Inspection on 04/05/06 for Camellia House

This inspection was carried out on 4th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 30/08/07

Camellia House 23/10/06

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 Unannounced Inspection 10:00 4th May 2006 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.V292016.R01.S.doc Version 5.1 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.V292016.R01.S.doc Version 5.1 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.V292016.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Three named service users who are older persons and have a learning disability 13th December 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 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. 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 current scale of charges is £300 - £325. Additional charges include in-house hairdresser at £5.00; Chiropody at £6; Incontinence pads, toiletries, newspapers, magazines, journals etc are all charged at commercial rates. All charges’ information provided by the Registered Person May 2006. The home does not have the specialist categories to provide care for people with significant dementia or mental frailty needs. The home does not provide intermediate care and it is not registered to provide nursing care. Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over two days: 1) Thursday 4th May 2006 between 10h45 and 18h00 when the Registered Person and Manager Miss Sunita Jhugroo was present for the inspection and provided information as required. Three members of staff, one visiting relative and three residents spoke to the inspector about their experience of the home. 2) Wednesday 31st May 2006 between 10h15 and 14h00 on which occasion Douglas Endean was the second inspector. On arrival at the home the Registered Person was out. On asking who was in charge of the home in her absence as it is this person with whom an inspection is conducted (this was explained to staff at the time of this visit), staff informed the inspectors that no one was in charge. Three care staff and a cleaner were on duty. Staff were either new, unqualified or had a NVQ Level 2. Only one member of staff was aware that the Registered Person was out, however it was not known for how long she would be away from the home, and it was only assumed she was out shopping. One care assistant since arriving for work had been responsible for domestic duties including lunch preparation. One staff member was assisting residents with daily living activities and the third staff member was endeavouring to involve other residents in a game of indoor skittles. This carer unfortunately decided to end this game in spite of encouragement from the inspectors that it continue regardless of the inspection. Staff and residents spoke to the inspectors during this visit about their experience of the home. On both visits care plans, staff files and other records and documents were inspected and there was a tour of the home and garden. The Commission received: • One Service User Comments Card • Three Relatives’ Comments Card • Ten Care Homes Care Workers Survey • A Pre-Inspection Questionnaire • A sample of meals over a two week period • A list of staff employed at the home including their position and contracted number of hours per week • A duty rota covering a four week period Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? What they could do better: No designated Senior Carer is left in charge of the home when the Registered Person is not on duty or has to leave the home for any reason when on duty. The Registered Person had not understood that this was necessary. An Immediate Requirement was made at the last inspection that the Registered Person must ensure that at all times there is sufficient and suitably qualified, competent and experienced staff on duty. This unannounced inspection found that Registered Person had failed to comply with that Immediate Requirement. Staff feedback portrays a picture of a staff team that feels very undervalued and working for a management that is not interested in either the welfare of the residents or the staff. Morale is extremely low amongst the staff and there is consequently a high turn over of staff. Management of the home is not transparent and actual. (See “Management and Administration”, S. 31-38)) Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 7 Written Comments received by the Commission state that night staff get up residents as early as 05h30 so they are dressed before day staff arrive for duty,” and they spend most of the day sleeping”, and that residents are put to bed before night duty staff start at 21h00. There were serious issues concerning confidentially of information about residents. Reviews of Care Plans were uninformative and poorly conducted. Receipts are not kept for all monies paid in and out of individual residents’ accounts held by the home. Discrepancies in actual amounts and recorded amounts were found at this inspection Activities for less independent residents are limited and there is little stimulation. Consequently residents spend long periods of time in the sitting room sleeping. Mealtimes are early and close together, i.e. 11h45 for lunch and 16h30 for tea. This leaves a long evening/night between tea and breakfast. A sample of recent menus was seen and it did not show that residents had been offered a choice of meals or alternative meals eaten by residents who preferred not to have the daily menu. Meals are basic and easy to cook because care staff are expected to prepare meals. As found at the last inspection freezers and fresh vegetables were poorly stocked although fresh fruit was available to residents to help themselves. There are serious health and safety issues throughout the home that must be addressed. (See S. 19-25 environment requirements) Staff are restricted in their levels of training made available to them by the Registered Person. There were discrepancies with the working duty rota. Staff do not have clear work patterns and receive insufficient notice of hours to be worked, as the shift pattern is not fixed. Staff whose CRB and POVA checks had not been confirmed with the home were seen working unsupervised and undertaking personal care despite the Registered Person stating that this did not happen. Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 8 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.V292016.R01.S.doc Version 5.1 Page 9 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.V292016.R01.S.doc Version 5.1 Page 10 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): 3, 4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents cannot be confident that the home will only accept them if their assessed needs can be met. EVIDENCE: The current residents at Camellia House have lived there for a number of years, and all moved in prior to the current owners taking on this home. There was therefore insufficient information on current residents’ files to show any pre-assessment or assessment of needs when moving into the home due to the time span (in some cases up to 14 years). Ms Jhugroo stated that anyone considering moving into the home now would have a full assessment of their needs, and they would only be accepted if Ms Jhugroo was confident those needs could be met by the home. On the second visit to the home Ms Jhugroo was absent as she was out apparently undertaking a pre-assessment. It later became apparent that in fact Mr Hurry (the home’s “volunteer handy man”) had been the lead person Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 11 conducting this pre-assessment. It was also made known to the Commission by a third party that Mr Hurry had agreed to accept this person despite knowing that the individual’s needs were “out of category” of the home’s registration, “Old age, not falling within any other category”. The home’s policy on Equal Opportunities seen during this inspection stated that people of ethnic minorities would be accepted “providing they can speak and write English”. Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 12 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, 9, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care of residents is reactive rather than preventative. The home has robust policies and procedures for the handling and administration of medicines however these are not always followed by staff. EVIDENCE: Each resident had a basic individual care plan that identified their needs and how each need should be met. The layout of the assessment page promoted independence by recognising what the resident could do for himself or herself before specific details of tasks requiring assistance. The care plan included abilities in daily living activities such as washing and dressing, as well as health and safety issues including fire safety awareness. The needs of one resident had deteriorated since the last inspection hence she is confined to her room. The care plan did not show evidence of appropriate assessment by, for example, a district nurse to monitor tissue viability or a physiotherapist to promote appropriate physical exercise to prevent pressure sores. Another resident chooses to remain in her room. Again there was no Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 13 evidence on the care plan to indicate that her limited mobility was being monitored. Staff had been informed in the team meeting (evidence seen in the minutes of this meeting), that a named resident needed to lose weight however it was not apparent who had made this judgement. There was no evidence of a weight chart to record regular weight checks to determine that this resident was overweight. On the Care Plan there was no evidence of a GP recommendation for a weight reduction diet, or a dietician having been consulted. Staff had written guidelines from the Registered Person on how weight loss could be achieved, but there was no evidence of a separate meal plan for this person. Other records showed that staff were not always vigilant in ensuring this resident was eating appropriately to lose weight. At the time of this inspection all the residents were registered with two local GP surgeries that are within walking distance of the home. The Registered Person stated that some residents are able and content to go independently to the surgery because of its close proximity to the home. There was no current input from District Nurses at the time of this inspection. A new dental practice has recently opened in Stoke Village and due to a recent local matter concerning the home’s previous dentist, the Registered Person hopes the residents will be registered there shortly. The chiropodist was visiting during this inspection. She confirmed that she comes to the home every six weeks to see residents, however she only treats those who wish and agree to be seen. At least two residents refused on this occasion, one because she did not want to go upstairs, and there is nowhere private downstairs where the treatment can be done. The Accident Book had a record of 15 accidents since the beginning of 2006. Three of these were staff incidents resulting from changing needs of a resident. All the other accidents were also recorded in the Daily Record of the resident concerned. Although each resident had a care plan identifying their capabilities and needs, the monthly reviews did not reflect any changes shown in the daily record. For example, one resident’s Daily Record showed that assistance to use an inhaler had been required on a number of occasions and the Registered Person confirmed that this resident has increasingly required more help, it was not a “one off” occasion. In spite of this the staff member undertaking the review had written “No change” every month. There was no evidence either that the resident had been involved in the review process. This was common practice for the majority of care plan reviews seen and cross-referenced with the Daily Record and the Accident Book. On the second visit to the home there was written evidence in the Staff Team Meeting Minutes of 18/05/06 that how to undertake a review had been explained to staff and that they should ask the Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 14 Registered Person if they didn’t understand. In spite of this some Care Plan Reviews had been done since the first visit and still stated “No change”. There was still no evidence that the resident had been involved in the review process or was even aware that it had taken place. Information about individual residents was seen recorded in Staff Team meeting minutes, and these notes were pinned up on an open access notice board. The medication was kept in locked cupboards. The pharmacist supplies it weekly in cassettes for daily doses. Ventolin and inhalers are kept in a separate cupboard. All prescribed medication including inhalers and creams was in date. There were no controlled drugs at the time of this inspection. No resident was self-medicating at the time of this inspection. The medication book was signed appropriately on the first visit, and the Registered Person stated that the home has a policy that it is mandatory for all staff administering medication to sign for it. On the second visit the Staff Handover Book reported that according to the medication book a resident had refused medication but the cassette for that dose was empty. The Registered Person explained that later in the day this same resident had agreed to take the medication however the staff member administering it had failed to record this in the medication book or anywhere else. Observation of staff during this inspection showed them being respectful and courteous to residents. They provided assistance when it was required and were not intrusive in “keeping an eye” on individual behaviour when necessary. Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 15 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, 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A minority of residents find the lifestyle experience in the home matches their expectations and preferences and satisfies their interests and needs. They do not receive a wholesome, appealing and balanced diet at times convenient to them. EVIDENCE: Although some residents are capable of taking themselves out and leading a relatively independent life within a care home setting, the majority of residents require supervision and/or assistance. Activities for these residents are limited and there is little stimulation. Observation of interaction between staff and residents during both days of this inspection showed them mainly assisting with daily living activities such as toileting or walking to and from the dining room. Consequently residents spent long periods of time in the sitting room sleeping. Since the last inspection the day centre used by two residents has closed. The home is apparently awaiting details from the local authority about alternative arrangements. There was no evidence on individual care plans to show that a review had considered this significant change in the routine of these residents. Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 16 Also there was no evidence on the care plans to show what the home is doing to meet the needs of these two residents to compensate for the withdrawal of the day centre service. An enabler comes in weekly for three hours to provide support as part of a care plan to an individual resident. They enjoy a variety of activities including walks on the Moor and shopping. The Registered Person stated that occasionally she takes out individual residents either shopping, or for breakfast or tea at local cafes. Those residents whom have contact with their families are encouraged by the Registered Person to maintain this. Residents’ care plans showed that one resident prefer to go out with family members; others have family and friends who visit them at the home. One resident spoken to during this inspection said that her family visit her at least weekly at the home. A family member of another resident spoken to during the inspection commented that he is always offered a cup of tea and can speak to the Registered Person about any concerns he may have about the care and welfare of his relative. Written comments by other relatives and received by the Commission confirmed likewise. The home’s policy seen during this inspection showed that staff are expected to greet family members and to offer a hot drink. This was also seen in supervision notes when staff apparently hadn’t been adhering to this policy. A minority of residents pursue their own choice of leisure interests and from a sample of residents’ files, it was seen that those who are able participate in such activities as going to the local shops, local pubs and the occasional “flutter” at the betting shop. There was no evidence of risk assessments for residents’ activities on individual care files to ensure that they are not putting the individual and/or others at risk. On the second visit, a carer was observed with the residents playing “skittles” in the sitting room. This was using plastic skittles and residents were throwing beanbags to knock them over. The same carer later endeavoured to play “I spy” with the residents. Written evidence was seen in the Staff Team Minutes of 18/05/06 that staff were to be more involved in doing activities with residents now that the home employs a regular cleaner. Care Worker Surveys received by the Commission had comments that residents needed more stimulation and activities, and one commented that staff were expected to involve residents in activities inappropriate for older people hence the residents were not interested. Several staff commented that more trips and activities outside the home would benefit the residents because some rarely leave the premises. The dining room was well presented with flower arrangements and decorative tables. The menus seen occasionally showed a choice of main course at lunchtime, however there was no evidence of records being kept to show what individuals actually ate if they did not want the option available. The Registered Person stated that alternative food could be provided should a Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 17 resident so wish, however the current arrangement of keeping food in a locked freezer and only putting out food for the day did not appear to allow for much flexibility. The teatime menus gave choices such as “salad or crisps”, “Yoghurts or assorted cakes”, “Assorted cakes or fresh fruits”. There was no evidence of any sort of record of what residents actually ate to support that they could and had had an alternative. There was no evidence of a separate meal plan or records of food eaten for a resident who had been identified by the Registered Person as needing to lose weight. Other records also showed that staff were not always vigilant in ensuring this resident was eating appropriately to lose weight. One resident is vegetarian however apart from vegetable burgers there was no evidence that either the Registered Person or staff had an understanding of such dietary needs. Again there was no evidence of food records for this resident. The Registered Person stated during this inspection that this resident was given meat to eat, apparently with her consent, even though she insisted that she was vegetarian. Staff also supported this statement with similar comments about giving the resident meat because it didn’t seem to matter even though the resident claimed to be a vegetarian she would eat the meat if it was put in front of her. The Registered Person compared the resident as “being like a child” because the resident was apparently inconsistent in her preferences about particular foods. On both days of this inspection lunch was served early, i.e. 11h45, and teatime too was early at 16h30. One resident was observed on her way to bed about an hour after tea, and was steered back towards the sitting room because it was “too early”. On the second visit the lunchtime meal was boiled potatoes, mushy peas and “boil-in-the-bag” fish in sauce. A packet of frozen vegetable burgers was seen on the worktop although it was unclear if these were being cooked for this particular meal. A staff member explained that all the meals were simple like this because care staff are expected to cook all meals even though they are not trained to do this. A staff member also confirmed that most meals were pre-prepared frozen meals. Care Worker Surveys returned to the Commission and verbal comments by staff stated that cooking was not something they wished to do, and it was not in their job description as far as they were aware. There were also written and verbal comments from staff that the home should employ a cook so that carers could work as carers. On this inspection as found at the previous inspection, care staff were expected to perform care tasks and meal preparation as part of the same shift. There was no evidence that staff for example, changed uniforms, or took appropriate measures to ensure there was no cross-infection or contamination when assisting residents with daily living activities as well as preparing and cooking food. It also meant that one care assistant was solely Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 18 doing domestic duties since starting her shift leaving only two other staff to assist residents with other activities. One of these two care assistants was still awaiting a CRB check to be returned and was providing personal care unsupervised. The Registered Person stated that the home used to employ a cook who left, and since then she has only been able to find cooks who wish to work full time, not part time, to cover the lunch time period only. She also stated, “we do our best” with regard to providing nutritional, balanced meals. There was no evidence of either the Registered Person or any staff member having done any form of training about dietary requirements of older people. Evidence seen during this inspection suggests that such training would be beneficial for all staff. Residents who were asked about their lunch were unsure what they had eaten although one resident thought that she might have eaten fish. Inspection of the two chest freezers found them both to be inadequately stocked. The freezer for the day’s food had several loaves of basic value sliced white bread, frozen vegetable burgers, and a few other sundry items. The main chest freezer was about a third full. The Registered Person stated that she does the shopping twice a week and that she buys fresh meat that she then freezes. The meat seen was a few packs (sufficient for one meal) of basic value chicken thighs. There was also a packet of vegetable burgers and several bags of frozen vegetables. The fresh vegetable rack was domestic in size and kind. It held a few potatoes, and tired looking carrots and cabbage. It was stored next to the washing machine. The freezers, washing machine and tumble dryer are all housed in the same room. No evidence of “Safer Food, Better Business” (Food Standards Agency) records were found at the home although the Registered Person is hoping to attend one of the seminars currently being run by the local authority. Future staff training planned includes a Foundation Certificate in Food Hygiene. Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 19 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, 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are at risk from potential abuse due to poor recruitment practices. EVIDENCE: Since the last inspection and before this inspection neither the home nor the Commission had received any complaints. Staff whose CRB and POVA checks had not been confirmed with the home were seen working unsupervised and undertaking personal care despite the Registered Person stating that this did not happen. References for newly employed staff were inappropriate and inadequate to ensure residents’ safety from abuse. . Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 20 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): 19, 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are serious health and safety issues throughout the home that must be addressed. EVIDENCE: The Registered Person is currently exploring different ways of upgrading the home’s kitchen. A tiling specialist was due during the first visit of this inspection but had to postpone the call. By the time of the second visit the tiler had been to remove all the old tiles however he had apparently cancelled three times because he needed the kitchen to be available all day to complete the work – no alternative arrangements for meal preparation had been made in advance of booking this work, therefore, care staff and the tiler were expected to work around one another in the kitchen. Boxes of tiles were seen at the rear of the building sufficient to cover approximately 20sqm. Mr Hurry (the home’s “volunteer handyman) explained that subsequently it had been agreed with the tiler that the residents’ meals would be changed around (i.e. Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 21 lunch time and tea time) to accommodate him, however the tiler had still failed to keep the appointment. Staff and the Registered Person expressed frustration about this situation because they were continuously clearing the kitchen in preparation for the tiler. There are areas of the kitchen that are in need of repair and possibly treatment for damp. The back door has been replaced so this may help prohibit the area around it from mildew and mould. The side door has also been replaced. The thermostatic valves for the baths had not been fitted despite on the previous two inspections the home apparently had the valves and was trying to find a local plumber to fit them. On testing the water it was found to be scalding. There was no evidence of a thermometer in any of the bathrooms. Staff have informed the Commission last year and again this year that despite hot weather the radiators in the home are still on full and they believe the central heating system is faulty. The washing machine and tumble dryer are domestic in size and there is no sluice facility on the washing machine. Staff reported that the washing machine does not heat the water to a temperature sufficient to disinfect laundry; therefore it is still soiled and smelly when the wash cycle is finished. The first floor toilet requires a window restrictor. The steps on the fire escape have been renewed however the Registered Person is still waiting for the company to return to repaint it. The back gate has been boarded to ensure the privacy of the residents when they are using the garden that is a paved area with a few raised flowerbeds and enclosed by stonewalls on either side. It was noted during the inspection that a dining room window opened outwards and was at head height for anyone using the side door to access the garden. The Registered Person apparently has a programme of maintenance for the home such as replacing vanity units when necessary, and redecorating bedrooms. The Commission has received no written evidence of a planned upkeep and maintenance of the home. One bedroom also noted on the last inspection had a strong smell of urine despite the windows being open and air fresheners in the room. A commode was placed on a small piece of linoleum covering the floor area beneath it. It was discussed with the Registered Person that maybe the carpet needed to be replaced and a different sort of floor covering considered for the whole floor area. Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 22 Each bedroom was individual in style with personal possessions such as photographs and soft furnishings. The shared bedrooms had screens available for privacy. None of the bedrooms had a lock nor was there any evidence of risk assessments on individual care plans supporting this. The home has a large sitting room with an archway that gives an impression of dividing it. In the larger part of this room there were high-backed, raised chairs suitable for people with limited mobility, whilst the smaller area had a suite of low settee and armchairs. The Registered Person explained that since taking on this home she has rearranged both areas to ensure the safety of residents as well as allowing them easier access into and out of the room. The dining room is at the rear of the home leading into the kitchen that is small and domestic in character. The dining room was light and airy with attractively presented tables and fresh flowers in the room. There was a bowl of fresh fruit available for residents to help themselves as they wished during the day and a resident was observed taking advantage of this without having to request permission from a staff member. Residents have open access to both the dining room and kitchen areas and three were seen using the dining room as an alternative communal seating area away from the television during the afternoon for a short period of time. A Care Worker Survey received by the Commission stated, “Make the kitchen off limits to residents”. There was no explanation why this should be so, however staff verbally reported examples of incidents occurring when staff are preparing meals and apparently residents wandering into the kitchen and turning on burners on the cooker. Since the last inspection an attractive lightweight curtain has been put across the window on the inner front door. This protects the residents’ privacy particularly when using the downstairs toilet that is located in the main hallway facing the front door. There are three bathrooms, one of which has a mechanical aid to assist with bathing. The top bathroom bath is not currently used because the room is too small for carers to safely assist any resident requiring help. The Registered Person explained that she is currently considering converting this bathroom into a shower room with a walk-in shower. The en-suite bathroom on the lower ground floor currently has no bathing aids however the residents of this room are capable of independent bathing at present. A Care Worker Survey received by the Commission requests “ a sit-in shower for less able residents. It’s such a struggle for some of them to get in and out of the bath”. Since the last inspection the needs of one resident have changed so assistance to transfer with a hoist is required, and this has now been provided. The Registered Person confirmed that staff using this hoist have been trained in its use. On inspection the hoist was found to be overdue with its service. It was Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 23 discussed with the Registered Person that a pressure-relieving mattress and other aids should be considered to improve the quality of life for this resident and that clinical guidance should be sought about this. Care Worker Surveys request cot sides with bumpers for one individual resident who is prone to falling out of bed, and another suggest a sit-in shower for residents who struggle with the bath. The home has employed a cleaner since the last inspection. She works Monday to Friday three hours per day. The home was clean and fresh throughout. At weekends the staff on duty are responsible for ensuring that the home is kept clean and tidy. There were a number of clocks around the home all set on different times on the first visit. The Commission was informed the following day that batteries had been bought to replace those in the clocks and in the Fire Safety Door Closures. Despite this the battery in a Fire Safety Door Closure required replacing on the second visit. Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 24 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, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff are untrained and expected to multi-task between domestic and care duties leaving residents potentially at risk. EVIDENCE: Since the last inspection the Registered Person has been successful in recruiting a number of new staff to work at Camellia House including a cleaner. She also stated that staff morale has improved since two staff members left at the end of last year. No evidence of a Recruitment Policy was found at the home. Inspection of staff files found that some references were inadequate and inappropriate for potential employment in the care sector and working with vulnerable people. Staff whose CRB and POVA checks had not been confirmed with the home were seen working unsupervised and undertaking personal care despite the Registered Person stating that this did not happen. One CRB check seen on a staff file was transferred from another work environment and employer. The Registered Person stated that a new application was being made for this worker yet the care assistant was seen working unsupervised and assisting residents with personal care needs. Inspection of staff files found that of those with a job description, it was generic for all staff. It was discussed with the Registered Person at the time of Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 25 this inspection that each staff member should have a job description pertinent to her/his post to ensure that each staff member was clear about his/her duties. She was also advised that this applied to volunteers too. Staff commented both verbally during this inspection and in Care Worker Surveys that they either do not have a contract with terms and conditions of employment, or for those who do, it is kept on their staff file but they do not have a copy. Inspection of the duty rotas found that they were not an actual record of hours worked by both staff and the Registered Person. They did not show in which capacity staff were working either with the exception of night staff who were shown as waker or sleeper. In discussion with staff it became apparent that instead of changing the duty rota the Registered Person keeps a separate timesheet for each staff member that they have to record their actual hours worked and then sign. Also if the Registered Person is on duty covering for a carer in addition to her normal working hours, these hours are not shown on the working duty rota. Likewise if, for any reason, the Registered Person does not work the hours shown on the working duty rota, this is not recorded on the working duty rota. There was no separate timesheet for the Registered Person as a record of her actual hours worked. Care Workers’ Surveys also state that Staff do not have clear work patterns and receive insufficient notice of hours to be worked, as the shift pattern is not fixed. The majority of Care Worker Surveys received by the Commission commented about the home not employing a trained cook. Carers are expected to assist residents with personal care tasks as well as take responsibility for preparation of meals. The meals are mainly ready-made frozen foods that require heating. Two staff members independently explained that this was because none of the staff is trained in food preparation and cooking so the meals have to be easy. Staff verbally also stated that they did not want to be responsible for cooking because they were employed as carers. The Registered Person stated that home used to employ a cook who left, and since then she has only been able to find cooks who wish to work full time, not part time, to cover the lunch time period only. She also inferred that she did not wish to employ a cook because it would be too costly. Since the last inspection the Registered Person has achieved a Registered Manager’s Award and her certificate of qualification was seen during this inspection as was that of another person who was recorded on the PreInspection Questionnaire as a volunteer. This person is known to live elsewhere in England and generally only available for work during school holidays. The Pre-Inspection Questionnaire records this person as “Assistant Manager” “Bank”. Apparently Mr Hurry also has a Registered Manager’s Award although he too is listed as a volunteer on the Pre- Inspection Questionnaire, “Deputy Manager” working 25 hours. Mr Hurry also informed the inspectors that he was “only the handyman” and responsible for the maintenance of the home. The Registered Person stated that having three “staff members” with a Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 26 Registered Person’s Award made it easier to cover shifts to ensure that there is always a senior carer on duty. On the second day of this inspection the home was found to be without a senior carer and without a designated person in charge during the Registered Person’s absence. At the last inspection there was only one member of staff, a care assistant, NVQ Level 2 in Care, on duty for a period of approximately one hour. It was unclear for how long this situation may have continued if there had not been an unannounced inspection. An Immediate Requirement was made at that inspection that the Registered Person must ensure that at all times there is sufficient and suitably qualified, competent and experienced staff on duty. This unannounced inspection found that this Immediate Requirement was ignored and the Registered Person had failed to comply with it. Three staff have an NVQ Level 2 in Care, two others are currently studying for their NVQ Level 2 in Care, and a further three staff have enrolled with a view to starting the NVQ Level 2 in Care shortly. As part of this training with Achievement Training, all staff apparently receive an Induction course that meets the National Training Organisation’s requirements. Achievement Training apparently holds the documentation and records of achievement relating to this training so it was not possible to see these during the inspection. The Registered Person agreed that she would request a copy for each staff member for the home’s records. Also the Registered Person is currently looking into using the “Skills For Care” Induction training course as a grant is offered for each person taking this course. Some staff have recently attended a course in First Aid. Care Worker Surveys received by the Commission included comments such as “We are not given the opportunity to further our careers. A few of us are interested in doing our NVQ 3 but are told we can’t”. In discussion with staff during this inspection, they supported the above written statement with information about the expectations of the Registered Person, i.e., they are expected to do duties of a senior carer, such as left to cover for her in her absence, yet they do not have the qualifications. They have requested further training and are keen to gain NVQ Levels 3 and 4 in Care. Staff are paid according to their qualifications not for the duties they have to undertake to safeguard and care for the residents. Staff do not have a staff room or somewhere separate from residents accommodation to ensure that their breaks are uninterrupted thereby beneficial to both staff and residents. Staff have been told they must take their breaks individually in the dining room. Staff reported that residents interrupt them because as this is residents’ accommodation they can freely use/access it all day. Also residents do not understand that staff are not working during these break periods. Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 27 Staff also expressed a preference to have shared breaks for company, and “someone to have a laugh with”. Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 28 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): 31, 33, 35, 36, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home is not transparent and actual. Its style is causing low staff morale and tension. EVIDENCE: Management of Camellia House is not transparent and actual because: • • • • On each inspection visit Mr Hurry was seen to be in day-to-day control and management of the home. Mr Hurry describes himself to other agencies either as the owner or a Senior Carer. Mr Hurry has informed the Commission that he is the home’s handy man. Staff clearly understand and refer to Mr Hurry as “the boss”. DS0000048342.V292016.R01.S.doc Version 5.1 Page 29 Camellia House • • Staff were witnessed being chastised, humiliated and undermined in a public space and in front of residents during the inspection by Mr Hurry. The Commission received evidence that a pre-assessment of a prospective resident had been done by Mr Hurry, not the Registered Person even though she inferred to the inspectors she had undertaken this assessment. The Commission received information and evidence that Mr Hurry had agreed to take this person even though the information given to him during the pre-assessment visit clearly showed that the needs of this person were outside the registration category of the home. Supervision notes showed that Mr Hurry had done some staff supervision. Staff Team Meeting minutes showed that Mr Hurry and the Registered Person had conducted Staff Team meeting. Mr Hurry has no job description or boundaries of authority. • • • • Since the last inspection Ms Jhugroo has become the Registered Manager as well as Registered Person of Camellia House having completed successfully the Registered Manager’s Award in April 2006. Despite this on each inspection visit Mr Hurry was seen to be in day-to-day control and management of the home. The Pre-Inspection Questionnaire lists Mr Hurry as a volunteer “Deputy Manager”, however when asked about this and during the inspection, Mr Hurry described himself as “just the handy man”. During the tour of the premises it became apparent that Mr Hurry has little knowledge of how to undertake repairs and upkeep of the home himself and is therefore reliant on using outside contractors. Different statutory agencies that have had contact with the home have been given by Mr Hurry different descriptions of him such as that he is the owner or a Senior Carer. A member of one of these agencies described Mr Hurry as “Unprofessional and unconvincing” when responding to a telephone call enquiry. During a Pre-Assessment visit to another care home, Mr Hurry led senior staff to believe that he was a doctor by the manner in which he presented himself Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 30 and because he apparently suggested a prescribed sedation medication and dosage for a resident at that home. Mr Hurry undertook a Pre-Assessment of a prospective resident. He also agreed to take this person even though he apparently had been told the needs of this person which were outside the categories of registration for the home. Apparently Mr Hurry has a Registered Manager’s Award. The Registered Person had earlier stated that she now had three staff members (including herself) with this qualification so it made it easier for her to cover all shifts with a senior carer in charge. Care Worker Surveys received by the Commission were very negative about “the management” (understood by staff to be both the Registered Person and Mr Hurry), and generally they seemed to feel that morale is low because of it. Staff spoken to gave mixed responses about working at the home, one was positive because of the flexibility of hours that suited a work-home balance, and that the home was within walking distance. Most staff were reluctant to talk to the inspectors during the inspection when Mr Hurry was present in the home. However ten members of staff completed and returned to the Commission a “Care Worker Survey”. Written statements received by the Commission include: • “Everyone seems so tense and on edge”; • “ Staff would be a lot happier in their work if instead of being told to do one thing one minute and another the next. There would be no confusion about who does what and the home would run better.” There were also several references to “nit-picking by management”. During the first visit of this inspection it was observed that the staff had to be motivated, and on more than one occasion staff were completing tasks together around the house whilst leaving residents unattended in the sitting room. This necessitated intervention by the Registered Person or Mr Hurry and they both inferred that this was a common occurrence. On the second visit during the absence of the Registered Person and Mr Hurry, staff were seen going about their work in an orderly and effective manner. On arrival at the home for the second day of this unannounced inspection, of the four staff on duty only one was aware that the Registered Person was out, none of the staff knew where she was nor for how long she would be gone (staff assumed that she was out shopping), and no-one was in charge. The Registered Person returned with Mr Hurry and was asked about this. Her main response was that staff are able to contact “them” by mobile ‘phone. Later during this visit, on two separate occasions staff were witnessed being shouted at in an accusatory manner by Mr Hurry; he brought one of these staff to the inspectors, told them to repeat what was said on the inspectors’ arrival. This staff member was in a state of agitation and anxiety at this point. It is not known what was said before bringing the staff member to the inspectors, Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 31 however both incidents took place in a public area in front of residents and both staff members were upset and distressed by Mr Hurry’s actions and manner. Care Worker Surveys received by the Commission had comments such as: • “Management are not interested in having happy staff, they just cause misery by nit-picking at staff undermining and making staff feel inadequate in their jobs”. • “Harry (Mr Hurry) very often shouts at staff and not letting staff explain themselves”. • “staff are often brought to tears because they have been shouted at by Harry.” • “If Harry thinks a member of staff is not performing as he likes, he shouts at them, staff cannot get a word in, he always shouts them down, often bringing them to tears.” Two staff members have written that the Registered Person, Ms Jhugroo, is approachable. Staff supervision is now unplanned and the Registered Person considers this to be as more effective. At the last inspection the Registered Person reported staff were calling in sick on days they were booked for supervision so it was agreed that she would look at alternative methods of ensuring staff have formal supervision. On this inspection the Registered Person confirmed that staff found it beneficial particularly for dealing with issues immediately. Staff opinion was contrary to this as their comments inferred they felt on edge and had not had the purpose of supervision explained to them. All supervision sessions are recorded. Inspection of these showed that some sessions are more of a disciplinary nature. Some supervision notes showed that Mr. Hurry had conducted the session. As part of her Registered Manager’s Award, Ms Jhugroo created a “Story Board” that she proposes to use as the basis for the home’s quality assurance. The document seen at this inspection was very detailed, giving changes that had been made, reasons for these changes, and outcomes resulting from changes. Residents and relatives have had comments cards made available to them for their feedback however this still does not reach wider to include views of other visitors to the home, GPs, social workers etc, or staff working in the home. Six residents have their personal allowances held by the home. During this inspection monies and accounts were checked and three did not balance having too much money in them. There was also surplus cash in the drawer with no explanation for its purpose. The Registered Person stated that all the accounts are checked weekly. It was recommended during this inspection that receipts should be kept in order to ensure that all monies in and out of each Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 32 account are recorded. Hairdresser fees and chiropodist fees are recorded in a separate book rather than individual receipts given to each resident. The fire system service was just before this inspection. The last recorded smoke alarm test was on 24/05/2006. Fire extinguishers were dated August 2005 as the last check, however there was no evidence of monthly pressure checks being done. Electrical appliances’ testing is due in February 2007 and the next electrical contractors test is due in 2010 having been completed last year. The emergency lighting service was May 2006 but again there was no evidence of monthly checks having been done. ‘Fridge’ and freezer temperatures are apparently checked daily however the book is kept in the kitchen not near the freezers so is not directly to hand for recording. It was also necessary during this inspection to lower the setting of the temperature of the ‘fridge’. Food was not dated or recorded when it was put in the freezer to ensure stock rotation. Food supplies were minimal so it is unlikely food would not be used shortly after it is purchased. The hot water boiler was renewed 6mths prior to this inspection. C.O.S.H.H. information is available for staff and it is compulsory for them to sign when they have read it. An Oxford mini hoist required servicing, as does the “Nurse Call” system. The thermostatic valves for the baths had not been fitted despite on the previous two inspections the home apparently had the valves and was trying to find a local plumber to fit them. On testing the water it was found to be scalding. There was no evidence of a thermometer in any of the bathrooms. There was no evidence of a Legionella risk assessment. The washing machine is domestic in size and staff report that it does not heat adequately therefore soiled linen is not clean after it has been washed. The tumble drier is also domestic in size and staff report that it is too small for the amount of residents’ washing, especially bedding. The upstairs toilet does not have a window restrictor. All other windows are fitted with restrictors. Residents have open access to the kitchen at all times including during meal preparation. Staff have verbally reported incidents concerning the health and safety of residents and staff caused by this access, however the Commission Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 33 has not received any Regulation 37 Notices with regard to these alleged incidents. Staff verbally informed the inspector of other health and safety matters because they have been concerned by the lack of attention taken by the Registered Person, for example, one resident is prone to wandering and on at least one occasion the police have been called to assist looking for her. Also a resident views the fire escape as “a private staircase” therefore regularly uses it. Staff were told that Regulation 37 Notices must be sent to the Commission, and in the case of any outbreak of infectious disease, the Health Protection Agency must be informed. Staff were also advised to record all these incidents on individual residents’ care records as evidence of their occurrence. All radiators are covered. One Care Worker Survey suggested that a sit-in shower would benefit residents. Another Care Worker Survey recommended cot sides with bumpers for a resident’s bed. Some staff have recently attended a course in First Aid. Others are due to attend a Foundation course in Food Hygiene. Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 34 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 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 X 18 2 1 3 2 2 3 2 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 2 1 X 1 1 Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 35 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 Person(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 4(1b) 4(3) 5(1a) Sch1.6 Requirement The Registered Person must assess prospective residents and they must only be accepted if the home is able to meet the assessed needs of the individual within the conditions of registration of the home. Each resident must have an individual care plan that is kept under regular review, and reflects any change in care needs. The review process must include the resident and/or their representative, and they must at least be aware that a review has taken place. This is outstanding from the previous two inspection reports and the timescale extended. The Registered Person must ensure that residents’ health needs are monitored and maintained with access to health care services for appropriate assessment when their needs change. The Registered Person must ensure that staff that handle DS0000048342.V292016.R01.S.doc Timescale for action 30/06/06 2 OP7 14 24 30/06/06 3 OP8 12(1) 13(1) 14(2) 30/06/06 4 OP9 13(2) 19(5b) 30/06/06 Camellia House Version 5.1 Page 36 5 OP12 12(1-3) 15 16(2n) 13(4b,c) 18(1a) 6 7 OP12 OP12 8 OP15 16(2i) 9 OP15 18(1c(i)) 10 OP15 Reg17 (2) Sch4 (13) 11 12 13 14 OP15 OP19 OP19 OP19 Reg17 (2) Sch4 (13) 12(1a) 13(4) 23(2b) 13(4a,c) 23(2b,d) medication adhere to the home’s policy and procedures. The Registered Person must ensure that residents have routines and activities that are flexible and varied to suit their individual assessed needs. All activities, particularly those outside the home, must be risk assessed. There must be sufficient, competent and suitably qualified staff on duty at all times to enable flexibility and variety for the residents’ welfare and to meet the assessed needs of each individual resident. Nutritious, wholesome and suitable food that is properly prepared and available must be provided the Registered Person. The Registered Person must ensure that staff that undertake meal preparation are appropriately trained in food hygiene. All food handling and preparation must comply with the Food Standards Agency regulations that apply from 1st January 2006. Records of food provided for service users must show more detail particularly when an alternative has been offered or for residents with special dietary needs. Records of food must show any special diets prepared for individual residents. Thermostatic valves must be fitted to the baths to ensure the water temperature is regulated. A window restrictor must be fitted to the toilet window The Registered Person must supply the Commission with a detailed programme of planned DS0000048342.V292016.R01.S.doc 30/06/06 31/07/06 30/06/06 30/06/06 31/07/06 30/06/06 30/06/06 31/07/06 30/06/06 31/07/06 Page 37 Camellia House Version 5.1 15 16 OP21 OP22 12(1) 13(4) 16(2c) 23(2c) 17 OP24 18 OP24 12(1a) 13(1b,4c) 15 16(2c) 12 (2,3,4a) 19 OP25 12(1a) 16(j) 23(5) 1,1a 13,4c 16,2c 23,1a2b,p 16(k) 20 OP25 21 OP26 22 OP26 13(3) 13(4c) 16(j) 23(k) 13(3) 13(4c) 16(k) 23(k) 18 23 OP26 redecoration and refurbishment The Registered Person must assess that bathing facilities meet the needs of the residents. All equipment used for assisting residents must be maintained and services carried out within compliance of regulated dates. The Registered Person must assess that residents have equipment suitable to their needs. Appropriate door locks must be installed when rooms become vacant or if individual service users request this facility or if circumstances in the home change The Registered Person must ensure water is stored and distributed at the correct temperatures to prevent risks from Legionella. The Registered Person must ensure that the home is heated appropriately for the time of year and the heating system is maintained in good working order. The home must be kept free of offensive smells, particularly the bedroom identified on both visits. Foul laundry must be washed at appropriate temperatures (minimum 65degrees Centigrade for not less than ten minutes) to thoroughly clean linen and control the risk of infection. The Registered Person must provide sluicing facilities. The Registered Person must ensure that at all times there is sufficient and suitably qualified, competent and experienced staff on duty. DS0000048342.V292016.R01.S.doc 31/07/06 31/07/06 31/07/06 31/07/06 31/07/06 30/06/06 31/07/06 31/07/06 31/07/06 31/07/06 24 OP27 Camellia House Version 5.1 Page 38 25 OP27 18(1a) 26 OP27 18(1a) Sch4(6e) 27 OP27 Sch4(7) 28 OP29 19 Sch2 12(1a) 19 Sch2 29 OP29 30 31 32 OP29 OP30 OP30 Sch2 (7) 18(1) 18(1) 21(1) This was an Immediate Requirement made at the previous inspection and the Registered Person was in breach of this on this inspection. The Registered Person must ensure that the skill mix of staff is appropriate to meet the assessed needs of the residents at all times. This is outstanding from the previous inspection and therefore the timescale has been extended. 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. This is outstanding from the previous inspection and therefore the timescale has been extended. The Registered Person must keep an actual record of the duty rota showing hours staff and the Registered Person actually work. The Registered Person must operate a thorough recruitment procedure to ensure the protection of residents. New care staff must not provide unsupervised personal care to residents until the home has received evidence of a satisfactory police check and protection of Vulnerable Adults (POVA), and NMC registers. CRB checks must be valid for the post held within the home. The home must keep records as evidence of any induction training undertaken by staff. The Registered Person must provide suitable facilities away DS0000048342.V292016.R01.S.doc 31/07/06 31/07/06 30/06/06 30/06/06 30/06/06 30/06/06 31/07/06 Camellia House Version 5.1 Page 39 23(3) 33 OP31 12(5) 34 OP32 7 9 39 43(3) 35 OP33 12 Sch1 (10) from residents’ accommodation 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 continue to be provided with sleeping accommodation that is separate from residents’ accommodation. This outstanding from the previous inspection and the timescale has been extended. The Registered Person must ensure that there are clear lines of accountability within the home and that professional relationships are maintained with staff. Management of the home must be transparent and actual. The Registered Person must inform the Commission if any person other the Registered Person carries on or manages the care home. An effective quality assurance system must be developed to establish the residents’ 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. This is outstanding from the previous two inspection reports and the timescale DS0000048342.V292016.R01.S.doc 31/07/06 30/06/06 30/06/06 31/07/06 Camellia House Version 5.1 Page 40 36 OP34 25 37 OP35 16(l) Sch4 (8,9) 38 OP37 12(4a) 39 OP38 16(i) 40 OP38 13(4c) 41 OP38 13(4c) 23(2c) 23(k) 23(5) 42 OP38 37 12 13 extended. The Registered Person must carry on the home in such a manner to ensure that it is financially viable for the purpose of achieving the aims and objectives of the home. A copy of the annual accounts verified by an accountant and including detailed running costs of the home (25(3b)) must therefore be supplied to the Commission as required in the letter dated 01/06/2006. The Registered Person must ensure that all monies in and out of residents’ accounts is witnessed and signed for as correct. All monies in and out must have valid receipts. Confidential information about residents must be kept secure and recorded on their individual care records. There must be adequate quantities of food with a variety of choice. This is outstanding from the previous inspection and the timescale extended. Food must not be prepared within an unhygienic and impractical environment so alternative arrangements must be made before any further building work is undertaken in the kitchen. The Registered Person must ensure that the washing machine is able to meet the laundry needs of residents appropriately and has specified programming ability to meet disinfecting standards. The Registered Person must inform the Commission of any incident that affects the health, safety and welfare of the DS0000048342.V292016.R01.S.doc 30/06/06 30/06/06 30/06/06 04/05/06 30/06/06 31/07/06 30/06/06 Page 41 Camellia House Version 5.1 43 OP38 23(4) residents. The Registered Person must ensure that all fire safety equipment is checked and recorded as checked in compliance with Fire Safety regulations. 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Person/s to consider carrying out. No. 1 Refer to Standard OP27 Good Practice Recommendations The Registered Person should consider the employment of a cook. a) This should ensure that staff are not jeopardising the care needs of residents because they have to do too many different tasks during their shift. b) This should ensure that standards relating to food, meals and nutrition are fully met. The Registered Person should consider the provision of a commercial washing machine and tumble drier to meet the laundry needs of its residents more appropriately. 2 OP19 Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 42 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 © 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 Camellia House DS0000048342.V292016.R01.S.doc Version 5.1 Page 43 - 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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