Inspection on 18/06/07 for Cambrian House

This inspection was carried out on 18th June 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cambrian House 03/11/09

Cambrian House 08/07/08

Cambrian House 17/10/06

Cambrian House 13/03/06

Cambrian House 01/07/05

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 Yvonne South Key Unannounced Inspection 18th June 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cambrian House Address 294 Chester Road North Kidderminster Worcestershire DY10 2RR 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) 01562 825537 F/P 01562 825537 None Kidderminster Care Ltd Mrs Shaida Ali (Acting manager) Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25), of places Physical disability over 65 years of age (25) Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 17th October 2006 Brief Description of the Service: Cambrian House is a care home providing personal care and accommodation for up to twenty-five older people of either sex, who may have a physical disability or a mental health need associated 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 residents is provided on the ground and first floor. On the first floor there are seven single bedrooms, five of which are en-suite and there are eighteen single bedrooms on the ground floor, fifteen of which are en-suite. There are communal bathrooms fitted with Parker baths and one conventional bathroom, and there are separate communal toilets provided in addition to those ensuite. Communal lounges, an activities/library room and dining areas are also provided. Access to both floors is provided by a shaft lift and handrails are appropriately placed through the home. There is parking at the front and side of the house and at the rear there is a good-sized level enclosed garden with seating and tables. The registered provider is Kidderminster Care Ltd (Mr Satwinder Powar) and the acting manager is Mrs Shaida Ali. Mrs Ali has recently been appointed and subject to a successful probationary period will be submitting an application to the Commission for Social Care Inspection (CSCI) for registration. On 18.06.07 the acting manager quoted the scale of charges for the home as being between £1412 to £1540 each month. Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection that incorporated information received by the Commission for Social Care Inspection since the previous key inspection, which took place on 17.10.06, a random inspection which took place on 26.04.07 and the information obtained during fieldwork on 18.06.07. The fieldwork took place over nine and a half hours, during which the inspector spoke to four residents and three staff. Documents were assessed and a partial tour of the premises was also undertaken. In May 2007 the acting manager Mrs Elaine Guest resigned her post and the current manager Mrs Shaida Ali was appointed. The new acting manager gave assistance during the fieldwork for this key inspection. Prior to the fieldwork the home was sent a copy of the Annual Quality Assurance Assessment (AQAA) document by the Commission for Social Care Inspection (CSCI) to complete and return. An extension to the timescale was requested due to the management changes occurring at that time and a further week was agreed, requiring the completed form by 08.06.07. The form was finally received on 18.06.07. Therefore it was not possible to distribute questionnaires seeking views of the service to residents, relatives and health care professionals prior to the fieldwork. This will be done prior to the next key inspection. Telephone calls were made to three relatives to discover their views of the service provided. The focus of this inspection was on the key National Minimum Standards and requirements and recommendations that arose out of the previous inspections. As part of the fieldwork and to obtain a broad view of the care provided, the inspector assessed the care of three residents. One person was a diabetic, one person was under the care of the district nurse and the third person was registered blind. What the service does well: Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 6 The home provides a warm and friendly welcome. The residents are well cared for and say they feel their needs are being met. The staff are well recruited and have been trained to provide them with the knowledge and skills they need to care for people. Health care is well managed and monitored. Residents and their relatives say they see the doctors, nurses, opticians, chiropodists and dentist whenever necessary and communication is good. What has improved since the last inspection? What they could do better: Full detailed and up to date information must be available about the home and service so that people have the help they need to make decisions regarding admission to the home. A more thorough assessment of the help people need should be carried out before people move into the home so that the staff are ready to provide the care needed. Risk assessments are necessary so that plans can be made to manage the risk and protect the residents. Clare plans must be available for everyone and in sufficient detail to provide staff with the information and guidance they need to look after the residents. Residents and/or, with their consent, their representative should be given opportunities to be involved in decisions regarding their care. Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 7 Information should be obtained regarding end of life wishes so that the staff can respond appropriately and provide the care each resident requires when the time comes. Although medication is well managed there are several documents describing how this should be done. These need to be reviewed so that staff have clear instructions and are not confused resulting in risks to residents. The range of activities and interests needs to be increased so that residents have something to look forward to each day. The office facilities are very poor and give a bad impression. These need to be improved so that staff are able to work in a pleasant and efficient environment. The home is very short of storage space for large items of equipment. This must be addressed so that residents are not inconvenienced and are safe. The quality of the service needs to be regularly reviewed so that areas for development and improvement can be identified and addressed to benefit the residents. The management of residents’ personal monies and property held in safe keeping needs to be improved so that there are clear records of actions and the residents are protected. Risk assessments for the home should be available in sufficient detail to enable the service to operate safely. 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. Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (An intermediate service is not offered by this home. Therefore standard 6 was not assessed.) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information is out of date concerning the home but will soon be available to prospective and current residents and their families. Full information is not always gathered prior to admission however places are not offered to prospective residents unless the home can meet the needs of the individual. EVIDENCE: The Statement of Purpose and Service Users’ Guide were available however they were out of date and the new manager was in the process of updating them to reflect the changes in the service. Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 10 Residents said that they were happy living in the home and one person said that her daughter had chosen it for her. She said that she was happy and therefore her daughter was happy. The residents confirmed that they were well looked after and happy with the care they received. Relatives said that the home had been recommended, they had chosen it after visiting several others, the location was good, they had been given opportunities to look round and ask questions and they had been given literature about the service. They were satisfied with the choice and the service. Care records for three people were assessed. It was said that an assessment of needs had been undertaken prior to places being offered to ensure the home would be able to provide appropriate care. The ‘standex’ system of recording was in use and it appeared in the first care record assessed, the document titled ‘Long term needs and Care Plan’, was comprised of information gathered by the previous manager during the preadmission assessment and used to form the initial care plan. In the second care record the document contained most of the necessary information. However in the third care record the document lacked a lot of information for example weight, medication, social interests, family and friends. One contract was seen that held the necessary information. Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some residents are at risk, as the staff do not have access to the information and guidance they need to care for and safeguard them. Medication is well managed so the residents received their medication safely as prescribed. EVIDENCE: Following the key inspection last year requirements were made that; • Residents’ care plans must set out in detail the action which needs to be taken by care staff to ensure that all aspects of health, personal and social care needs are met. • The registered person must ensure that the outcomes of risk assessments are included in the plans of care with details of appropriate interventions. DS0000018498.V337474.R01.S.doc Version 5.2 Page 12 Cambrian House • Risk assessments must be undertaken regarding a resident’s ability to manage medication independently and medication must be managed in accordance with the home’s policy and procedure, and good practice. The resident’s wishes regarding terminal care and arrangements after death must be discussed and recorded in order that they can be carried out. • It was observed from the records assessed that none of these requirements had been fully met under the previous management. The three care plans assessed during this inspection varied greatly in quality. The first set of documents contained good detailed plans that provided staff with the information and guidance they needed to provide the care for the individual. Minor improvements were recommended that included the need to always enter dates in full on all documents, always identify creams that are applied, always include information regarding religion and always undertake a pressure care assessment as soon as possible after admission. Care plans regarding diet and foot care mentioned the diabetic condition but a full diabetic care plan was recommended. The second set of documents again held good quality care plans but there was no information regarding the management of Parkinson’s disease. Although the care plans had been reviewed each month a Social Service Review indicated the need for a major rewrite that had not been carried out. The third set of documents related to someone who had lived in the home for four weeks. The assessment/initial care plan contained good information but there were several omissions. However no on going care plans had subsequently been drawn up to reflect the information that had been obtained before and since admission. Risk assessments had been carried out for mobility but other risks had not been considered. For example there was no risk assessment or subsequent care plan for someone with impaired vision. Information regarding end of life wishes and religious needs was not available. Daily records for everyone were well maintained and included good detail. There was evidence of visits undertaken by doctors, district nurses, chiropodists and opticians. Four residents confirmed that they were happy with the care they received. They considered the staff to be helpful and they were well looked after. Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 13 Residents moved freely around the home and spent their time in the different lounges, dining rooms and their bedrooms. Relatives confirmed that health was well monitored, doctors and nurses visited when necessary, and they were kept informed of events. It was observed that medication was well managed. Storage and security was good and records were well maintained. The inspector was informed that none of the current residents managed their own medication. Staff had received medication training and their records and their statements confirmed this. Signature and initial lists were available for comparison with the records. The medication policies and procedures were in need of review. Privacy and dignity was respected. It was observed that staff knocked on doors and treated residents with kindness and respect. The staff confirmed that mail was delivered to the addressee unopened and assistance given if required. Phone calls could be received in private in the office and some residents had private phones in their rooms. Residents confirmed that they were treated well. Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Due to a lack of designated staff and a specific programme, residents have limited opportunities and participate in a limited range of activities and interests. Links with families, friends and faiths are maintained. Residents enjoy a good nutritional diet. EVIDENCE: In one lounge there was a display of photographs of residents in ‘Easter Bonnets’ and information regarding the visits from an external activities adviser who came once every two weeks. There was also a display of photographs identifying staff. There was little information in the residents’ records indicating their interests, and participation in and response to activities had not been recorded. Residents were observed watching the televisions, reading and talking. During the afternoon a small group participated in ball exercises. Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 15 The manager said that musical events also took place, bingo and skittles. Entertainers also visited the home and the hairdresser came each week. Activities took place three or four times a week. The records indicated that some residents belonged to the Church of England and some to The Roman Catholic church. The manager said that those who wished were visited by the local vicar and priest and were able to participate in services held in the home. The records need to reflect where support is required by residents for example reminding them or assisting them to services if they like to attend. During the course of the day visitors came and went and some residents went out with family members. Relatives said that they had observed the entertainer visiting and the residents enjoyed music and exercises. Some residents were able to pursue their private interests such as reading and jigsaws. There was no programme of activities and no activities organiser was employed. Staff said that activities were undertaken when they were told by the manager or if there was nothing to do. The menu indicated that a varied and nutritious diet was provided and residents said that the food was ‘good, lovely, great’. It was observed that residents had enjoyed their lunch. Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available to support people who have concerns and they raise concerns in confident expectation that they will be taken seriously and receive a response. Staff are well recruited and trained to ensure the people who live in the home are protected from abuse. EVIDENCE: It was observed that a copy of the complaint procedure was contained in the Statement of Purpose and the Service Users’ Guide and there was also a copy displayed in the home. The new manager confirmed that all residents would be given a copy of the updated Service Users’ Guide when it was ready. The complaint record held details of two complaints. One concerned the loss of slippers and the behaviour of another resident and the second concerned a cracked window that appeared dangerous and had not been attended to despite requests. The records indicated that both complainants had been responded to and the issues had been addressed. The staff who spoke to the inspector demonstrated that they knew how to respond if in receipt of a complaint and residents confirmed that they knew what to do if they were worried. Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 17 The relatives confirmed that they were able raise their concerns and had done so in the past. They gave examples such as lost items, the need to clean a room, the lack of towels in ensuite facilities. These had been responded to. The staff and their records indicated that they had been well recruited with applications, interviews, references and checks being undertaken before appointments were made. Training had been provided and there had recently been an intensive programme ensuring staff were up to date with mandatory courses that included the Protection of Vulnerable Adults. Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents live in a clean house that meets their needs. However residents are disadvantaged by the lack of storage facilities and staff have difficulty working in the poor office area. EVIDENCE: At the time of the last key inspection on 17.10.06 it was observed that there was a strong odour of urine in two bedrooms. In one bathroom it was observed that due to a lack of storage space it was being used for equipment when not needed for bathing. The ‘sit on scales’ needed to be cleaned and the seat pad had split and needed to be replaced. In a bathroom upstairs the door lock had been removed. Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 19 The office consisted of two rooms that were so small meetings took place in both at the same time with people in both areas, speaking through the connecting doorway but separated by a very thick wall. There was no external ventilation to either room. New commercial machines had been installed in the laundry and work was about to commence repairing the wall behind so that it could be easily cleaned. Requirements had been made that; • equipment and the environment must be maintained in good repair. • storage areas must be provided for aids and equipment. It was recommended that thought be given as to how the office facilities can be improved. During the fieldwork for this key inspection a partial tour of the home was conducted and it was observed that there was an odour of urine in two different bedrooms. Other bedrooms that were seen were clean, pleasant and well decorated. However the bedside table in one room was damaged leaving a raw edge that could cause injury and would harbour germs. Residents had displayed their personal possessions as they wished. There had been no action to meet the requirement relating to the provision of storage. Bathrooms and bedrooms, corridors and alcoves were all being utilised to store large items of equipment. In one bedroom it was observed that items had been stored there as the bathroom was needed. Thought and action must be given as to how this problem can be successfully addressed. The sit-on scales had been repaired and the bathroom door lock had been replaced. Unfortunately it did not work. No improvements had been made to the office space. The décor was particularly poor and the carpet worn and soiled. The area gave a very poor impression to everyone who entered the room. The wall behind the laundry machines had apparently been repaired. However it was observed that this had proved ineffective as the damp had penetrated the paint and repair, and the wall was crumbling again. The area could not be cleaned effectively. However the remainder of the room was clean and tidy. The small lounge by the entrance to the home had been rearranged and was obviously a favourite area for some residents. Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 20 Unfortunately one of the curtains had come down and the chandelier, like many in the home, looked dusty and badly in need of cleaning. The conservatory on the first floor had been cleared of unnecessary furniture and equipment and provided the residents with a pleasant room over looking the garden. The carpet needed to be shampooed and the call bell needed to be repaired. Retainers had been fitted to the windows to prevent accidents. A lounge area at the back of the home had been cleared of unwanted furniture and it was intended that the room would be available for use as a library and for activities. It was a dark room and lighting would need to be improved and the call bell needed to be repaired. All areas used by residents must have a call bell in working order and sufficient light to be safe and able to use the facilities. Lounges and dining areas were well decorated and furnished. Since the random inspection on 26.04.07 the construction of two new bedrooms with ensuite facilities, and a communal assisted bathroom had been completed. The communal bathroom held a bath, hand basin and a ‘Belfast sink’ but no toilet. Towel rails, a window blind, a call bell lead, disposable towel and liquid soap dispensers were needed. The two bedrooms were well arranged. The extractor fan in the ensuite of one room was very noisy and the electrician/installer needed to be consulted. Window blinds, towel rails, toilet roll holders, light shades and door locks needed to be provided in both ensuites. The majority of ensuite doors in the home lacked locks. It is considered good practice and respectful of privacy and dignity that they be fitted and it is of concern that the new build had not had them installed as a matter of course. The bedrooms were well decorated and furnished but lockable storage had not been provided and the bedroom door locks did not meet the criteria recommended by the Fire Authority. The locks were not suitable for people with short term memories or dementia illnesses as there was a risk of entrapment. These issues will need to be addressed before the rooms are used. When the work has been completed the Commission for Social Care Inspection will need to be contacted to approve the rooms before they can be used. The registered provider said that it was not his intention to apply to increase the registration of the home at this time. Two of the established bedrooms were currently used as single rooms, although approved for use as doubles. This flexibility of use would be retained so that a couple could be accommodated if required. Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 21 The front of the home had been swept and tidied up, the garden had been attended to and flower baskets had been hung. This had been appreciated by the residents, and the new manager intended providing tables, chairs and parasols so that the facilities could be used in comfort and safety. Generally the home was clean and equipment was available to address the risks of cross infection. Staff and their records confirmed that they had received training in infection control. The practice of not immediately replacing towels in ensuite facilities when others are taken to the laundry needs to be addressed. Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient staff are well recruited and trained so that the residents receive the care they need. EVIDENCE: The registered provider stated in the AQAA that there were concerns regarding staff turnover and maintaining staff levels. Seven full time staff had left the home in the past twelve months. It was the intention to recruit and improve this situation in the coming year. The inspector spoke to three staff. They confirmed that they had been well recruited and appropriate checks had been undertaken. They had received training and were aware of the needs of the residents. The manager said that she was in the process of forming a training matrix and this would help her to prioritise and plan future training. There had been intensive training in mandatory subjects since the random inspection and all staff were up to date. Information provided indicated that 73 of the staff had National Vocational Qualifications (NVQ) to level 2 or above. Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 23 Residents were complimentary regarding the staff. Comments made included kind, fine, helpful, approachable, and wonderful. They said that they were well looked after. Three relatives said that they found them supportive, pleasant and respectful. One person said that she could not fault them, however another person said that she thought the more mature staff were better able to relate to the residents than the younger people. However the information provided indicated that only 6 of the 23 staff were under 24 years old and the age range extended up to 65 years with one employee being over 65. One person had special praise for the night staff. Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The new manager is reviewing all structures and systems to ensure they are up to date and able to support the service. This is improving the quality of the service provided so that residents receive god care and a good quality of life. The recent intensive staff training and actions taken have improved safety. However there are still risks to everyone as there are no comprehensive risk assessments for the service. Residents are at risk of financial abuse because of poor storage and recording. EVIDENCE: At the time of the previous two inspections the home was managed by an acting manager and it was intended that she would apply to the Commission for Social Care Inspection for registration. Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 25 However due to personal reasons there was a delay and immediately prior to this inspection she resigned and a new manager was appointed. Although not on duty when the inspector arrived she was contacted by the staff and arrived shortly after. She appeared knowledgeable and enthusiastic. She considered that there was a lot to do in the home but was reassured by the strong staff team that had demonstrated good caring practice. The staff described the new manager as ‘fine’. Relatives appreciated that they had been contacted by her through an introduction letter and those that had met her considered her to be efficient, pleasant and very nice. They were looking forward to the meetings that she intended to hold. The home did not have a quality assurance system in place. However questionnaires were ready to be dispatched to relatives and residents seeking their views of the service and there was a business plan for 2007. A few residents had personal money held for them in safe keeping. This was not well managed. Storage was not acceptable and records were not kept. Some receipts had been retained for hairdressing and chiropody. Secure storage must be provided and individual records maintained showing income and expenditure if the home is asked to manage the money. Each entry must be dated and signed by a member of staff and preferably the resident, their representative or another member of staff. Receipts must always be given for income and items to be held in safekeeping and receipts must always be retained for expenditure. The random inspection took place in response to an emergency that occurred one night when there had been a burst water pipe and bedrooms were flooded. The fire brigade was called and were concerned that the senior staff member on duty was unable to respond to the emergency in a calm efficient manner. Assessment of the training records indicated that the requirement for training made in October 2006 had not been met therefore an immediate requirement was made that: staff on duty throughout the night have up to date fire safety training. This training is to include knowledge of the fire procedures within the care home, the use of fire fighting equipment and participation in a fire drill. Staff are to be assessed as duly competent following this training. All staff must receive fire safety training in accordance with the recommendations of the Hereford and Worcester Fire Authority. Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 26 It was also observed during the random inspection that some of the windows on the upper floor could be opened to such an extent as to a present a hazard to some residents. Therefore a requirement was made that the registered provider should; ensure all window openings located above the ground floor level are suitably restricted to a maximum opening width of no more than 100mm. Ensure that unnecessary risks to the health and safety of residents are identified and as far as possible eliminated. Evidence was received within the timescales set that these requirements had been met. The staff demonstrated during this inspection that they were aware of the emergency action they should take in case of fire. It was observed that accident records had been well maintained, portable electrical equipment had been tested, the file containing information relating to the care of substances that were hazardous to health had been reviewed and there was a cleaning schedule in place for the kitchen. The general risk assessments for the home were not comprehensive or in sufficient detail to be very useful. All fire safety matters were acceptable. Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 1 X X 2 Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 15 Requirement The registered person must ensure that risk assessments for residents are undertaken and the outcomes are included in the care plans with details of appropriate interventions. So that residents are safely cared for. This requirement was made following the previous inspections and has now been amended to include the findings of this inspection as well. A new timescale has been set within which the new manager must meet the requirement in full. Residents’ care plans must set out in detail the action which needs to be taken by care staff to ensure that all aspects of health, personal and social care needs are met. This requirement had not been met under the previous management and has therefore been repeated with a new timescale. DS0000018498.V337474.R01.S.doc Timescale for action 30/08/07 2. OP7 15 30/08/07 Cambrian House Version 5.2 Page 29 3. OP22 23 Storage areas must be provided for aids and equipment. No action had been taken to address this matter and residents are disadvantaged within the home 01/12/07 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 OP1 Good Practice Recommendations The Statement of Purpose and Service Users’ Guide must be brought up to date as soon as possible so that residents and their relatives have full information regarding the service. The Commission for Social Care Inspection should be informed within 28 days of the changes made. Residents, or with their consent their representatives, should be given opportunities to be involved in the care planning process. The residents’ wishes regarding terminal care and arrangements after death must be discussed and recorded in order that they can be carried out. The several documents relating to medication policies and procedures should be reviewed to develop one single comprehensive policy and procedure so that staff have clear instructions and guidance. There should be a programme of daily activities available and implemented that are varied and suit the interests and abilities for those residents who wish to participate, providing them with stimulation and entertainment. 2 OP7 3 OP11 4 OP9 5 OP12 Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 30 6 OP19 It is recommended that thought be given as to how the office facilities can be improved so that staff can work in a suitable environment. There must be a quality assurance system in place based on a systematic cycle of planning, action and review that identifies where the service can be developed and improved. Facilities must be provided to keep monies and personal property in safe keeping for residents if required. Written records of all transactions must be made and receipts must be given for income and retained for expenditure so that there is a clear audit trail available. Detailed risk assessments and management details must be available for the home so that staff are able to operate the service safely for everyone. 7 OP33 8 OP35 9 OP38 Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cambrian House DS0000018498.V337474.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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