CARE HOMES FOR OLDER PEOPLE
Camellia House 5 Belmont Place Stoke Plymouth PL3 4DN Lead Inspector
Brendan Hannon Announced 6 July 2005
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Camellia House D52-D07 S48342 Camellia House V226752 060705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Camellia House Address 5 Belmont Place, Stoke, Plymouth, Devon, PL3 4DN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01752 509697 Sunita Jhugroo Mrs Alisa Ursula Blee Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Camellia House D52-D07 S48342 Camellia House V226752 060705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: The Home must employ a Registered Manager for 2 years. One named Service with Learning Disability 2 named elderly persons who have a learning disability Date of last inspection 25/11/04 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 in central Plymouth. A full range of amenities and facilities are within walking distance of the home. The home can accomodate up to fourteen residents over four floors. It has a shaft lift though few of the residents need to use this facility. There are three communal bathrooms in the home and one ensuite bathroom. The main lounge is by the front entrance of the building. There is a dining room towards the rear of the building. Behind the building is a patio area which can be accessed from either the lane to the back of the property or from the rear of the building. There is garden furniture available on the patio for residents to use. Being in central Plymouth the home does not have a garden area though there are pot plants on the patio area. There are three double bedrooms in the home and all the others are single bedrooms. The home is made up of the original building and a three floor extension to the rear. Because of the age of the building many of the rooms in the older part of the building have high ceilings which help the rooms, and the home in general, feel more spacious. The service offered by the home is primarily for older people who are more independant. The home does not have the specialist categories to provide care for people with significant dementia or mental frailty needs. The present residents are mostly fully mobile. The residents have a mixed range of abilities. Camellia House D52-D07 S48342 Camellia House V226752 060705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was announced. Preparation for the inspection included, analysis of the pre inspection questionnaire, the previous inspection reports and resident and relative comment cards. An inspection plan was developed from this information. The inspector was in the home for 6.5 hours from 9.45am till 4.00pm. The inspector spoke to five of the fourteen residents with particular attention given to two residents whose care was looked at closely. The owner of the home, Sunita Jhugroo and the assistant manager Mr B. Hurry were spoken with at length. Care plans and various records, including medication administration records, staff/employment records, and health and safety records, were inspected. Some policies and procedures were also inspected. What the service does well: What has improved since the last inspection?
The management of the home continues to make steady progress in further improving the quality and professionalism of care delivery at Camellia House. The provider has introduced individual care plans and risk assessments for all the residents.
Camellia House D52-D07 S48342 Camellia House V226752 060705 Stage 4.doc Version 1.40 Page 6 All the initial visits made to the home by prospective residents or their relatives are now recorded demonstrating that these visits are welcomed by the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Camellia House D52-D07 S48342 Camellia House V226752 060705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Camellia House D52-D07 S48342 Camellia House V226752 060705 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5 The home provides information about the service to allow a new resident, and their representatives, to make an informed decision to use the service. EVIDENCE: Both the service users guide and the homes statement of purpose were available. The information in these documents would enable potential new residents and their relatives to understand the service provided by the home. Residents and care staff were observed and spoken to during the inspection. Through this observation, looking at care plans, and looking at records there was good evidence to show that resident’s needs are being met. To ensure that Camellia House can meet the needs of prospective residents, a pre admission assessment is always carried out by the homeowner. The home was advised to put more detailed information in this assessment document. There were records of initial visits to the home. Initial visits will help to inform potential new residents and make their move into the home easier. All the residents receive either a contract if privately funded, or a statement of terms and conditions if supported by the local authority. This written agreement helps to inform residents of their rights and conditions of stay at the home. Camellia House D52-D07 S48342 Camellia House V226752 060705 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 The delivery of resident’s care is good but is hampered by limited care planning and resident risk assessment. Improvements in these areas will support further progress in the delivery of consistent, high quality support to the residents. EVIDENCE: Resident’s care plans were sampled. All the residents’ files had a care plan and risk assessment in place. The information held in the care plan document and the risk assessment was quite generalised. This information needed to be more detailed and specific in order to clearly state all the resident’s needs and the directions given to staff to meet those needs. The resident’s risk assessment should also detail any restriction of choice agreed to be both in the resident’s interests and needed to maintain their safety. When a more detailed care plan has been developed for each resident the quality of their care support will be further improved and this should therefore improve the resident’s quality of life. There was good evidence of the involvement of healthcare professionals such as the GPs and district nurses in the support of the health of the residents. Medication is well managed in the home but it is recommended that the care staff dealing with medication have external accredited level medication administration training to further support the training given by the management of the home.
Camellia House D52-D07 S48342 Camellia House V226752 060705 Stage 4.doc Version 1.40 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,15 The home supports residents’ leisure and social activity both in and outside the home. The residents’ nutritional needs are met and residents receive enough good food. EVIDENCE: There is an individual resident’s daytime and night-time report and this was well maintained. There was also a separate leisure activity record book. These records describe the quality of each resident’s day and any contact with friends and family from outside the home. Indoor activities include professionally led reminiscence groups, sing along sessions, ‘dancefit’ sessions and quizzes. The home had held a sherry party in the patio garden the week before the inspection. Some residents regularly enjoy going out unaccompanied to the pub and the book-makers. Others go out regularly in small groups using the owner’s transport to go to the shops and for meals out of the home. Resident’s food likes and dislikes are found out by the service. A four-week menu plan is in place but the food actually prepared is not rigidly dictated by this plan. There was no record kept of the food actually provided. The home should record the food made available to the residents including demonstration of the choices offered. This record will help to ensure that the food provided is nutritionally balanced and wholesome and will therefore help to maintain the health and quality of life of the residents. The dining room décor is good giving a satisfactory environment to take meals in. Camellia House D52-D07 S48342 Camellia House V226752 060705 Stage 4.doc Version 1.40 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Complaints are properly managed by the home protecting the welfare of the residents. EVIDENCE: There is an adequate complaints procedure and this is clearly displayed in the home and has been distributed to all the residents as part of the Service Users Guide. The contact details for the CSCI are given within the procedure. The home has all the required adult protection policies in place and the homes management has attended adult protection training. It is hoped that further members of staff will soon be able to attend Adult Protection training. Camellia House D52-D07 S48342 Camellia House V226752 060705 Stage 4.doc Version 1.40 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26 The residents have a good quality of life within the home because the quality of the environment in the building is maintained at a good level. EVIDENCE: A complete tour of the building was made during the inspection. Most of the building is elderly and the owner has made substantial investment in the quality of the living environment. All the seating in the lounge and dining room has been replaced during the past year. It was also noted that the aid call system had been replaced throughout the whole building. The management stated that they intended to replace the lounge curtains and much of the rear fire escape during this financial year. No significant maintenance faults were seen in the building during the inspection. Considerable investment has been made in creating a safer environment in the home. All the radiators have been covered to eliminate the risk of pressure burns from contact with a hot surface. All the window openings above the ground floor have been limited to eliminate any risks of falls from windows. Some of the hot water taps at sinks have had hot water temperature control
Camellia House D52-D07 S48342 Camellia House V226752 060705 Stage 4.doc Version 1.40 Page 13 valves fitted and it is planned to adapt all the other hot water outlets beginning with fitting at the three baths. The residents benefit from a safer environment. All surfaces in the laundry are impermeable and easily washable. The laundry houses an industrial washing machine, industrial dryer and second domestic washing machine. The laundry was clean ,tidy and the COSHH chemicals were locked away. There may in the future be a need to open sluice some laundry and the home was advised that if this should arise then a procedure for open sluicing would need to be developed and the appropriate protective equipment should be provided for the staff. In general the decoration in communal areas was good. There are a lot of pictures and ornaments in the home. The bedrooms have been personalised by the residents and generally facilities in the bedrooms are good. The three double bedrooms have built in curtain screens which allows the residents’ more privacy. The residents enjoy a well decorated environment to live in. Camellia House D52-D07 S48342 Camellia House V226752 060705 Stage 4.doc Version 1.40 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Resident’s needs are met by enough competent, qualified, properly vetted and trained staff. EVIDENCE: The pre inspection questionnaire and staff records showed that some of the care staff have achieved an NVQ2 care qualification. The present owner purchased the home less than two years ago and is still in a process of developing training in the home. If all the staff presently following courses complete them, 84 of the care staff will be qualified to NVQ level 2. Both the registered provider and the deputy manager are qualified to NVQ4. The residents are better cared for because the staff team is trained and competent to deliver care. There is an adequate level of staffing detailed in the staffing record to meet the service users needs. The staff were seen throughout the inspection to be relaxed, patient and helpful when assisting the residents. The staff personnel files, supported by evidence from the management showed that a small number of Criminal Records Bureau (CRB) clearances had not yet been received though they had been applied for. CheckS of the Protection Of Vulnerable Adults (POVA) register has been made for all members of staff. Appropriate references are in place for each member of staff. The management was advised to obtain a copy of the General Social Care Council Codes of Conduct for each member of staff. The residents can be assured that they are secure and safe when left in the care of all of the staff. A simple induction system is in place for new members of staff. This system does not comply with the National Training Organisation (NTO) specification for induction. The home should develop a new induction format that is compliant
Camellia House D52-D07 S48342 Camellia House V226752 060705 Stage 4.doc Version 1.40 Page 15 with the NTO specification, is practical for the home to manage and ensures that new staff can meet the needs of the residents early in their work at the home. Camellia House D52-D07 S48342 Camellia House V226752 060705 Stage 4.doc Version 1.40 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35,37,38 The management of the home is effective and continues to ensure that the needs of the residents are met. EVIDENCE: There is a system of supervision beginning in the home. The supervision format developed by the home is good and will be effective when used regularly. Staff should receive regular individual supervision and a supervision procedure should be developed. Regular supervision will help to monitor and improve staff practice and training and therefore improve the care received by the residents. Though there are regular residents meetings there is no formalised quality assurance system at the moment. An effective, practical quality assurance system should be developed based on the views of the residents and other interested parties, and supported by a policy and procedure stating how this process is carried out at Camellia House.
Camellia House D52-D07 S48342 Camellia House V226752 060705 Stage 4.doc Version 1.40 Page 17 Personal money records held on behalf of the residents are well managed using a clear and practical system. Amounts of cash held on behalf of residents were sampled and checked against balance sheet entries and all were correct. Health and safety is managed satisfactorily in the home. However some issues were identified during this inspection that should be addressed. The fire protection system was generally well maintained. Maintenance checks are being carried out. A number of appropriate hold open devices are fitted to self closing fire doors. However one door was being held open by a residents chair. The resident should be given the opportunity to hold the door open using an appropriate hold open device. The home has begun to fit hotwater temperature control valves. Till all the hot water taps available to residents have been physically adapted, an individual risk assessment should be put in place to identify that any risk is being managed. The management should carry out and retain a Legionella risk assessment to demonstrate that this issue has been assessed by the service. The homes kitchen was being well managed . Food hygiene and health and safety was being respected. However some of the fridge and freezer temperatures were not being taken regularly. These records for all fridge and freezer appliances should be kept thorughly in future. Gas and electrical appliances were being routinely serviced and checked. Good health and safety practice will reduce any unreasonable risk, affecting residents or staff, to an acceptable level. Camellia House D52-D07 S48342 Camellia House V226752 060705 Stage 4.doc Version 1.40 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 2 x 3 x 2 2 Camellia House D52-D07 S48342 Camellia House V226752 060705 Stage 4.doc Version 1.40 Page 19 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action 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. Refer to Standard 7 Good Practice Recommendations All the residents should have a detailed care plan and individual risk assessment which should be reviewed monthly. All the residents needs should be identified and how the staff are to meet these needs. All care staff involved medication administration should recieve accredited level medication administration training. The induction training structure should be redeveloped to the level specified by the National Training Organisation. An effective quality assurance system should be developed based on the views of the residents and other interested parties and supported by a policy and procedure stating how this process is carried out at Camellia House. A system of regular individual supervision, including the development of a supervision procedure, should be put into operation for the care staff. A record of the food provided in the home, and where necessary inventories of residents personal belongings of value, should be introduced. An individual risk assessment should be in place for each hotwater outlet that has not yet been physically adapted to
D52-D07 S48342 Camellia House V226752 060705 Stage 4.doc Version 1.40 Page 20 2. 3. 4. 9 30 33 5. 6. 7. 36 37 38 Camellia House 8. 38 limit hot water temperature. A Legionella risk assessment should be put in place. A specific bedroom door should be fitted with a appropriate hold open device. Acurate fridge and freezer temperatures should be recorded for each of these appliances. Camellia House D52-D07 S48342 Camellia House V226752 060705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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