CARE HOMES FOR OLDER PEOPLE
Camellia House 5 Belmont Place Stoke Plymouth Devon PL3 4DN Lead Inspector
Megan Walker Unannounced Inspection 13th December 2005 13:30 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 Camellia House DS0000048342.V273332.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. Camellia House DS0000048342.V273332.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Camellia House Address 5 Belmont Place Stoke Plymouth Devon PL3 4DN 01752 509697 01752 509697 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) Miss Sunita Jhugroo Miss Sunita Jhugroo Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Camellia House DS0000048342.V273332.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Three named service users who are older persons and have a learning disability 6th July 2005 Date of last inspection Brief Description of the Service: The home is a large end of terrace building, approximately 150 years of age, and located on a small cul de sac road close to Stoke Village, Plymouth. A full range of amenities and facilities are within walking distance of the home. The home can accommodate up to fourteen residents over four floors. It has a shaft lift. There are two communal bathrooms in the home and one en-suite bathroom. The main lounge is at the front of the building and the dining room is towards the rear of the building, leading into the kitchen. At the back of the house is a patio area with pot plants, and garden furniture available for residents’ use. There are eight single and three double bedrooms in the home. Only one double room has en-suite facilities. The home is made up of the original building and a three-floor extension to the rear. The service offered by the home is primarily for older people who are more independent. The home does not have the specialist categories to provide care for people with significant dementia or mental frailty needs. It does not provide intermediate care and it is not registered to provide nursing care. Camellia House DS0000048342.V273332.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on Tuesday 13th December 2005 between 13h30 and 17h45. The inspector toured the premises. All the service users at home were introduced to the inspector and two offered comments and views about living at Camellia House and the care services they receive. Time was spent talking with the Registered Provider Ms Sunita Jhugroo, and other staff on duty during the inspection. Care records, staff files, and other records and documents were inspected. Fourteen requirements, one of which was an Immediate Requirement at the time of the inspection, and two “Good Practice” recommendations have been made as a consequence of this inspection. What the service does well: What has improved since the last inspection?
Care plans are being re-organised to be more specific and provide sufficient detail for staff to ensure individual residents’ needs are met as recommended in the previous inspection report. Ms. Jhugroo has been given contact details by the home’s pharmacist for all staff to receive accredited training in administration and handling of medication as recommended in the previous inspection report. The new staff Induction Training is being rewritten to ensure that it meets the National Training Organisation specifications as recommended in the previous inspection report. . A “Comments Card” is being devised for distribution to all residents, their families and friends, and any other visitors to the home. This will then be correlated to produce an annual newsletter with updates on the past year’s events, improvements and changes within the home, residents and visitors views about the home, and future plans for the benefit of the residents. All residents have an inventory of personal possessions on their individual files.
Camellia House DS0000048342.V273332.R01.S.doc Version 5.0 Page 6 A handyman has been contracted to work at the home to install required hot water valves and door safety fireguard closers. What they could do better:
On the day of the inspection the front door was not locked hence it was possible for anyone to gain easy access to the inside of the building and for residents to go out unsupervised. On the day of the inspection there was only one member of staff, a care assistant, on duty for a period of approximately one hour. It is unclear for how long this situation may have continued if there had not been an unannounced inspection. Since coming on duty at 07h00 this member of staff had had responsibility for residents’ breakfast, medication, personal care, mid-morning drinks, and cooking lunch for the residents. During part of this time there had apparently been two other staff assisting with some residents’ personal care needs. The care assistant also had to take her lunch-break in the residents’ lounge and attend to residents who needed assistance whilst she was eating her lunch because she was alone on duty. There is no staffroom or separate facility for staff to take proper breaks or to change. Also night sleeping staff are required to sleep on the settee in the residents’ lounge because there is nowhere else available. The home must ensure that at all times there is adequate staff cover for both personal care needs of residents, and domestic tasks around the home. It is inappropriate that care staff take their breaks with the residents because this does not allow staff a proper break to which they are entitled under Working Conditions’ legislation. Also it is inappropriate that staff sleep in the residents’ lounge because this room should be available to residents at any time they may choose to use it, and again it contravenes Working Conditions legislation as well as the Care Standards Act 2000. Staff records showed a high rate of sickness in recent weeks and Ms Jhugroo stated that it had been difficult to provide cover for those periods. She stated that frequently she had had to continue working, even though she had already done the previous shift. This poses a risk to both her health and that of any other staff required to work excessive hours, and thereby it is a risk to the safety of the residents. There must be sufficient backup to ensure all “gaps” can be covered in the event of staff absenteeism. The toilet situated in the main hall is visible through the clear glass window in the inner front door, and from the top of the stairs. Although this toilet has a door and a curtain around it, residents were observed during the inspection using this toilet without closing either the curtain or the door. Once darkness had fallen and the hall lights were switched, it was possible to look from the street into the home and see through the hall, up the stairs, into the toilet, and into the dining room. The net curtains across the inner front door window were tied back so there was nothing to ensure residents privacy from either neighbours or passers-by. Although a thermometer was seen in the freezer, there were no charts to show regular records of temperature checks. The one chest freezer inspected had a
Camellia House DS0000048342.V273332.R01.S.doc Version 5.0 Page 7 large supply of white sliced bread and a few other food items in the two baskets. The main part of this freezer was empty. There is only one assisted bath in use and available to all the residents which could be restrictive on choice of bath times. 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. Camellia House DS0000048342.V273332.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 Camellia House DS0000048342.V273332.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): 0 These standards were not inspected on this occasion. EVIDENCE: Camellia House DS0000048342.V273332.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, 9, 11 Residents can feel confident that the home’s management is making improvements to ensure their safety and welfare. EVIDENCE: Ms Jhugroo has started to reorganise residents’ care plans so that more detail about individual residents care needs is on each file. A sample of files were inspected and cross-referenced with the Accident book and the “Daily Record”. The individual care files corresponded with both the other records, however there was no review to support future staff input when caring for particular individuals. Each resident and/or their families are asked about their wishes for burial or cremation after their death. This is recorded on the individual care files. The home’s annual pharmacy inspection took place on the 12th October 2005. The pharmacist has provided contact details for staff training by the Co-op pharmacy (the home’s medication supplier). Ms Jhugroo also has information about the administration and handling of medication training available at the Cornwall College, Saltash, in February 2006. She is making enquiries about both training providers to ensure that all staff who handle residents’
Camellia House DS0000048342.V273332.R01.S.doc Version 5.0 Page 11 medication receive appropriate accredited training as required at the last inspection. Camellia House DS0000048342.V273332.R01.S.doc Version 5.0 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 the following standard(s): 12,13,14 Residents are encouraged to be as independent as is possible for each individual. EVIDENCE: At the time of the inspection all the residents were of a Protestant Christian background, there were no non-believers, Catholic Christians, or followers of any other faith. Ms Jhugroo explained that she had received an enquiry about taking an older person who was Hindu. She had had to refuse this admission only because she would have been unable to support the religious needs of this person because there is not a Hindu temple in Plymouth. All other care needs for this individual were assessed as being possible to be met by the home. There is a Christian hymn singing session every 6 weeks held at the home. On Tuesday afternoons an external provider comes into the home to do a “Dance Fit” session for an hour with the residents. This was observed during the inspection with most of the residents actively participating. Two residents were out at day centres on the day of the inspection. An enabler comes in weekly to provide support as part of a care plan to an individual resident. Contact with families is actively encouraged with either trips out with family members or visits by family and friends to the home. Individual residents are taken out by Ms Jhugroo either shopping, or for breakfast or tea at local cafes.
Camellia House DS0000048342.V273332.R01.S.doc Version 5.0 Page 13 Residents are encouraged to pursue their leisure interests and from a sample of residents’ files, it was seen that they participate in such activities as going to the local shops, local pubs and the occasional “flutter” at the betting shop. All residents’ activities are assessed to ensure that they are not putting the individual at risk. Two residents stated that they feel they are well cared for and that staff look after them. Camellia House DS0000048342.V273332.R01.S.doc Version 5.0 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 the following standard(s): 17 Residents can feel confident that their legal rights are protected. EVIDENCE: All the residents are registered on the electoral role and can choose to vote at election time. Ms Jhugroo gave an example of circumstances when an individual resident had used the services of an advocate. Camellia House DS0000048342.V273332.R01.S.doc Version 5.0 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 the following standard(s): 21, 22 The residents are restricted in choice of bath times if they require bathing assistance. Inadequate measures compromise privacy and dignity of residents. EVIDENCE: Although there are adequate bathrooms for the number of residents living in the home, only one bath is available for those residents requiring bathing assistance equipment. The age and layout of the home partially contributes to this restriction. The first floor communal toilet has its door directly opening into the main reception hall and is evident through the window in the inner front door. During the inspection residents were observed going to use this toilet. Those using it independently struggled with both the curtain and the door, particularly those using walking frames. There was a lengthy discussion with Ms Jhugroo about this and the issue of dignity and privacy for residents. Ms Jhugroo stated that she is proposing to replace the clear glass window in the inner front door with frosted glass. She also stated that there are also plans for new curtains for the door. The current net curtains were tied back at the
Camellia House DS0000048342.V273332.R01.S.doc Version 5.0 Page 16 time of this inspection because, Ms Jhugroo explained, they are old. In the long term Ms Jhugroo plans to replace the outer front door with another window door. During the day this outer door is left open to allow as much natural daylight as possible into the hall. It also provides residents with another external view through the window in the inner front door. Camellia House DS0000048342.V273332.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): 27, 30 Staff are competent in doing their jobs but there are insufficient staff to meet the care needs of the residents. EVIDENCE: On the day of the inspection there was only one member of staff, a care assistant NVQ Level2, on duty for a period of approximately one hour. It is unclear for how long this situation may have continued if there had not been an unannounced inspection. Since coming on duty at 07h00 this member of staff had had responsibility for residents’ breakfast, medication, personal care, mid-morning drinks, and cooking lunch for the residents. During part of this time there had apparently been two other staff assisting with some residents’ personal care needs. The care assistant also had to take her lunch-break in the residents’ lounge and attend to residents who needed assistance whilst she was eating her lunch because she was alone on duty. A student on work experience placement at the time of the inspection confirmed that she is not allowed to do any personal care for residents. From observation during the inspection it was unclear who was responsible for the supervision of this student’s placement and what benefit it was providing for residents. There is no staffroom or separate facility for staff to take proper breaks. Also night sleeping staff are required to sleep on the settee in the residents lounge because there is nowhere else available for them. Staff records showed a high rate of sickness in recent weeks and Ms Jhugroo stated that it had been difficult to provide cover for those periods. She stated that frequently she had had to continue working, even though she had already
Camellia House DS0000048342.V273332.R01.S.doc Version 5.0 Page 18 done the previous shift. It was agreed at the time of this inspection that Ms Jhugroo would inform the Commission should she be short staffed again in the future. This will include staff sickness, staff working excessive hours and staff giving notice without warning. The Staff Induction training has apparently been updated to comply with the specifications of the National Training Organisation. It was not possible to see a copy of the revised staff handbook at the time of the inspection because it was allegedly at the printers. Five staff started an NVQ Level 2 course with “Achievement Training” in November 2005, due to be completed by December 2006. Adult Protection Training has also been offered by “Achievement Training” and Ms Jhugroo is awaiting confirmation of a course in January 2006. A District Nurse who regularly visits the home is arranging training for all staff in Infection Control and Diabetes (Food Control). All staff require First Aid training. The annual fire training was in June 2005. Camellia House DS0000048342.V273332.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, 37, 38 The management is beginning to focus on residents’ best interests. EVIDENCE: A “Comments Card” is apparently being devised for distribution to all residents, their families and friends, and any other visitors to the home. This will then be correlated to produce an annual newsletter with updates on the past year’s events, improvements and changes within the home, residents and visitors views about the home, and future plans for the benefit of the residents. During a tour of the premises the food storage area was inspected. One of two freezers was unlocked. Its contents were minimal: a large number of “Basics” white sliced bread, and a few other sundry items. The care assistant explained that food to be eaten imminently was transferred into this freezer from the freezer that was locked, and usually both were locked. There was a thermometer in the freezer however there did not seem to be any charts or recordings of regular temperature checks for the freezers and ‘fridge’. On the day of the inspection the front door was open (as is daily practice by the home), however the inner front door was on the latch allowing easy access
Camellia House DS0000048342.V273332.R01.S.doc Version 5.0 Page 20 inside and outside the home. Ms Jhugroo stated that usually this door is kept locked for security of the premises as well as for the protection of residents who may wander. Despite this statement, a visitor to the home later walked in to the home. Camellia House DS0000048342.V273332.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 2 8 X 9 2 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 X X X 2 2 X X X X STAFFING Standard No Score 27 1 28 X 29 X 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X X X 1 1 Camellia House DS0000048342.V273332.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? YES 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 OP7 Regulation 14, 24 Requirement Each resident must have an individual care plan that clearly identifies their individual care needs and how staff should meet those needs. Each plan must be kept under regular review, and changed at any time circumstances alter. This is outstanding from the previous inspection report and the timescale extended. All care staff who administer medication must be appropriately trained in accredited “Handling and Administration of Medicines” This is outstanding from the previous inspection report and the timescale extended. The Registered Provider must ensure the privacy, dignity and safety of residents is not compromised by the location of the communal toilet and its proximity to the front door of the home. At minimum curtains on the inner front door must be provided that are in good condition and kept drawn together across the window.
DS0000048342.V273332.R01.S.doc Timescale for action 31/01/06 2 OP9 18© 31/03/06 3 OP10OP14 OP21 4a:23,1a, 2a,n;Sch1 ,18 19/12/05 Camellia House Version 5.0 Page 23 4 OP27 18 5 OP27 18(1a), Sch4 (6e) 6 OP27 Sch4 (6e) 7 OP27 37(1e))2) 8 9 OP30 OP30 13(4) 18(1) 10 OP30OP38 18(1),21( 1),23(3) 11 OP33 12, Sch1 (10) The Registered Provider must ensure that at all times there is sufficient and suitably qualified, competent and experienced staff on duty. This was an immediate requirement made at the time of the inspection. Staff deployment in the home must ensure that care staff are not undertaking too many different tasks during any one work period and thereby compromising the care and safety of the residents. Copies of care assistants’ duties and hours of employment each week must be supplied to the Commission. The Registered Manager must inform the Commission of any situation such as staff shortages that may adversely affect the wellbeing of residents as agreed at the time of the inspection. All staff must have up to date and recent training in first aid. The induction training structure must be redeveloped to the level specified by the National Training Organisation. This is outstanding from the previous inspection report and the timescale extended. The Registered Provider must provide suitable facilities for staff to ensure that they have proper breaks during their working periods as required by legislation governing employment and working conditions. Also sleeping night staff must be provided with sleeping accommodation that is separate from residents’ accommodation. An effective quality assurance system must be developed to establish the residents’ level of
DS0000048342.V273332.R01.S.doc 13/12/05 31/01/06 19/12/05 31/03/06 31/03/06 31/03/06 31/03/06 Camellia House Version 5.0 Page 24 12 OP37OP38 12(1a) 13(4c) 17 13 OP38 16(i) 14 OP38 12(1a),13 (4),16(1) satisfaction with the care services they receive in the home. This must also be extended to all visitors to the home including health and social care professionals, to establish their level of satisfaction with the care services being provided in the home. The results of all the surveys undertaken must be published and available to prospective service users and the Commission. This is outstanding from the previous inspection report and the timescale extended. Regular freezer and ‘fridge’ temperature checks must be taken and recorded to ensure food hygiene. This is outstanding from the previous inspection report and the timescale extended. Food storage must include labelling and dating to avoid food poisoning. There must be adequate quantities of food with a variety of choice. The premises must be kept secure. 31/01/06 31/12/05 31/12/05 13/12/05 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 Refer to Standard OP22 OP27 Good Practice Recommendations The Registered Provider should ensure that specialist equipment such as bathing aids are adequately available to meet the changing care needs of the residents. The Registered Provider should consider the use of agency staff to ensure adequate staff cover at all times.
DS0000048342.V273332.R01.S.doc Version 5.0 Page 25 Camellia House 3 OP27 3 OP36 The Registered Provider should consider the employment of domestic staff. This may ensure that staff are not jeopardising the care needs of residents because they have to do too many different tasks during their shift. A system of regular individual supervision, including the development of a supervision procedure, should be put into operation for the care staff. This recommendation has been carried forward from the previous inspection report. Camellia House DS0000048342.V273332.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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