Inspection on 01/07/05 for Cambrian House

This inspection was carried out on 1st July 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cambrian House 03/11/09

Cambrian House 08/07/08

Cambrian House 18/06/07

Cambrian House 17/10/06

Cambrian House 13/03/06

Cambrian House 17/11/04

Cambrian House 02/05/04

Cambrian House 02/04/04

Cambrian House 16/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cambrian House 294 Chester Road North Kidderminster Worcestershire DY10 2RR Lead Inspector Annie OMara Unannounced Inspection 1st July 2005 7:00am 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cambrian House E52 S18498 CAMBRIAN HOUSE V230806 010705.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cambrian House Address 294 Chester Road North, Kidderminster, Worcestershire DY10 2RR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01562 825537 01562 825537 Kidderminster Care Ltd Care Home 25 Category(ies) of DE(E) Dementia - over 65 (25) registration, with number OP Old age (2) of places PD(E) Physical disability - over 65 Cambrian House E52 S18498 CAMBRIAN HOUSE V230806 010705.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 17 November 2004 Brief Description of the Service: Cambrian House is a care home providing personal care and accommodation for up to twenty five older people who may have a physical disability or a mental health need associatd with old age. It is located in a residential area on a main road about a mile and a half from Kidderminster town centre. The home is a large three-storey house, which has been adapted and extended for its current purpose. Accommodation for the service users is provided on the ground and first floor. On the first floor there are seven bedrooms two of which are ensuite. There are sixteen bedrooms on the ground floor thirteen of which are ensuite. There are three Parker baths and one bath with a hoist. There are five separate toilets throughout the building. Access to both floors is provided by a through floor lift. There are separate lounge and dining areas. There is parking at the front of the house; at the rear there is a good-sized enclosed garden with seating and tables. Cambrian House E52 S18498 CAMBRIAN HOUSE V230806 010705.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection began in the early morning whilst the night staff were still on duty, until the early afternoon. A brief tour of the building was undertaken and general observations made whilst care staff were working. Four care plans were examined, six residents were spoken to, and two visitors asked for their views on the home. What the service does well: What has improved since the last inspection? What they could do better: Care planning in the home is in need of developing, as are the ways in which residents are consulted, both about what is offered at the home and about their own individual needs. There are some concerns around the management of the residents’ medication and further training is needed in this area. Cambrian House E52 S18498 CAMBRIAN HOUSE V230806 010705.doc Version 1.30 Page 6 The acting manager needs to apply to be registered with the Commission for Social Care Inspection. Better systems need to be put in place to ensure that the service continues to meet the residents’ needs and continues to develop good practices. 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. Cambrian House E52 S18498 CAMBRIAN HOUSE V230806 010705.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Cambrian House E52 S18498 CAMBRIAN HOUSE V230806 010705.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4. Assessments in the home are not carried out in enough detail to ensure that new residents care needs are understood and met. EVIDENCE: Assessments had been carried out prior to the residents’ moving in to the home. The assessments carried out by the home were not done in detail. It was a concern that assessment forms for the newly admitted resident could not be located. There was no care plan in place for this resident. This raised the issue as to how staff knew what the care needs were for this resident. Once located, the assessment form had not been signed. Cambrian House E52 S18498 CAMBRIAN HOUSE V230806 010705.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10. Care planning systems have improved although there are still shortfalls in the information provided to staff about individual needs which means that some residents are placed at risk. Medication administration systems are not appropriately managed to ensure the safety and wellbeing of residents. Personal support is offered in a way that promotes the privacy and dignity of the residents. EVIDENCE: The care planning systems in the home did not provide adequate information as to what the residents care needs were or how they were to be met by staff. There was no care plan in place for the newest admission. Other care plans had not been updated to show the changing needs of the residents’ although the daily records kept did indicate that residents’ health care needs were being met. One resident who was unwell had monitoring forms in place to show that she was receiving regular care and attention throughout the day and night. Generally, the daily records were a good record of the care received by each resident through the day and night. Cambrian House E52 S18498 CAMBRIAN HOUSE V230806 010705.doc Version 1.30 Page 10 Day staff and night staff filled in different record sheets which made it difficult to track the care given over a twenty-four period. Residents had not signed their care plans. There were no risk assessments in place for the newest admission to the home. Other risk assessments were seen to be out of date and on the files seen there were no skin care risk assessments, up to date nutritional risk assessments or moving and handling risk assessments. A risk assessment for challenging behaviour had not been updated since July 2004. There was no risk assessment in place for the use of bedrails on a residents’ bed. Immediate requirements were left in respect of these matters. Medical records were kept separately from the residents’ records which, again made it difficult to track the care given. A district nurse who visited the home was able to say that she had no concerns about the way her instructions were carried out, and, said she was always called in appropriately. There was no consent form, risk assessment or written agreement about a resident who was receiving medication in their food. Night staff who were on duty did not have medication training. They did not give out prescribed medication but were left the keys to the medication cupboard to give out any pain relief that might have been needed during the night. The record of checking prescriptions had not been carried out since April 2005. The list of staff authorised to give out medication was not up to date. The senior on duty, although a qualified nurse from abroad, had not received medication training. Residents who were asked about the care they received said, “its marvellous, can’t speak too highly of staff” “quite contented” “lovely”. They also confirmed that their privacy and dignity was respected by staff. Observations made during the inspection also confirmed that residents were treated with respect. A visitor was also able to confirm that he was happy with the care given to his relative. Cambrian House E52 S18498 CAMBRIAN HOUSE V230806 010705.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 15. Activities and meals are not offered in a way that ensures individual needs are being met. EVIDENCE: Out of the six residents spoken to, four said that they did not have enough to do during the day. There was an activities list that indicated one main activity each week. Staff said that they had time to spend with residents undertaking activities although this was not recorded. There were no restrictive routines and residents confirmed that they could get up and go to bed when they chose. There were mixed comments about the quality of food on offer. Three residents said that the food was good and other comments included “mediocre” “o.k.” “sometimes you have what you want, the puddings are very good”. The choices available included a cooked breakfast, two choices at lunchtime plus an alternative if necessary. Cambrian House E52 S18498 CAMBRIAN HOUSE V230806 010705.doc Version 1.30 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were inspected on this occasion. EVIDENCE: There have been no recent complaints received by the Commission for Social Care Inspection. Cambrian House E52 S18498 CAMBRIAN HOUSE V230806 010705.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22, 24, 26. The standard of the environment is good and provides the residents with a comfortable, homely place to live. EVIDENCE: The home was well maintained, clean and comfortable. The home provides adaptations for residents with physical disabilities. One resident said that they would like a further handrail fitted to the toilet outside their bedroom. The en-suite toilet in a downstairs bedroom did not have a call bell fitted. A resident said that they were sometimes left waiting for help. One bedroom visited did not have the required numbers of chairs although this was not mentioned in their care plan. Bedrooms visited were generally comfortable and well maintained. Good hygiene practices were observed during the visit and residents confirmed that staff wore aprons and gloves whilst carrying out personal care. The laundry room was clean and tidy but the area behind the washing machines needed to be sealed/painted. The treads on the steps up from the cellar were in need of replacing. Cambrian House E52 S18498 CAMBRIAN HOUSE V230806 010705.doc Version 1.30 Page 14 Cambrian House E52 S18498 CAMBRIAN HOUSE V230806 010705.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27. Staffing has improved in the home with training being given a higher priority to safeguard the residents. EVIDENCE: The rotas indicated that four members of staff were on duty during the morning shift and three during the afternoon shift. There was a domestic member of staff and laundry assistant during the week. The rotas did not show the designated senior member of staff on duty. Staff who were on duty were able to confirm that they were receiving core health and safety training although records could not be checked on this occasion. Dementia and adult abuse awareness training had also been received. One member of staff said that the new manager was “hot on training”. Residents were very complimentary about the staff saying they were “friendly” “hardworking” “lovely”. Cambrian House E52 S18498 CAMBRIAN HOUSE V230806 010705.doc Version 1.30 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33. The atmosphere and morale in the home has greatly improved, which has a positive impact on the way in which residents are cared for. The systems for consultation with residents and relatives are poor, with the outcome that they are having limited opportunity to air their views. EVIDENCE: There is a new acting manager in post who has yet to be registered with the Commission for Social Care Inspection. However, it was apparent from the change in atmosphere in the home that staff morale had greatly improved and staff were feeling more valued. Staff said they were having more staff meetings although minutes were only available from February 2005. Quality assurance systems were not effectively being used to ensure the service continues to develop to meet the residents’ needs or to help longer term planning for the home. Minutes from the last residents meeting were Cambrian House E52 S18498 CAMBRIAN HOUSE V230806 010705.doc Version 1.30 Page 17 dated 17th October 2004 and there have been no recent questionnaires sent out. Cambrian House E52 S18498 CAMBRIAN HOUSE V230806 010705.doc Version 1.30 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 3 x x 2 x 2 x 2 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x 2 2 x x x x x Cambrian House E52 S18498 CAMBRIAN HOUSE V230806 010705.doc Version 1.30 Page 19 yes 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 3 15 (1) Regulation 14 OP7 Timescale for action Assessments must be carried out 31st July in detail for all new residents and 2005 be available for staff to consult. The registered person must 31st July ensure that service users’ care 2005 plans are up-dated and must accurately reflect all service users care needs.Timescale not met 31st January 2005. Care plans must be signed by 31st July residents or their 2005 representatives. Timescale not met 31st January 2005. Risk assessments must be 31st July undertaken for nutritional and 2005 skin care needs of the service users, and must be signed and dated. Timescale not met 31st January 2005. Risk assessments must be 31st July undertaken for any challenging 2005 behaviours presented by service users. Timescale not met 31st July 2005. Accurate records must be kept of 31st July any changes in service users 2005 health care. Risk assessments must be put in 31st July place for residents who have 2005 bedrails on their beds. A protocol must be in place for 31st July Version 1.30 Page 20 Requirement 3. 13 OP7 4. 13 OP8 5. 15 OP8 6. 7. 8. 15 15 13 13(2) OP8 OP8 OP9 Cambrian House E52 S18498 CAMBRIAN HOUSE V230806 010705.doc 9. 13(2) OP9 10. 11. 12. 13(2) 13(2) 16(n) OP9 OP9 OP12 13. 12(2) 15 14. 15. 16. 23(J) 23(J) 23(f) 22 22 24 the covert administration of medication and must include consultation and agreement with multi-disciplinary team including the pharmacist. All staff who have access to medication keys and who give out any type of medication, must receive training. All prescriptions must be checked before they go to the pharmacist. Staff authorised to give medication must provide a sample signature. Activities provided in the home must take into account the individual needs and wishes of the residents. Meals provided in the home must take into account the individual needs and wishes of the residents. All en-suite toilets must be fitted with a call bell. Individual mobility needs must be assessed and the appropriate equipment provided. All the items of furniture specified in Standard 24.2 must be provided in residents bedrooms. If the provision of any item of furniture poses a risk to the resident or they decline the provision this should be recorded in the residents assesment of need. Timescale of 30th JUne 2004 not met. The area behind the washing machines and dryers in the laundry must be sealed/painted. The steps to the laundry room must be repaired/made safe. Regular staff meetings must be held and minutes kept. 2005 31st July 2005 31st July 2005 31st July 2005 30th September 2005 30th September 2005 30th September 2005 30th September 2005 30th September 2005 17. 18. 19. 16(j) 23(2) 24 26 19 33 30th September 2005 30th September 2005 30th September Page 21 Cambrian House E52 S18498 CAMBRIAN HOUSE V230806 010705.doc Version 1.30 2005 20. 24 33 A quality assurance program must be introduced, which includes regular consultation with residents.Timescale of 31/7/04 31st October 2005 21. 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. 2. 3. 4. Refer to Standard 7 7 Good Practice Recommendations Night and day records should not be written separately but should be continuous for ease of reading. Records of activities undertaken by residents should be kept. Cambrian House E52 S18498 CAMBRIAN HOUSE V230806 010705.doc Version 1.30 Page 22 Commission for Social Care Inspection The Coach House John Comyn Drive, Perdiswell Park Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cambrian House E52 S18498 CAMBRIAN HOUSE V230806 010705.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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