Inspection on 16/11/05 for Cambridge House

This inspection was carried out on 16th November 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 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

Cambridge House 26/05/06

Cambridge House 16/06/05

Cambridge House 14/04/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

1 Marten Road

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE Cambridge House Cambridge House 141 Gordon Avenue Camberley Surrey GU15 2NR Lead Inspector Sandra Holland Announced Inspection 16th November 2005 10:30 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 Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 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. Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cambridge House Address Cambridge House 141 Gordon Avenue Camberley Surrey GU15 2NR 01276 691035 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) Mr Naushad Heeroo Mrs Christine Anne Heeroo Mr Naushad Heeroo Care Home 16 Category(ies) of Dementia - over 65 years of age (11), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (5), Old age, not falling within any other category (16) Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The age/age range of the persons to be accommodated will be: OVER 65 YEARS OF AGE Of the total number of persons accommodated up to 11 may be in the catergory (DE(E)) and 5 may be in the catergory (MD(E)). 16th June 2005 Date of last inspection Brief Description of the Service: Cambridge House is a care home accommodating up to 16 people aged over 65 years. Up to eleven of the people living at the home may have dementia and up to five people may have a mental disorder. The home is a large, two storey building, situated in a residential area of Camberley, a short distance from the town centre. It is well served by public transport, with the towns station within walking distance. Mr. and Mrs. Heeroo are the registered providers and Mr. Heeroo is the registered manager. As the registered manager, Mr Heeroo is in day to day control of the home and Mrs. Heeroo provides administrative support. Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was the second to be carried out in the Commission for Social Care Inspection (CSCI) year April 2005 to March 2006. As the inspection was announced, everyone at the home should have been aware that it was taking place. The inspection was carried out by Mrs. Sandra Holland, Lead Inspector for the service and took place over a five hour period. Mr and Mrs Heeroo, Registered Providers, were present representing the service. A number of records and documents were examined, including Medication Administration Record (MAR) sheets, staff recruitment and training files and the complaints and compliments record. Areas of the premises were seen and nine residents, two visitors and five members of staff were spoken with. Further information was gathered for this inspection from the pre-inspection questionnaire which was supplied to the home. This was completed and returned to CSCI within the timescale, to allow for the information to be assessed. A number and variety of comment cards were also supplied to the home by CSCI. These were to be given or sent to residents, relatives and friends and healthcare professionals who are involved in the support of the residents. It was pleasing that the majority of these were completed and returned to CSCI. Most were very complimentary and positive about the standard of care, support and service provided. To fully assess how the home is meeting the requirements of the National Minimum Standards, it will be necessary to read the reports of both inspections. The people living at this home prefer to be known as residents and that is the term that will be used throughout this report. The inspector would like to thank the residents, staff and management for their hospitality, time and assistance. Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Improvements are required in the system of medication administration. The amount of stock held must match the record held, prescribed medication must always be available to residents and the receipt of all medication must be recorded. Any changes to prescribed medication must be obtained in writing from the person prescribing, any handwritten entries to the MAR sheets must Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 Page 7 be signed and dated by the person making the entry and countersigned by another member of care staff who has checked the entry for accuracy. It is recommended that photographs of residents are attached to divider cards inserted between MAR sheets. This is for ease of identification and to separate the individual sheets to reduce the risk of error. It is also recommended that the medication system in use is reviewed and monitoring visits by a pharmacist are carried out. It is good practice to supply staff with a copy of the notes made during supervision meetings, signed and dated by the supervisor and the staff member. 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. Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 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 Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6. The manager advised that intermediate care is not provided. EVIDENCE: Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 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 the following standard(s): 7, 8 and 9. Residents’ healthcare needs are well met. The system of medication administration needs to be improved to ensure residents’ safety. EVIDENCE: The manager stated that resident’s individual plans of their care and support needs are being regularly reviewed each month and a record of this was seen in the plans. From the individual plans, it was noted that a number of healthcare professionals are involved in the support of the residents. These include general practitioners (G.P.’s), community psychiatric nurses, chiropodist and care managers. CSCI comment cards were completed and returned by seven healthcare professionals and all were very complimentary, saying that the home is well run, staff were helpful and attentive and residents are encouraged to be independent. It is clear from information that has been regularly supplied to CSCI, that any changes in residents health are closely monitored and that appropriate treatment is promptly obtained. Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 Page 11 A number of shortcomings were noted in the system used to administer medication. Medication is supplied by a local pharmacy in “dosset” boxes. These are divided boxes which are filled by the pharmacist and contain the prescribed medication for different times of day. The divisions are sealed by a clear plastic film, which is only broken when the medication is administered. The manager stated that the receipt of medication is recorded in a separate file and not on the MAR sheet, which has a specific space for this. The receipt file was seen, but using this method of recording combined with the MAR sheets, makes it difficult to follow an audit trail. Liquid medication had been recorded as received, but this had not been carried forward to the MAR sheet and it was not possible to calculate the amount of stock which should remain. This leaves the system potentially open to abuse. Handwritten entries had been made on the MAR sheets, to list additional medications such as antibiotics, which had been started since the MAR sheet monthly cycle. These did not indicate where the details for the administration of the medication had come from. These had not been signed or dated by the person making the entry. It is good practice for a second member of care staff to check a handwritten entry and to sign to confirm that this has been done. A handwritten entry on a MAR sheet for one resident stated the name of the medication and the dose, but did not state when it should be given, how often or how many. Amendments had been made by hand, to the administration details on some MAR sheets, such as changes to the time the medication should be given or that a medication should no longer be given. There was nothing to indicate on who’s authority, these changes to the resident’s prescription were being made. For the safety of residents it is required that all changes to prescribed medication, are confirmed in writing, by the prescriber. For one resident, the stock of a prescribed medication had run out and the medication had not been administered for four days. The manager stated that a new prescription had been issued the previous day but the medication had not been obtained. The manager obtained the medication during the course of the inspection. Although named photographs of each resident are held in the MAR sheet file, these are all together at the front of the file and not linked to the individual resident’s MAR sheet. It is recommended that the photograph is attached to a card that divides the individual sheets. This will help to identify the correct resident and help to prevent the wrong medication being given to a resident. An immediate requirement and a recommendation were made. Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 Page 12 Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 12 and 15. More regular activities are taking place. Wholesome and appetising meals are served. EVIDENCE: It was pleasing to hear that the range and frequency of activities has been increased, as residents had commented at the last inspection that this was needed. The manager stated that trips to the local shopping centre are taking place each Friday and twice a week, on Sundays and Wednesdays, a local walk is arranged. Residents were playing dominoes and enjoying art activities during the inspection. Notes of the most recent residents’ meeting referred to an outing to the theatre to see a singing group, that had taken place in October. During the meeting, the CSCI comment cards had been shown to residents, with an explanation about completing them. The manager advised that if residents were unable to read the notes of the meeting, a member of staff reads them and explains them to the resident and then signs and dates the notes to show this has been done. From the menus supplied with the pre-inspection questionnaire, it is clear that well-balanced meals are prepared for residents. The main meal of the day is Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 Page 14 served at 12.30 p.m., with a lighter meal served for supper from 5.30 p.m. The meals were of a nourishing and home-cooked style and it was pleasing to see that all of the residents who responded to the CSCI comment cards, stated that they enjoyed the food served. Meals are served in the spacious dining room and the tables are attractively laid. Staff are available and assist residents in a discreet manner, if needed. The resident’s guide states that meals can be taken in resident’s rooms if preferred. The home has two cooks, one working full-time during weekdays and another at weekends, which ensures continuity for the standard of food provided. Visitors are offered refreshments whenever they visit, they advised. Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 Page 15 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 the following standard(s): 16. Any complaints are managed appropriately. EVIDENCE: A record book is available in the main lounge, for anyone to note a complaint, comment or compliment. This was seen and entries that had been made, had been addressed by the manager and stated what action had been taken. The manager advised there if a resident is unable to read the complaints procedure, this is supplied to their representative on their behalf and the representative is asked to sign to show this has happened. Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 Page 16 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 the following standard(s): 25 and 26. The home is maintained in a clean and hygienic manner. EVIDENCE: All areas of the home that were seen were clean, well maintained and freshly aired. The service is decorated in an attractive, family style and furnished to meet the needs of the residents. The environment of the home was comfortable and warm and appropriate lighting was available in the areas seen. Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 and 30. Staff recruitment and training is effectively managed. EVIDENCE: From the staff files seen, it was clear that recruitment of staff is carried out as required. All the necassary records and documents had been obtained, including references, confirmation of identity and Criminal Record Bureau (CRB) disclosures. If members of staff have been recruited from abroad or are working under a work permit, the appropriate documents have been held on file. An individual training record is held for each member of staff and these were seen. The manager stated that the induction and basic training of staff is drawn up to a nationally recognised standard. The induction training record was seen to be comprehensive and covered all areas of support and care of residents. Staff undertake training that is legally required and other training to develop their knowledge and skills. The manager stated that some of the training undertaken by staff is provided by external trainers and this included medication training and moving and handling training. Other training is arranged “in-house”, by the manager or providers and a course of videos have been purchased to enable this. The provider stated that staff complete a questionnaire after watching the videos to ensure that they have understood them. These are also used to refresh and remind staff of issues affecting their work. Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 Page 18 Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 and 36. Regular reviews of the service provided are carried out. Staff are appropriately supervised. EVIDENCE: The provider stated that reviews of the service provided are carried out each year. The review is divided and a survey is supplied to residents at one review and to relatives and representatives of residents at the other. The most recent survey was carried out three months ago, but the results were not available. It is good practice to include all those involved in the support of residents, such as G.P.’s and community nurses in the survey, as they are able to provide an external view on the service. A good response had been received to the CSCI comment cards, which were supplied with the pre-inspection questionnaire. These had been distributed to residents and their representatives and two thirds of the resident group and a Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 Page 20 similar number of representatives responded. The majority of the responses were positive and complimentary about the standard of the care, support and service received at the home. Residents’ meetings are held every eight weeks, approximately, and notes are taken of the matters that are discussed. This enables residents who were not present at the meeting to know what was covered. The compliments, comments and complaints record book also enables residents, their representatives or staff to make their views known. The manager stated that monies are not held for safekeeping for residents and that no one in the home is involved in the support of resident’s finances. Wherever possible residents manage their own affairs or are supported by their family or friends. Where the home makes payment for residents for items such as hairdressing or chiropody, the monies are reimbursed by the resident or their representative. From the records seen and from speaking to staff, it is clear that staff are appropriately supervised. Supervision notes are kept on file but the provider stated that staff have not been supplied with their own copy of these notes. It is good practice for both the supervisor and the person being supervised to sign and date the supervision notes and for a copy to be kept by both parties. This is to ensure that both can refer to any point discussed for reference and to ensure there are no misunderstandings. A recommendation has been made. Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x x x x x x x 3 3 STAFFING Standard No Score 27 x 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x 3 2 x x Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 Page 22 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 (2) Requirement The registered person must make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Specifically – (a) Prescribed medication must be available to residents at all times; (b) The stock of medication must match the record held; (c) The receipt of medication must be recorded to enable an audit trail to be followed; (d) Handwritten entries on the medication administration record sheets (MAR), must be transcribed from the original prescription or the label on the original medication container; (e) Any handwritten entries must state where the details were obtained, be signed and dated by the person making the entry and be checked and signed by a second member of care staff; (f) Any changes to a prescribed medication must be confirmed in writing by the prescriber. Timescale for action 16/11/05 Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 Page 23 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 Refer to Standard OP9 OP9 Good Practice Recommendations It is recommended that the system of medication administration is reviewed. For ease of identification and to reduce the risk of giving the wrong medication to the wrong person, it is recommended that a divider card with the person’s photograph attached is inserted between each resident’s MAR sheets. It is good practice to arrange for a pharmacist to carry out monitoring visits to the home to assess the complete medication administration system and process. It is recommended that members of staff are provided with a copy of the notes made at supervision meetings, which both parties have signed and dated. 3 4 OP9 OP36 Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Cambridge House DS0000013583.V254264.R01.S.doc Version 5.0 Page 25 - 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. 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