropriate preventative actions to be taken before physical intervention is used. The residents’ likes and dislikes were documented in their care plans with details such as what television programmes or type of music they preferred. Residents said that they received good support from the staff to, as one resident commented ‘ do the things I like doing’. A resident who was busy painting a picture, talked with staff about going to buy a frame and where to hang the painting when finished. Staff spoke with him in an encouraging and supportive manner. During the visit residents were observed discussing ‘life at the home’ with staff such as which staff members were on duty, residents choosing what they would like to do and eat and the colours used for the redecoration of rooms. A resident said that he had met with the new resident and agreed that he could live at the home and the registered manager said that a resident had been involved in the interview of a new staff member. Risk assessments were contained in the care plans. Assessments had been completed for the resident accessing areas of the home such as the kitchen, bathroom and day care room and for when out and about such as road safety. The registered manager provided the inspector with risk assessments that covered residents attending college, sensory unit, work placements and social events. Residents carried a mobile phone and a CHOICE contact card when away from the home without a staff member. The registered manager said that this was only required for two residents. The psychologist had completed risk assessments for one resident who had travelled by train alone to visit friends. However this assessment had been completed when the resident had lived at another care home and had not been reviewed for the new placement. The registered manager said that this would be reviewed with the psychologist as soon as possible. Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 13 Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 14 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to participate in a wide range of activities both in the home and in the community. The registered manager is aware of the need to encourage a more healthy diet for residents. EVIDENCE: The residents are very involved in the local community, accessing the shops frequently to gain ‘money skills’ and the leisure centres and swimming pools. During the visit one resident had been to the video rental shop to choose his videos. Another resident said that he liked going to the library and during the visit a staff member from the library telephoned the home to discuss setting up a reading group for the residents at the library. One resident has a work placement on a farm, one attends college, two have paper rounds and two residents help at an animal sanctuary. Residents also visit social groups in the locality and the registered manager said that following
Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 15 discussions with the residents, they were planning to set up a social group at the home. Residents also visited places of interest and some had been to Exbury Gardens the previous day. Care plans seen for one resident said that one of his goals was to go on holiday with his parents in August. This holiday had been arranged and the resident said that he was looking forward to it. Other residents also had either recently been on holiday or were due to go on holiday later in the year. During the visit residents were seen to be involved in a number of different activities. One was going to the GP surgery for a routine check up, one visited the sensory unit in Southampton, one was at work placement, another visiting relatives, one shopping for the meals for the day and one was busy with art work. One resident spent time in his room telling staff that he was not doing anything because he didn’t want to. Recording of the activities residents had been involved with was muddled and it was not always possible to identify what had taken place and whether the resident had enjoyed it or participated fully. The day service organiser showed the inspector forms that she had prepared to record activities in the future, that would document which activities the residents had participated in and would give a much clearer picture as to how goals were being met. The registered manager said that one of the residents had recently broken up with his girlfriend and his records documented how he was coping with this. The residents have the opportunity to socialise with friends and people in the community through social clubs and visits to places such as the leisure centre. Records seen documented visits home by some of the residents and one resident had gone to visit friends for a few days at the time of the inspection. Relatives and friends of the residents were also able to visit the home as they wished provided the resident was in agreement. Residents said that they enjoyed the meals provided at the home and were involved in the choice of foods purchased and cooked. On the day of the visit a resident had helped prepare homemade soup for lunch. One resident did not wish the soup and chose to have a sandwich instead. The registered manager said that the residents decide on a weekly basis what the menu is to be, each person choosing the main meal for one day of the week. The residents then take turns to go and purchase the food and help prepare the meal they have chosen. Records of meals eaten suggested that sometimes meals were not ‘healthy eating’, with fried egg, beans and chips, chicken and chips and eggs, beans and curly fries and cheese pasty, documented for one resident whose care plan indicated that he was to eat healthily as he was overweight. The registered manager said that efforts were made to encourage healthy eating but at times Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 16 this proved difficult. Staff accompanying the resident to the shops suggested healthier alternatives to snacks such as crisps and encouraged fresh fruit. The registered manager said that he was aware of the issue regarding the choice of foods and would monitor the menus and make staff more aware of the need for healthier options. Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents said that they received personal support in their preferred manner and they were protected by staff following the home’s procedures for the safe handling of medicines. The registered manager is aware of the need for staff to regularly monitor the weight of residents to minimise risk to their health. EVIDENCE: Residents said that they were able to receive personal care in the manner they wished. During the visit one resident wished to take a bath with the door of the bathroom closed and a staff member spoke with the resident a few times during this time to ensure they were able to manage. The preferences of the residents for the way support was given for personal care was documented in their care plans and staff spoken with were aware of their wishes. A resident said that staff supported him to make an appointment to visit the GP when he felt unwell and he was going to see the doctor later that day for a check up.
Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 18 Health records seen for three residents indicated that they received the attention they needed with visits to GPs, dentist, optician, chiropodist and outpatient clinics documented. Advice was also sought from psychologists and psychiatrists. Care plans for one resident stated that regular blood tests were required and the health records confirmed that these were taking place as required. The responsibilities of the key workers were documented in the file for their records of care for the resident for whom they had responsibility. One of the responsibilities was to monitor the weight of the residents by weighing monthly. Records seen for two residents did not reflect this with one residents weight recorded only six monthly and the other with a four- month gap in recorded weights. According to the care plans of one of the residents, he was to have a healthy diet and to reduce his weight. The registered manager said that this would be addressed through staff supervision. At the time of the visit none of the residents were self administering their own medication. Medication records seen had been completed appropriately and medicines were stored safely. Clear guidelines were in place for the reasons for administering ‘as needed’ medicines for residents and following administration a review meeting was held to discuss why the medication was required. Since the last inspection an appropriated controlled drugs record book has been obtained and when medication was administered two staff members had signed the records. The records seen for one resident matched the stock held. All staff except two had received training in the administration of medicines. The two staff members sometimes worked together on the night shift. The registered manager had arranged training sessions for the staff but until they had attended, he had put procedures in place to minimise the risk of error by organising staff who handed over to the night staff to give the medication before they left. If any residents required ‘as needed’ medicines during the night shift, the on call staff member was to be called and would visit the home to administer the medicines. On call staff live locally. The training was due to take place in the next few weeks and so the procedures were a temporary measure to safeguard the residents. Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents feel able to discuss any concerns with staff who will take actions if needed to resolve the issue. Residents are protected by staff awareness for the protection of vulnerable adults. EVIDENCE: Two residents said that they talked with the registered manager or one of the staff members if they felt unhappy with the care provided at the home. During the visit one resident spoke with the shift leader, about some concerns he had about living at the home and the staff member listened and spoke sensitively with the resident. A review of the placement had been arranged to give the resident and all staff involved in his care the opportunity to look at the current needs of the resident. The home has complaints procedures in place that indicate who will investigate the complaint and timescales for resolving the issue. At the time of the last inspection the registered manager was not clear on the procedures to follow should abuse be suspected and some staff had not received training in the protection of vulnerable adults. The registered manager was very aware of the procedures for reporting any suspected abuse at this visit. Staff spoken with said that they had received
Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 20 training in the prevention of abuse and records seen confirmed that all staff had received the training. The home holds small amounts of money for residents. The money is kept in individual containers in a safe place. Records are kept of all transactions and records seen for three residents matched the amount held. One resident said that he was going shopping that afternoon as part of his gaining skills with money session. Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 21 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents like their rooms and the communal areas but the home would benefit from some redecoration and refurbishment. The registered manager is addressing the need to provide a cleaner environment by employing domestic staff. EVIDENCE: Cambria House is a large detached property situated in the centre of Winchester, close to shops and local amenities. Although homely, some of the home décor and furnishings in the home looked in need of redecoration and refurbishment. This was noted at the last inspection and the registered manager said that work was still outstanding. New furniture had been ordered for the lounge and discussions were taking place with a flooring company to replace the flooring in the office and en-suite rooms. The registered manager said that some en-suite rooms were to be
Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 22 changed to wet rooms as this was thought to be of more benefit for some of the residents. The kitchen was due to be refurbished in September 2007. Accommodation is provided over three floors with bedrooms on each floor. The lounge, dining area, kitchen and office are situated on the main floor and the sensory room and laundry are on the lower ground floor. Residents are all accommodated in single rooms. Three of the residents accompanied the inspector to look at their rooms. One of the residents was in the process of redecorating their room in their chosen colours, with the assistance of the maintenance man. Another resident said that he was really pleased with his room as he had enough space to have a cage for two budgerigars and a large fish tank. The three residents said that they liked their rooms and had all they needed which included televisions and audio systems. One of the residents said that he liked his room because it was ‘his space’. Bathrooms and toilets seen looked clean except for areas like the skirting boards, but still required redecoration as there was flaking paintwork. One of the residents said that hot water came out of some of the sink taps for cold water and this could be a nuisance. The registered manager said that this was an on going problem that had been reported to the maintenance department on a number of occasions and records seen confirmed this. The lounge has a dining area and the residents at home, ate lunch together here during the visit. One resident also used the dining tables for working on his art projects. The home has a garden to the rear of the property, which has a decking area and seating provided. At the time of the last inspection the home did not look as clean as it should and this was still the case in some areas such as skirting boards and paintwork. The registered manager said that a domestic had been recruited and was due to start work as soon as the CRB check had been completed. Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 23 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by staff who are recruited through robust procedures and who receive the training and supervision to do their jobs. EVIDENCE: When the inspector arrived at the home the registered manager was attending a training session and was not at the home. A staff member who was the shift leader in the absence of the registered manager, was aware of his role and responsibilities and other staff on duty knew that the shift leader would take the lead in running the home for the morning. Staff said that they received a job description with details of their roles and responsibilities when they started work at the home and these were updated as needed. Copies of job descriptions were seen in staff files. The home employs the registered manager, an assistant manager, a shift leader, three senior support workers, nine support workers and a day service organiser. Additional staff worked at the home as day care workers and there is also the provision for calling on the services of a bank support worker.
Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 24 The registered manager said that there were currently two staff vacancies and staff were covering these shifts as needed. No agency staff have been employed at the home for over a year. The registered manager and four care staff are on duty during the day plus two day care support workers. In the afternoon there are four staff members and at two waking night staff at night. The registered manager or a senior member of the staff team are on call when not on duty so that staff at the home can always contact them for advise or support as necessary. The home has clear procedures for the recruitment of staff. Records for one staff member who had recently started work at the home were seen to contain all the information required including two written references. Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks had been completed before the staff member had commenced employment. The records stated which staff member was to be the new person’s mentor and they were put on the same shifts for the induction period. The registered manager said that no new staff are able to start work until all the information had been received and a new staff member was due to start work as a domestic at the home as soon as the CRB and POVA were completed. New staff members visited the home for an interview and a resident was asked to assist with the interview process. The registered manager said that this was new for the residents and provided them with the opportunity to participate in the recruitment of appropriate new staff. Ten of the support staff hold NVQ level 2 or above in care and a new staff member who has recently started work at the home is due to undertake training specifically focused in learning disabilities (LDAF) before commencing NVQ training. Since the last inspection all staff have received training in bi polar disorder and adult protection. The registered manager said that training was being arranged for all staff in mental health issues. Records seen indicated that staff were receiving mandatory training in health and safety including moving and handling. A staff member said that there were good training opportunities and she was encouraged by the registered manager to attend training sessions. The registered manager said that he provided supervision for the senior staff and they in turn supervised the support workers. A staff member said that they received regular supervision and records seen confirmed this. Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of the residents and the registered manager is pro active and works to address areas requiring improvement as they arise. EVIDENCE: The registered manager, Mr Andrew Key, holds a BSc degree in Social Care Studies and a City and Guilds Licentiateship Award in Social Care Practice. He is due to start studying for the Registered Managers Award later this year. Mr Key has been the manager of the home since August 2006. Staff and residents spoke highly of the support they received from Mr Key and it was evident during the visit that he had a good rapport with them. A staff member said that they had seen the quality of care provided at the home
Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 26 improve since Mr Key has become manager and this has been noted during the visit with the thirteen requirements issued during the last inspection now met. Mr Key said that he was supervised and supported by his line manager, an operational manager for the company. Residents said that they could speak with the registered manager at any time and during the visit residents came to speak to him in a relaxed manner. Two residents also said that meetings are held for them to discuss the quality of care provided at the home and this was confirmed by records of minutes seen. During the visit residents said that Cambria House was ‘their home’ and they felt they were involved in all decisions about life at the home. Staff spoke with them in a friendly, sensitive and supportive manner, always asking the residents for their views or querying how they would like things done. The registered manager said that frequent contact was maintained with relatives and a letter seen from one parent indicated that they were very happy. Records seen indicated that the resident’s relatives were often present at care reviews, at least annually and comments recorded also indicated that relatives were very satisfied with the care provided. During the visit hazardous substances such as cleaning fluids were kept safely stored in locked rooms. The kitchen looked clean and the temperatures of the fridge and freezer were monitored and recorded to ensure food was stored at the appropriate temperature. The laundry was in good order but there were no hand washing facilities available. A staff member said that they washed their hands in a nearby bathroom. As there have been occasions in the past year, where a resident has been incontinent, it is recommended that hand washing facilities are provided in the laundry room to minimise the risk of cross infection. At the time of the last inspection there were no records of fire safety equipment checks, fire risk assessments were not up to date and staff had not received regular fire safety training. Records seen during this visit indicated that checks on fire safety equipment were taking place regularly and fire risk assessments had been completed for each room of the home. Staff had received training in fire safety but records for fire drill attendance did not always record which staff members had attended and it was not possible to confirm that all staff had attended fire drills in the last year. Since the visit the registered manager has notified the inspector that a fire drill with evacuation was held on the 13th July and all staff had now attended a fire drill. The registered manager said that he was putting a matrix in place to clearly identify when staff had attended a fire drill and fire safety training and would ensure that all staff were kept up to date with the procedures. Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 27 Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 3 29 x 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x 3 3 3 x x 2 3 Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 29 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard YA17 YA19 Regulation 16 (2)(i) 13 (4) (c) Requirement Healthier meals should be encouraged to minimise the risk to residents’ health. The weight of residents should be monitored regularly to minimise risks to their health. This is of particular importance for one resident whose health records state that he should reduce his weight. All staff should attend fire drills to ensure they are aware of the procedures to follow should an incident occur. Records of staff attendance at fire drills should be maintained and kept available in the home. Timescale for action 15/08/07 15/08/07 3. YA42 23 (4) (e) 30/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA30 Good Practice Recommendations Hand washing facilities should be provided in the laundry
DS0000047346.V341121.R01.S.doc Version 5.2 Page 30 Cambria House room to minimise the risk of cross infection. Cambria House DS0000047346.V341121.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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
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