Inspection on 30/08/07 for Camellia House

This inspection was carried out on 30th August 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Camellia House 23/10/06

Camellia House 04/05/06

Camellia House 13/12/05

Camellia House 06/07/05

Camellia House 25/11/04

Camellia House 15/06/04

Camellia House 02/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Camellia House 5 Belmont Place Stoke Plymouth Devon PL3 4DN Lead Inspector Megan Walker Key Unannounced Inspection 30th August 2007 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 Camellia House DS0000048342.V336982.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. Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Camellia House Address 5 Belmont Place Stoke Plymouth Devon PL3 4DN 01752 509697 01752 509697 camelliahouse@hotmail.co.uk 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.V336982.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user who is an older person and have a learning disability 23rd October 2006 Date of last inspection Brief Description of the Service: Camellia House is a care home registered for up to fourteen people, who have care needs within the categories of Old Age - that is, people over retirement age – and not falling within any other category. The home does not have the specialist categories to provide care for people with significant dementia or mental frailty needs. Nor does it provide intermediate care, and it is not registered to provide nursing care. 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, with level access to the home at the rear of the building. The home is made up of the original building and a three-floor extension to the rear. Some rooms on the top floor are staff rooms. 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 an enclosed patio area with pot plants, and garden furniture available for residents’ use. There are eight single and three double bedrooms in the home, of which one double room has en-suite facilities (including a bath). There are two communal bathrooms in the home. The service offered by the home is primarily for older people who are more independent. The current scale of charges ranging from £279.00 to £340.00, according to assessment of care needs. Additional charges include in-house hairdresser, chiropody, incontinence pads, toiletries, newspapers, magazines, journals etc, all charged at commercial rates. All charges’ information was provided at the time of the fieldwork visit to the home on 30/08/2007. The Commission for Social care Inspection (CSCI) reports on the home are available on request from the Registered Manager, Deputy Manager or the Assistant Manager. Camellia House DS0000048342.V336982.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, carried out by two inspectors, Megan Walker and Rachel Fleet. The fieldwork part of this inspection was unannounced, and took place on Thursday 30th August 2007 between 10h30 and 18h15. The Registered Manager was not present at the time of this visit due to annual leave. However, the Deputy Manager and the Assistant Manager who were in charge of the home were able to assist us. We ‘case-tracked’ three people who lived at the home. This involved looking into their care in more detail by meeting with them, checking their care records and other documentation relating to them (such as pre-admission assessments and, medication records), observation of care they received, and talking with staff. The three included men and women, people new to the home, people with more diverse needs, someone who had no visitors, and people with more complex or changing physical or mental health needs. We made a tour of the premises, also talking to other people who live there and observing staff interactions with them. We looked at care plans, staff files, medication, and other records or documentation. Of Comment cards and surveys we sent out for people who live at the home, their relatives/visitors, staff and Health/Social Care professionals in contact with the home, we received one back (from a visitor). Other information we used to inform this inspection included: • The Annual Quality Assurance Assessment (AQAA) completed by the Registered Manager (- a CSCI questionnaire about the home, which asks for an assessment of what they do well, and their plans for improvement). • The previous two inspection reports. • All other information relating to Camellia House received by us since the last inspection. Five requirements and three “Good Practice” recommendations were made as a consequence of this inspection. There were eight unmet requirements from previous inspections, although some of them related to each other, being about the same issues. What the service does well: Camellia House provides clean, homely accommodation, in which people who require twenty-four hour care are encouraged to be as independent as possible. People can feel confident that their needs will be assessed before they choose to move into the home, and that they can visit to make an Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 6 informed choice about moving to the home, helping to ensure the success of any admission to the home. Staff respect peoples’ privacy and choices, promoting their dignity and rights. They are treated as individuals and can lead fulfilling lives, in part because the home respects their different needs due to religion, age, disability, etc. They can continue to enjoy familiar supportive relationships with family and friends. Systems in place help to safeguard their financial interests. They can feel confident that any complaints or concerns will be taken seriously and acted upon by the home. A visitor reflected some of our findings when they said, “The care home provides a warm, friendly atmosphere for residents, with good food, and the staff get involved with the residents doing various activities. As a visitor I am always made welcome whatever time I visit, and I am always informed of my relative’s condition.” Involvement of other community-based professionals and appropriate medication systems ensure that peoples’ health needs are met. And they have the benefit of wholesome appealing meals, eaten in pleasant surroundings. What has improved since the last inspection? What they could do better: The Registered Manager is popular with people living at the home, their families, and with staff. However, management of the home and quality assurance systems need to be more proactive, robust and transparent, to fully Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 7 assure people that the home is run in their best interests, with staff able to carry out their responsibilities in her absence. Availability of information needs to be addressed - for CSCI inspections as well as for staff (care plans, related information, etc.), and for others. The written complaints procedure could be made more accessible, for peoples’ information, for example. People have benefitted greatly from refurbishment throughout the home, but health and safety issues must also be identified and attended to in a timely way to ensure that they have a safe home. Two immediate requirements were made in relation to this, for matters identified as needing urgent attention at the last inspection. Staff recruitment and training must be improved to ensure that people are cared for by suitable and competent staff. 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. Camellia House DS0000048342.V336982.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 Camellia House DS0000048342.V336982.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 & 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People choosing to use this service and their families can feel confident that their needs will be assessed before moving into the home, and that they can visit the home, enabling them to make an informed choice about moving to the home. EVIDENCE: Inspection of a selection of care files found that for someone who moved in recently, a comprehensive assessment of their needs had been done before they moved to the home. The person’s care manager had also provided a Social Services care plan that provided extra information. The person confirmed they had visited the home for tea and then for an overnight stay, before moving in. They said they had been able to choose which of two rooms they wanted. Another person who spoke to us confirmed Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 10 that they had been for a short respite stay at the home prior to making the decision to move there. The Statement of Purpose and the Service User’s Guide were all under review and being updated by the Registered Manager at the time of this visit, so were not inspected on this occasion. Camellia House DS0000048342.V336982.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 good. This judgement has been made using available evidence including a visit to this service. Care plans generally inform staff well about peoples’ very individual needs and preferences, but lack of some information creates a risk that care may not always be safe or so person-centred. Multidisciplinary working and safe medication systems ensure that health needs are met. There is good respect for peoples’ privacy, with promotion of their dignity and rights. EVIDENCE: During our case tracking, we saw care plans for two people, dated March 2007. These identified what they were able to do for themselves, and what support or help they needed from staff with their daily lives. They were very detailed, including assistance needed with personal care, preferred activities, dietary likes and dislikes, how people might show they were in pain if they did not complain verbally about it, which ear people wore their hearing aid in, etc. Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 12 One care plan had been shared with the person’s next-of-kin, with an indication in the other that it had been discussed with the person concerned although they were unable to sign the care plan to verify this. The care plan for a third person, newer to the home, was not available during our visit. An assessment of their care needs was available, but with insufficient guidance for staff as to how to meet those needs. And no social histories were seen on the care files provided to us. We were later told, by the manager, that there was a care plan for this person as well as records of peoples’ social histories, but they were kept in a different place to the records we saw. We agreed we would see these on our next visit. Risk assessments were seen which generally gave staff guidance as to how to reduce risks whilst still enabling or supporting individuals in a positive way. For example, managing aggression or mood changes, or what to do if a meal was declined. A small number lacked detail – for example, ‘No road danger sense’ was noted but without further guidance as to how this should be managed. And there were no risk assessments available for one person, even though preadmission information identified a risk of choking. Monthly reviews usefully assessed the success (or otherwise) of the care planned. Reviews for one person showed their mobility and ability to communicate had improved over time. They included any additional actions staff needed to take, ensuring needs related to changeable states of wellbeing - such as a risk of sore skin, or mobility being affected by worsening of arthritic pain, for example - were met. Language in records was generally very appropriate, reflecting caring, vigilant staff. Records showed one person had had new glasses, that people had help to ensure they attended hospital appointments, and that medical advice was sought in a timely way, both from emergency services and GPs, when people’s condition changed. One person with a particular medical condition confirmed they had just been to their doctor surgery for a health check. Records of individuals’ weights were not seen, but one person confirmed they had been weighed that morning, and food eaten was reflected in some daily notes seen. One person who was asked said they were satisfied with how the home managed their medication for them. Eight staff, including the Registered Manager, are responsible for handling and administration of medication. The Assistant Manager confirmed that they had all had training. She explained that medication was given to one person at a time, the medication record signed as given and if taken (or not, e.g. if refused). Two people’s medicines were checked. They were all in date, with the correct number of tablets available. At the time of our visit, no-one was taking any controlled medications. One medication record sheet showed that someone’s medication had not been signed as given on one occasion the previous day. This was brought to the Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 13 Assistant Manager’s attention. One person had a penicillin allergy noted in their care records, which was not noted on their medication record. It would be good practice to do so, to reduce the risk of medication errors. We saw staff were respectful about people’s privacy. Some care plans identified staff preferred by individuals, which was particularly helpful in ensuring certain needs were met where people otherwise declined help. Screens were provided in shared bedrooms. Locks had been provided for those people who had asked to have a key for their room. Camellia House DS0000048342.V336982.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 good. This judgement has been made using available evidence including a visit to this service. People are treated as individuals and lead fulfilling lives, in part because the home respects their different needs due to religion, age, disability, etc. Their right to choice is promoted through support to follow their chosen lifestyle, interests and activities, including within the local community. They can continue to enjoy familiar supportive relationships with family and friends. And they have the benefit of wholesome appealing meals, eaten in pleasant surroundings. EVIDENCE: One person who recently moved in to the home told us that they were “really happy here” and pleased to have moved in here. They also said that the staff were helpful and friendly, clothes were always clean, and staff took time to help people with their personal appearances. Another person told us that staff helped them with manicures, nail painting and putting on make-up. Daily care notes showed that in the past month people had joined in with musical Bingo, singing, dancing and a book club held at the home. There was an outing to the Torbay area in May 2007, and more recently to Looe in Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 15 Cornwall. One person new to the home continued to attend the place of worship and the clubs they went to before going to live at the home. Another person also went to one of these clubs. One person said they didn’t want to go out because they were unsteady on their feet. We saw people enjoyed the company of their peers, and daily notes included visits by relatives. One person said they had known some of their peers from before they moved into the home. During time spent in the lounge, one or more staff were present for the majority of the time. One found someone a puzzle and helped them to complete it. They had a slightly abrupt communication style, but clearly knew people and their needs well. Another engaged with other people in general light conversation or in one-to-one communication, checking her understanding of people’s responses before continuing. The television was on throughout, with some people actively watching some programmes. When someone finished their newspaper and offered it to staff, the staff member offered it to another person, who was glad to have it. Staff asked one person if they would put out coffee tables for their peers to use, when drinks were served midmorning. An assortment of games, jigsaws, knitting and colouring books and pencils were all seen kept in the lounge for people to use. The Assistant Manager confirmed that an external provider seen at the home during previous inspections continued to come weekly to do a “Dance Fit” session with people who wish to join in. Bedrooms were personalised with peoples’ possessions. One person spoken with said, “It’s like home from home.” Daily care notes kept by day and night staff showed there was flexibility around the time people got up or went to bed. Someone who staff found was up early was brought a cup of tea. They also said staff helped them bathe at the time of day they used to have a bath before moving in. A visitor said they were always made welcome whatever time they visited. One person said staff had offered to walk to the local shops with them, so they could do some shopping themselves. And for their birthday, they were going to be taken to the shops they used to visit before coming to live at the home. A record was seen that one person had gone to vote in local elections earlier in the year. Everyone who was asked said they liked the food provided. Dietary likes and dislikes were noted in care records. We saw the home uses fresh produce as well as frozen supplies. Meals seen were attractively presented, and there was a calm atmosphere in the dining room, which is very homely. Some people chose to eat elsewhere (in their own room, etc.), with meals covered whilst being taken to them on a tray. Camellia House DS0000048342.V336982.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 adequate. This judgement has been made using available evidence including a visit to this service. Although peoples’ access to the written complaints procedure could be improved, they can feel confident that any complaints or concerns they raise will be taken seriously and acted upon by the home. However, the home needs to be more proactive than this if they are to ensure people are protected from abuse or harm. EVIDENCE: We have not received any complaints about the home since our last inspection. Three people living at the home said they felt able to raise any concerns or issues with the Registered Manager or a member of staff, and felt the matter would be addressed. Generally they said they would go to the Registered Manager because she was approachable and would listen to them. The Complaints Procedure was seen displayed in the main hallway near the front door. It was written in small print that was difficult to read, and was not immediately obvious due the number of pictures and other notices on the same wall. The Service User’s Guide was at the printers at the time of this visit so it was not possible to confirm that it had been updated to advise people to contact the CSCI should they wish to make a complaint about this service. We saw evidence that two staff had recently attended training on safeguarding adults (- previously known as ‘Protection of Vulnerable Adults’ training or Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 17 ‘POVA’ training). A new member of staff confirmed that she had attended “Safeguarding Adults” training in the past twelve months although this was with a previous employer. The Registered Manager stated in the home’s Improvement Plan dated 28/03/2008 that: “3 staff members have attended POVA training. In future POVA procedures will be followed.” She has also written in the Annual Quality Assurance Assessment (AQAA) that all staff members will attend safeguarding training when it becomes available, and that “new members of staff aware of any early signs of abuse through induction”. This includes domestic as well as care staff. Camellia House DS0000048342.V336982.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, 20, 23, 24, 25, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been much investment in improving peoples’ private and shared accommodation, so people enjoy a pleasant, comfortable and clean home. However, health and safety measures must also be attended to, to ensure that it is a safe home for them. EVIDENCE: A tour of the premises found that the ongoing plan of refurbishment continues and people live in a clean, comfortable home. One toilet had been decorated recently and the floor was recovered in attractive linoleum. Most of the bedrooms had new, replacement vanity units. Three bedrooms had been decorated and had new carpets; two other rooms had new carpets. People we asked said they liked their bedrooms. The Assistant Manager, who accompanied us around the building, confirmed that people had been consulted individually about the redecoration of their rooms. Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 19 Everyone living in the house had also been consulted about repainting the dining room, and they had opted for an apple green instead of its current pink walls. To encourage people to be involved in daily living activities, a rota has been set up for setting the tables. As well as giving people a sense of purpose, it also meant that tables were laid just prior to a meal so that anyone who may be confused was not disorientated about the time. The Assistant Manager also explained that people use the dining room to sit in as an alternative to the sitting room. The small bathroom at the top of the house is still not in use and for safety reasons the hot tap has been dismantled. The Registered Manager is awaiting quotations from building companies about converting this bathroom into a shower room. This would provide people with the option of a walk-in shower or a bath in the downstairs bathroom. A matter of serious concern was that hot water taps in the en-suite bathroom on the lower ground floor were not regulated, creating a scalding risk. This is relevant to Standards 19, 25 and 38; any requirement that might have been made in relation to Standard 25 in this report is covered by the requirements made under Standards 19 and 38, so a separate requirement has not been made on this occasion. An Immediate Requirement was made at the time of this visit, to address this. The Deputy Manager contacted a plumber who agreed that he would finish fitting hot water regulators around the home within two weeks of this visit. At the last inspection, we raised another matter of serious concern - the top floor fire door, which was difficult to open. We again found, on this visit, it was still stiff to open and then would not close. The fire door on the first floor had a sign on it – “Do Not Open”. The Assistant Manager was unable to explain this. On closer inspection it was found that the threshold of this door was in need of repair, and possibly the doorframe also. A second Immediate Requirement was issued for the Registered Manager to contact the Fire Safety Officer to request a visit. We have written to the Fire Safety Officers for Plymouth advising them of our concerns. Following the Health Protection Agency Nurse’s visit to the home for the last inspection, liquid soap and paper towel dispensers were seen fitted in bathrooms, toilets, the kitchen and the laundry. Pedal bins had also been provided. Chemicals and other hazardous liquids were seen kept in a locked cupboard. The room used to dry laundry was also kept locked to prevent anyone wandering in there. Relevant requirements have been made under Standard 38. Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. Although the home is taking steps to ensure people receive a safe basic level of care, staffing arrangements are not yet robust enough to assure people that they will be looked after by suitable and competent staff who can meet their existing and changing needs. EVIDENCE: When we arrived, there were initially three care assistants on duty to look after 12 residents, in addition to the two senior staff who assisted us throughout the day. There were two care assistants on duty in the afternoon. We were told senior staff would be available to maintain safe staffing levels at the home, if someone wanted to go out in the afternoon and needed staff to go with them. One of the senior staff did the cooking during our visit. Some staff are employed separately for housekeeping duties (cleaning, etc.). One person living at the home said staff were friendly, with others also reflecting staff had positive qualities. When individuals in the lounge called to staff, they were given prompt, sympathetic, unhurried attention. We saw one person being patiently encouraged to independently sit themselves back in their chair, after being walked into the lounge by two staff, being praised when they achieved this. Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 21 We requested that senior staff give us the personnel files for the three most recently appointed staff. The files we were given generally contained required information about each individual (including police checks), which had been obtained before the person started working at the home. However, full employment histories were not routinely obtained as part of the application process. And where individuals had provided this information, there was no evidence that a satisfactory explanation had been obtained for gaps in their employment history. We also saw that application forms were not dated. We did not see evidence of induction in these files, although a senior staff said the individuals might have the record themselves. We saw the induction record for a fourth staff member, which had been signed to say their induction had been completed after three months of employment. Their records showed they had had manual handling training and fire safety training this year. But they had not had any training specific to the needs or conditions of people living at the home (such as conditions of old age- diabetes, etc. - or learning disabilities, etc.), to ensure they can meet peoples’ current or changing needs. The three staff whose files we looked at all had previous care work experience, with two having and one undertaking nationally recognised care qualifications when appointed. One staff member we spoke with confirmed that she had completed a National Vocational Qualification (NVQ) in Care Level 2 and was waiting to continue with a Level 3 as soon as training was available. A file recording matters relating to ‘Quality Assurance’ included that three staff were starting a recognised care qualification (NVQ2). The AQAA said staff are encouraged to progress to achieving an NVQ at Level 3. Two staff had attended a manual handling course and a safeguarding course since our last inspection. However, most training certificates seen in personnel files related to training undertaken in previous employment. It was not clear if the home verified people’s current knowledge and competency in relation to these, to ascertain that they were relevant to the employee’s current care setting. Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 22 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): 31, 32, 33, 35, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Registered Manager is popular with residents, their families and staff. However, processes of managing the home are not transparent, proactive and robust enough to fully assure people that the home is run in their best interests, although systems in place safeguard their financial interests. EVIDENCE: People living at the home were complimentary about Miss Sunita Jhugroo, the Registered Manager, and felt that she was approachable and someone who listened to them. People working in the home told us they could talk to her without fear of recrimination. One said that the ill feelings between staff had gone since there had been a number of new staff recruited, and it was a much Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 23 better place to work at. The Registered Manager successfully completed the Registered Manager’s Award last year. The CSCI has introduced a legal document called an Annual Quality Assurance Assessment (AQAA). This is sent to all service providers for them to provide us with information about the provision and quality of their service, as well as how people using the service are involved in deciding what and how the service is offered and provided. The AQAA from Camellia House was returned incomplete. Information we requested from senior staff during our visit was also incomplete, necessitating follow up at a later date; they told us they thought the information existed but did not know where it was kept. This was information required by staff to carry out their responsibilities and also required by regulation. There are ongoing, outstanding requirements from previous inspections. The Quality Assurance file included improvements or changes made since the last visit – repairs to the structure of the home, new carpets in some bedrooms, two new staff appointed to replace two departing staff, and some staff training. We saw simple comment cards provided by the home - one person living at the home and two visitors/relatives (including visiting professionals) had completed them earlier in the year. No issues were raised, and one of the latter commented, ‘Friendly all the time’. The manager acts as appointee for one person only, because that person knows no-one else willing to take on that role. However, some other people have asked the home to keep some monies on their behalf, for daily shopping needs, hairdressing, etc. One person who lived at the home was satisfied with the way their money was kept by the home, saying it was readily made available to them when they asked for some. We checked the personal monies records of three people who we were casetracking. Cash balances for each individual were held separately, and tallied with the running total shown on each person’s records. Receipts were available for shopping transactions recorded, where checked at random. The current hairdresser and chiropodist sign the individual records rather than provide separate receipts. One person had signed their records when they withdrew amounts from the money held by the home. We discussed with a senior staff member that it would be good practice if two people signed entries to verify their correctness, rather than just one person as at present. There were 10 entries in the accident book for 2007, with five happening to one person (who had last fallen in June 2007). Recent accidents were seen recorded in individuals’ care notes and reflected in monthly reviews, although it was not clear if accidents were audited in other ways. Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 24 The hoist had been serviced in October 2006. Current clinical waste and call bell servicing contracts were seen. Relevant information (about maintenance of equipment) was not completed in the AQAA returned by the home. Care staff are currently responsible for any catering. The AQAA said a third of staff have undertaken a recognised food hygiene course (- addressed in requirement relating to Standard 30). Records showed fire safety checks for alarms, extinguishers and automatic door closers had been completed at recommended intervals. However, there was no evidence that emergency lighting was checked regularly. Fire training was given at six monthly intervals by an external trainer, although no record of attendees was seen. See also the section on ‘Environment’ regarding two concerns about the safety of the environment. We made immediate requirements that the home urgently addresses two matters of serious concern, relating to fire safety and risks from hot water. Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 25 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 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 3 X X 3 3 2 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 X 2 1 Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 26 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 12(1)(a) Requirement ‘The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health & welfare of service users’, and ‘(1) The registered person shall— (a) Maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the service user; (3) The registered person shall ensure that the records referred to in paragraph (1) are at all times available for inspection in the care home by any person authorized by the Commission to enter & inspect the care home.’ - Ensuring care plans & related information, etc. are available to staff, and to CSCI when we visit the home. Timescale for action 31/10/07 & 17 Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 27 2. OP18 13(6) ‘The registered person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse’. - Ensuring all staff receive training on safeguarding, including local safeguarding protocols, etc. ‘The Registered Person shall not employ a person to work at the care home unless - subject to paragraph (6), (8), (9) - he has obtained in respect of that person the information and documents specified in (i) paragraphs 1 to 9 of schedule 2.’ - This refers to the lack of essential information held on staff files, including a full employment history, together with a satisfactory written explanation of any gaps in employment. Timescale of 31/12/06 partly met (- police checks and written references obtained). This requirement is outstanding from the previous two inspections. 31/12/07 3. OP29 19(1) Sched. 2 31/10/07 Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 28 4. OP30 18(1) ‘The Registered Person shall ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform.’ This refers to outstanding mandatory training that staff still have not had made available to them (food hygiene, etc.), safeguarding, and topics specific to the needs of the people they look after. Timescale of 31/12/06 partly met (- induction courses in place). This requirement is outstanding from the last two inspections. ‘The registered provider/ registered manager shall, having regard to the size of the care home, the statement of purpose, and the number and needs of the service users, carry on/ manage the care home (as the case may be) with sufficient care, competence and skill.’ - This includes that information required by regulation (the AQAA, etc.) is made available, requirements & improvement plans are addressed in a timely way, etc. 31/12/07 5. OP31 10(1) 31/10/07 Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 29 6. OP33 12(1)&(2) & 24 An effective quality assurance 31/12/07 system must be developed to establish peoples’ level of 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. Timescale of 31/12/06 not met. This is outstanding from the previous four inspections. Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 30 7. OP37 17(3)(a) (1) The registered person shall— (a) maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the service user; (b) ensure that the record referred to in sub-paragraph (a) is kept securely in the care home. (2) The registered person shall maintain in the care home the records specified in Schedule 4. (3) The registered person shall ensure that the records referred to in paragraphs (1) and (2)— (a) are kept up to date; and (b) are at all times available for inspection in the care home by any person authorized by the Commission to enter and inspect the care home. - Especially regarding care information & staff records. 30/11/07 Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 31 8. OP38 13(4) & 23(4) The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; and unnecessary risks to the health or safety of service users are identified and as far as possible eliminated, and ‘The registered person shall after consultation with the fire authority provide adequate means of escape. This refers to the poor maintenance of the fire door on the first floor that could cause trip hazards in the event of an emergency. An immediate requirement was made that the registered person must consult with the fire authority to ensure that the emergency exits are fit for purpose, contacting a Fire Safety Officer within 24 hours to make arrangements for them to visit the home. This immediate requirement was addressed within the timescale given for it. Original timescale of 31/12/06 not met; partly met now (-objects stored on fire escape removed). 02/09/07 Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 32 9. OP38 13(4) The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; and unnecessary risks to the health or safety of service users are identified and as far as possible eliminated. This refers to the lack of written risk assessments of potential risks in the environment such as water temperatures and trip hazards. Original timescale of 31/12/06 not met 31/10/07 Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 33 10. OP38 13 (4a, c) & 23 (1) The registered person shall 14/09/07 ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; unnecessary risks to the health or safety of service users are identified and as far as possible eliminated, and Subject to regulation 4(3), the registered person shall not use the premises for the purposes of a care home unless the premises are suitable for the purpose of achieving the aims and objectives set out in the statement of purpose. This refers to the risks to service users and staff such as hot water temperature, all identified in the Environment section of this report and by the Health Protection Agency Nurse in the last inspection report. An immediate requirement was made that hot water taps must be regulated to prevent scalding, with hot water taps to be fitted with regulators within 2 weeks as agreed during this visit. This immediate requirement was addressed within the timescale given for it. Timescale of 31/12/06 partly met (-risks to service users and staff from freestanding radiators and rodent bait addressed). Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 34 11. OP38 23(4) (b) The registered person] shall after consultation with the local fire and rescue authority provide adequate means of escape - Including that emergency lighting is tested as recommended by the local fire authority. 31/10/07 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. 2. Refer to Standard OP16 OP18 Good Practice Recommendations It is recommended you review the complaints procedure displayed in the hallway, to help ensure the home’s complaints procedure is clear and accessible. It is recommended you ensure that all staff having timely training on safeguarding, updating them regularly, so that there are more robust procedures to protect service users from abuse or harm. It is recommended the processes of managing & running the home are made more open and transparent, so that all staff are clear about their roles & their responsibilities, particularly with regard to regulation and inspection. 3. OP32 Camellia House DS0000048342.V336982.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP 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. 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