CARE HOMES FOR OLDER PEOPLE
Cambrian Lodge 4 Battery Road Portishead North Somerset BS20 7HP Lead Inspector
Carrolle Wise-Scanlan Announced Monday 19 September 2005
th 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 Lodge DD53-D02 S41626 Cambrian Lodge V243496 190905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Cambrian Lodge Address 4 Battery Road Portishead North Somerset BS20 7HP 01275 848844 01275 849649 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) Welling Limited Mrs Judith Marion Adams Care Home 28 Category(ies) of OP Old Age (28) registration, with number of places Cambrian Lodge DD53-D02 S41626 Cambrian Lodge V243496 190905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: May accommodate up to 28 persons aged 65 years and over requiring personal care. Date of last inspection 27th April 2005 Brief Description of the Service: Cambrian Lodge provides personal care for up to 28 older people. The home is located in a residential area close to the lake grounds in Portishead. Cambrian Lodge is a period property, with a purpose built extension owned by Welling Limited to which Mr Beale is the managing director. Two passenger lifts offer easy access to all areas of the home. Car parking is provided at the front of the building, and there is a pleasant garden and patio to the rear. Accommodation is offered in 22 single and 3 double rooms. At present no rooms are shared and en-suite facilities are provided in 11 of these. Cambrian Lodge DD53-D02 S41626 Cambrian Lodge V243496 190905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place over 8 hours. The inspector spoke with twelve of the twenty-five current residents and two visitors. The commission also received positive comments about the home from a GP practice. Karen Cox is the registered manager designate; her previous role was that of deputy manager. She has applied to the commission to be the registered manager. The Responsible Individual, Mr Alan Beale is present at the home on a regular basis. He has been supporting the manager in ensuring the safe running of the home. Cambrian Lodge has not had a registered manager in place, despite several people having been appointed to manage the home over the last twelve months. The inspector also looked at a number of records that need to be kept in the home. What the service does well: What has improved since the last inspection?
Care plans now provide much more information on how residents needs should be met by staff. The manager is aware that further improvement and focus in this area is still needed. The last inspection report was readily available for resident’s staff and visitors to read should they wish to, in the reception hallway.
Cambrian Lodge DD53-D02 S41626 Cambrian Lodge V243496 190905 Stage 4.doc Version 1.40 Page 6 Every effort had been made to recruit further domestic staff and there has been further advertising regarding the position. Consultation with the residents continues to improve and residents are asked to express their views of the home. An example of how the home acted upon the views expressed in a ‘satisfaction questionnaire’ is that of now offering a further light snack at suppertime. Residents meetings continue, with the residents suggesting that smaller more intimate meetings may be more valuable which the manager is looking to facilitate. What they could do better: 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 Lodge DD53-D02 S41626 Cambrian Lodge V243496 190905 Stage 4.doc Version 1.40 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 Lodge DD53-D02 S41626 Cambrian Lodge V243496 190905 Stage 4.doc Version 1.40 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, 5. Resident’s needs are taken account of prior to moving into the home, with suitable arrangements made for residents and their families to review the homes facilities. EVIDENCE: The statement of purpose and service user guide at Cambrian Lodge is a combined document, recently updated to include the details of the new manager designate Mrs Karen Cox. Several residents met by the inspector recalled being visited by the manager to discus moving into Cambrian Lodge and about whether the home could meet their care needs. A few years ago several residents moved into the home at the same time and have become ‘good neighbours’ with each other and feel that Cambrian Lodge ‘suits’ them well, several developing good friendships with each other. Documentation verified that resident’s needs are assessed prior to them moving into the home. The manager said that assessing the residents prior to coming to live at the home also provides opportunities for the residents and their families to ask further questions about the home. Offers to look round the home are made, this enables prospective residents to meet
Cambrian Lodge DD53-D02 S41626 Cambrian Lodge V243496 190905 Stage 4.doc Version 1.40 Page 9 other residents, see the facilities offered and look around the accommodation available. Cambrian Lodge DD53-D02 S41626 Cambrian Lodge V243496 190905 Stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10, 11. Care plans now provide much more information on how residents needs should be met by staff. Recording of resident’s medications and medication procedures need to be improved to safeguard the residents. Residents and staff have developed a good rapport and treat each other with respect. EVIDENCE: Residents said they have as much independence as they want within the bounds of their ability, and retain responsibility for many of their personal care tasks. Should they require some personal shopping a list is made and a staff member will do their shopping for them or take them shopping, dependant on the staffing levels. Several residents had some degree of sensory disability such as hearing loss. The inspector suggested that it may be useful, in the communal lounge area with the dining room adjoining, to consider the use of a ‘loop system’ to make it easier for those residents to chat with others.
Cambrian Lodge DD53-D02 S41626 Cambrian Lodge V243496 190905 Stage 4.doc Version 1.40 Page 11 Residents who described their day-to-day routines said the staff did everything they could to assist them should they need help. Staff were observed knocking and waiting for responses prior to entering rooms and residents felt that sufficient account is made to ensure their dignity and privacy. Care plans have improved since the last inspection but still lacked some of the care details. There is a need to incorporate the risk assessments into the care planning process. Each care plan is evaluated monthly and involved the resident or their representative, which is good practice. Medications are supplied to the home in cassette boxes by Lloyd’s pharmacy. The resident’s quantity of medication should be written on the Medication Administration Record on receipt from pharmacy. This should read as a total quantity. It was clear from the random auditing of medications that the total quantities had not been listed. One set of medications had more in stock than had been signed for and one had not been signed for but appeared to have been given. This potentially places residents at risk. The manager alert to these issues will complete a full stock audit and liaise with the pharmacist in this regard. Staff receive medication training updates and complete a Lloyds pharmacy workbook. The homes admission documentation is designed so that the questions regard residents wishes in the event of their death can be discussed and documented. Not all the records reviewed contained funeral arrangement details. Whilst the subject of discussing funeral arrangements needs to be sensitively addressed it is important that the resident’s wishes are recorded. Cambrian Lodge DD53-D02 S41626 Cambrian Lodge V243496 190905 Stage 4.doc Version 1.40 Page 12 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, 13, 14. Residents have control over their day-to-day routines and are supported and encouraged to partake in activities of their choice. EVIDENCE: On spending some time with twelve of residents it became clear that each had differing responses to the activities they would wish to take part in, if at all. Some residents enjoyed chatting with other residents at meal times and retiring to their private rooms to rest, watch television, listen to music or knit after. Other residents had local community links and continue to access those. Families visit and take their loved ones out to lunch, or sit and enjoy each other’s company. Many residents had very full and active lives prior to moving into the home and the inspector spent time talking to some of them about their experiences of living at the home. What became evident was that residents have excellent relationships with the staff. One resident said that ‘this really is a home from home’. Some activities are arranged on a four-week program consisting of events such as music and movement, craft, shopping and the home receives a visit from one of the local church representatives. Those who took part in the craft sessions seemed to really enjoy them. Residents were recently surveyed regarding their views of the home. Resident’s views suggested that a supper light snack be offered for those who want it. This has been a great success with the food at the home praised by those residents met. Although the food and menus were not inspected during
Cambrian Lodge DD53-D02 S41626 Cambrian Lodge V243496 190905 Stage 4.doc Version 1.40 Page 13 this visit the residents met thoroughly enjoyed the food offered and had welcomed the choices on the menu. Residents stating that they get a choice now of main meal and if they don’t ‘fancy anything too heavy, they’ll make you up something lighter if you want it’. Residents choose when they retire for the evening or get up in the morning with the only set routine being that of the meal times. Cambrian Lodge DD53-D02 S41626 Cambrian Lodge V243496 190905 Stage 4.doc Version 1.40 Page 14 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) 16, 18. Resident’s felt able to raise any concerns with the manager and homes management and felt assured that these would be appropriately addressed. EVIDENCE: The home has a complaints policy in place written in plain English and made available to residents and visitors alike. Copies are held within the combined statement of purpose and service user guide, with a copy in the homes reception hallway. Staff appeared clear about whom they should report to in the event of a complaint and with regard to ‘whistle blowing’. Residents felt that their issues are listened to and taken account of by the manager. Several remarked that the Proprietor, Mr Alan Beale, who now holds a ‘surgery’ each two weeks at the home for a number of hours would be someone else they could discuss issues with. There have been very few complaints received by the home since the last inspection. There were two events at the home, which triggered Adult Protection procedures. These were acted upon promptly. They clearly followed the protocols and procedures in place to safeguard the interests of the residents. Cambrian Lodge DD53-D02 S41626 Cambrian Lodge V243496 190905 Stage 4.doc Version 1.40 Page 15 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) 19-26 The home is well maintained to ensure the comfort and safety of residents. EVIDENCE: Cambrian Lodge is arranged over four floors accessed by a passenger lift or stairs. It has several communal rooms all of which are on the ground floor. One separate lounge overlooks the front of the property with an open plan lounge overlooking the rear garden, which adjoins to the dining room. The conservatory area leads onto the raised patio/balcony garden again overlooking the rear of the property. Gardens are well maintained, laid to lawn areas, with flower and shrub beds pathways and seated areas. The home has twenty-five bedrooms, 22 single, 8 of which are en-suite and 3 for shared use 2 of which have en-suite facilities. Each room has access to the call bell system. Radiators are covered with low temperature guards. Within the home there are nine toilets and five bathrooms. Several toilets have raised seats and all have hand grab rails. Cambrian Lodge has a calm and unhurried feel to it and a homely ambience. The home was well presented with some rooms recently redecorated and reCambrian Lodge DD53-D02 S41626 Cambrian Lodge V243496 190905 Stage 4.doc Version 1.40 Page 16 carpeted. The home has a rolling re-decoration program based upon identified priorities by the manager with a certain percentage of the rooms to be redecorated each year. The home had no offensive odours and smelled pleasant throughout. The laundry is based on the ground floor and a new tumble dryer had recently been purchased. The linen cupboards looked well stocked and in good order. The staff have access to hoisting equipment, which they receive training in the use of to assist with safe moving and handling of the residents. The proprietor is also considering a ‘stand aide’ to assist the staff and further benefit the residents. Resident’s rooms were arranged with their own possessions and several had some small items of their own furniture. Pictures, photographs, hobbies and craft works adorned the resident’s rooms. A few overseas staff ‘live’ at the home during their induction and training period. This was discussed further with Mr Beale regarding contracts and the safeguarding of the residents and staff. Cambrian Lodge DD53-D02 S41626 Cambrian Lodge V243496 190905 Stage 4.doc Version 1.40 Page 17 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, 29 & 30 The home’s recruitment and training procedures are aimed at protecting residents from risk of harm and ensuring staff are competent to do their jobs. EVIDENCE: Residents found that the staff although at times appear very busy always have time for them and they did not feel ‘rushed’ when being attended to. One resident remarked that “You only have to ask and the staff would do anything to help you”. One visitor suggested that it would be helpful to have a staff board with names and roles on. As it happens the manager had a huge board with photographs names etc on it waiting to be put up in the reception area. The home has a full carer staff compliment currently with a vacancy recently advertised to fill a domestic position. The homes structure consists of the manager, an administrator, two team leaders; two senior care assistants and eight care assistants, domestic staff, two cooks and a student general assistant. The manager has ensured that there are deputising arrangements in place in event of her absence and further advice and support available from Mr Beale. The homes own staff generally cover staff sickness but agency staff are needed on some occasions. Staff from overseas are also recruited into carer positions. All staff receive an induction, which they sign as each policy procedure or care practice has been explained, and their competence explored satisfactorily by the manager. The overseas staff have account made of any language or communication difficulty and if needed the induction or supervised practice may be extended to ensure safe practice.
Cambrian Lodge DD53-D02 S41626 Cambrian Lodge V243496 190905 Stage 4.doc Version 1.40 Page 18 The recruitment records were well organised and each file contained records of the staff checks undertaken. All those seen were in accordance with the standards and demonstrated a methodical and robust approach. Each of the files seen also contained staff training records and training certificates. The home uses a mix of in-house training and outside agencies. The videos used to update the staff training are that of ‘BVS’. Mr Beale advised that the training had been certified and approved. He was happy to forward a copy of this record for the manager to hold on the training master files for future reference. Mandatory training updates are regularly undertaken and the training records are set out on an excel document for ease of review. First aid training according to the manager was undertaken last year. She felt that updates for some staff might be due in order that there is always a staff member qualified in first aid available on each shift. Cambrian Lodge DD53-D02 S41626 Cambrian Lodge V243496 190905 Stage 4.doc Version 1.40 Page 19 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) 33, 35 & 38 The change of manager was managed effectively with minimal disruption felt by the residents and staff. Maintenance and service records are robust safeguarding the residents. EVIDENCE: Karen Cox is the new manger designate at Cambrian Lodge and has recently submitted her registered manager application to the commission. Karen has been the deputy manager at the home for some time, is well liked and respected by the staff and residents alike. There has been a smooth transition over to her new manager role, assisted by the proprietor Mr Beale and a ‘mentoring’ system with one of the managers of one of the other homes in the Welling Ltd group. Karen Cox is currently midway through the Registered Managers Award. Cambrian Lodge DD53-D02 S41626 Cambrian Lodge V243496 190905 Stage 4.doc Version 1.40 Page 20 A residents survey was recently undertaken and the findings were generally positive the suggestions made by the residents have begun to be acted upon by the homes management. The consultation with the residents is very good and also includes that of residents meetings and the manager meeting residents on a one to one basis regularly. Residents maintain their own finances or do so with the help and assistance of their representatives. Personal allowances and monies safeguarded by the home are locked securely with records made of any transactions, such as hairdressing, chiropody etc. The inspector suggested that the account receipt books could be improved. They should include two signatures one of which should be either the resident or their representative. The record should contain details of the transactions the value, the amount withdrawn and the balance. Welling Ltd does produce a document, which meets this criteria and was started on the day of the inspection. It was further suggested that residents who have large amounts of money might wish to consider this being placed in their own savings account, which would earn them interest. Fire drills and procedures are undertaken regularly and recorded. The last training lecture was held in May. The gas and central heating systems were also checked in May 2005. All maintenance and contract services according to the pre inspection questionnaire appear to be in order. Cambrian Lodge DD53-D02 S41626 Cambrian Lodge V243496 190905 Stage 4.doc Version 1.40 Page 21 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 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 2 x x 3 Cambrian Lodge DD53-D02 S41626 Cambrian Lodge V243496 190905 Stage 4.doc Version 1.40 Page 22 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. Standard OP9 Regulation 13(2) Requirement Medication recording and receipt of medications must be completed in accordance with the Royal Pharmaceutical Society. A list of named staff who can administrater medication and their signitures to be commenced. Timescale for action 19/10/05 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. 5. 6. 7. Refer to Standard OP7 OP8 OP11 OP22 OP26 OP26 OP26 Good Practice Recommendations Care plans to contain further detail to enable staff to safely care for residents. Identified risks from the risk assessments should have an associated care plan action. Nuritiional screening to be assessed further. Residents wishes concerning terminal care and arrangements after death to be discussed and recorded. Consider the use of a loop system for those hard of hearing in the communal lounge area. Toilet light pull cords need to be replaced or deep cleaned. Mop heads need to be replaced regularly. Deep cleaning is needed to the toilet seat raisers through out the home.
DD53-D02 S41626 Cambrian Lodge V243496 190905 Stage 4.doc Version 1.40 Page 23 Cambrian Lodge 8. 9. 10. OP30 OP38 OP38 Copy of the training approval to be held on file at Cambrian Lodge. Ensure that there is always a staff member available who is qualified in first aid. Consider the contracts of the staff accomodated at the home to ensure that the residents and staff are safequarded eg/ their visitors/friends CRB implications. Cambrian Lodge DD53-D02 S41626 Cambrian Lodge V243496 190905 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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