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Inspection on 17/02/09 for Camellia House Nursing Home Ltd

Also see our care home review for Camellia House Nursing Home Ltd for more information

This inspection was carried out on 17th February 2009.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There are good admission procedures in place that ensures that only people whose needs can be met are admitted to the home. Everyone living at the home has a care plan. All bedrooms are lockable and communal areas are reasonably maintained and laundry is well managed. Staff are aware of the needs of the individuals and said that they were keen to do a good job.

What has improved since the last inspection?

The activities organiser is preparing social activity plans for everyone at the home and there has been an increase in the number of activities on offer as well as the type. Complaints are now recorded separately.

What the care home could do better:

During the course of the visit the need for improvement in several areas were identified. For example, the lack of instructions to staff on how to meet the needs of individuals means that people may not have their assessed needs met, this is aggravated by low staffing levels at certain times and a lack of relevant training.All required checks and records must be obtained before staff begin work at the home. Any medication that is prescribed must be obtained and administered as soon as possible. People`s choice should be respected, especially relating to getting up times, bathing and food. People`s dignity must be respected and they should be taken to the lavatory in a timely manner. Everyone should have easy access to a call bell to get assistance as required. People should be aware of the complaints procedure, feel able to raise any concerns they may have and be confident that they will be listened to and acted on. There needs to be a programme of refurbishment and particular attention needs to be paid to bedrooms and bathrooms to make them more comfortable for people living at the home. The home must be kept free from hazards at all times to ensure the safety of people living at the home. There needs to be a formal quality assurance system in place that ensures people are consulted on about the quality of care provided at the home, and a system must be put in place to ensure people have access to their finances. The Responsible Individual for the home must visit at least monthly and prepare a report on their visit. There have been a number of concerns raised about the quality of care provided by the home for quite some time. There have been some improvements but concerns continue to be raised. This will be the third key visit resulting in a `poor` rating for the home. None of the requirements made at the last visit have been addressed. Consequently the Commission is considering enforcement action.

CARE HOMES FOR OLDER PEOPLE Camellia House Nursing Home Ltd 5 Oak Park Villas Elm Grove Road Dawlish Devon EX7 0DE Lead Inspector Sue Dewis Unannounced Inspection 17th February 2009 09:15 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 Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Camellia House Nursing Home Ltd Address 5 Oak Park Villas Elm Grove Road Dawlish Devon EX7 0DE 01626 864272 01626 867217 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) Camellia House Nursing Home Ltd Manager post vacant Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (30), Old age, not falling within any other category (30), Physical disability over 65 years of age (30) Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Dementia - over 65 years of age (DE(E)) 30 Mental Disorder, excluding learning disability or dementia - over 65 years of age (MD(E)) 30 Old Age, not falling within any other category (OP) 30 Physical Disability - over 65 years of age PD(E)) 30 Date of last inspection 20th August 2008 Brief Description of the Service: Camellia House is a Care Home that is registered to provide Personal and Nursing Care for up to 30 people. The house is a large Victorian villa built on level ground with an extensive walled garden. The home is in a quiet residential area, within one mile of the seaside town of Dawlish. The accommodation is over two floors with a passenger lift, and ramps to reach mezzanine floors. There is a large lounge and separate dining room. The home has been adapted to meet the needs of people living there and grab rails and specialist equipment has been installed, including accessible bathing facilities. The Acting Manager is a registered nurse and is supported by a team of registered nurses and care staff, who provide 24 hour care. The inspection report is available on request from the office. Current fees range from £433 to £520 per week, depending on the room and the level of care needed. Fees do not include, hairdressing, chiropody, physiotherapy, newspapers and taxis. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk . Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This unannounced visit took place over 9 hours, one day in the middle of February 2009. The home has completed an AQAA (Annual Quality Assurance Assessment) within the previous 12 months. This shows us how the home has managed the quality of the service provided over the previous year. It also confirms the dates of maintenance of equipment and what policies and procedures are in place. Information from this document was used to write this report. Although only one inspector undertook this inspection, throughout the report there will be reference to what we found and what we were told. This is because the report is written on behalf of the Commission for Social Care Inspection. During the inspection 3 people were case tracked. This involves looking at peoples individual plans of care, and, where possible speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. Shortly after this visit a meeting was held at the home with relatives to discuss the management of the home and concerns they had. CSCI were not present at this meeting, but minutes were forwarded to us and information from these minutes has been used to illustrate the concerns of relatives. There have been ongoing safeguarding meetings relating to Camellia House for some time and because of this is it was decided that Devon County Council Adult and Community Services (ACS) would undertake a series of reviews of their clients within the home. Information from these reviews has also been included in this report. During the visit 6 people living at the home were spoken with individually as well as observing staff and people living at the home throughout the day. We also spoke with 4 staff and the acting manager. A full tour of the building was made and a sample of records was looked at, including medications, care plans and staff files. All key standards were inspected. We were joined for this visit by an Expert by Experience. Experts by Experience are people who have used or visited the type of service we are inspecting. Their role is to bring a different and independent view to the Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 6 inspection process by working alongside inspectors, observing and gaining the views of people who use the service. The Expert by Experiences background knowledge of services enables them to ask different questions and explore different themes. They are able to pick up on and note details, such as care practices, accessibility within the home, interaction and non-verbal communication between staff and people who use the service. People who use the service are able to talk openly and differently to the Expert by Experience and this makes them feel valued. Following the visit the Expert by Experience sent us a report on their findings. Information from this has been included in the main report. What the service does well: What has improved since the last inspection? What they could do better: During the course of the visit the need for improvement in several areas were identified. For example, the lack of instructions to staff on how to meet the needs of individuals means that people may not have their assessed needs met, this is aggravated by low staffing levels at certain times and a lack of relevant training. Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 7 All required checks and records must be obtained before staff begin work at the home. Any medication that is prescribed must be obtained and administered as soon as possible. Peoples choice should be respected, especially relating to getting up times, bathing and food. People’s dignity must be respected and they should be taken to the lavatory in a timely manner. Everyone should have easy access to a call bell to get assistance as required. People should be aware of the complaints procedure, feel able to raise any concerns they may have and be confident that they will be listened to and acted on. There needs to be a programme of refurbishment and particular attention needs to be paid to bedrooms and bathrooms to make them more comfortable for people living at the home. The home must be kept free from hazards at all times to ensure the safety of people living at the home. There needs to be a formal quality assurance system in place that ensures people are consulted on about the quality of care provided at the home, and a system must be put in place to ensure people have access to their finances. The Responsible Individual for the home must visit at least monthly and prepare a report on their visit. There have been a number of concerns raised about the quality of care provided by the home for quite some time. There have been some improvements but concerns continue to be raised. This will be the third key visit resulting in a ‘poor’ rating for the home. None of the requirements made at the last visit have been addressed. Consequently the Commission is considering enforcement action. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission procedure ensures that there is a proper assessment prior to people moving into the home, and that they can be assured that their care needs can be met. EVIDENCE: No one has been admitted to the home for some time, so the files of three people now living in the home were looked at. The acting manager told us the procedure that she has followed previously when people had been referred to her for possible admission to the home. We were told that this included sending out information about the home, inviting the person to visit the home and then visiting them to complete a pre-admission assessment. All three files looked at showed a detailed assessment had been completed prior to the Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 10 person moving into the home. The home did not previously write to people to confirm that their assessed needs could be met before they moved in. However, we were told that this would be done for any new people thinking of moving into the home. The home does not provide intermediate care. Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans are detailed, but do not provide staff with clear information that would enable them to meet peoples health and social care needs on a day to day basis. The administration of medication needs to be improved to a satisfactory level. EVIDENCE: All people living at the home have an individual plan of care. We looked at the care plans for three people. There has been little change to the care plans since the last visit. There is some evidence that people and their representatives had been involved in updating care plans. There was also evidence that the care plans were being reviewed. Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 12 The care plans contain very detailed and comprehensive information about identified needs. However, the information is so comprehensive that staff may not have time to read and update their knowledge on each person’s care needs each time they come on duty. Care staff did tell us that they found the care plans useful when they looked at them. They also told us that they generally found out about any changes in care through a verbal handover from the nurse on duty. However, although the care plans contain good details of the needs of the individual, they remain difficult to extract relevant information from, in relation to what staff need to do in order to meet the individual’s needs. For example, plans often state ‘effective management of ……’ as the way staff should deliver care. This is not specific and could lead to inconsistent care being given. Daily records do not always specify where identified needs have been met. For example ‘all care given’ is often written, but this does not say exactly what type of care had been given. Care plans contain a variety of risk assessments, including assessments for the use of bedrails. There was also an ‘accident prevention tool’ that had been completed on each care plan. However, as noted during the previous visit, several of these tools highlighted a high risk, but then there was no detail of any control measures that had been put in place to reduce the risk. Manual handling plans do not look at the capacity or the understanding of the individual, which may have an impact on the method used to move someone. In summary care plans are confusing. They do not set out how staff are to meet the day to day needs of people living in the home, nor do they show how the goals identified in care plans are to be met. Therefore there is the potential for people to not have their needs met. Information about visits from chiropodists, district nurses (for residential placements) and doctors had been recorded in individual care plans, showing clear evidence that people are supported to maintain access to specialist medical services. However, there was also evidence that health care needs were not always being met. For example, one care plan showed that a repeat prescription had been requested from the GP, and that almost 2 weeks later the medication had still not been received. The care notes clearly showed that this medication was needed at the time it was requested and that it was not requested in advance. This is not acceptable. The home must ensure that people receive any prescribed medication promptly. All people we saw during this visit looked well cared for. They were all wearing their own clothes, which were clean and well ironed. Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 13 Two people told us that they often had to wait until lunch time before they could get up because there were not enough staff available. This was also reported to ACS staff while they were reviewing people. ACS staff were also told by people that staff told them to ‘pee and pooh’ in their pads as they didn’t have time to take them to the toilet. Relatives also reported that they had heard staff say similar things to people. This was discussed with the acting manager who said that there had been a member of staff who had said these sorts of things, but that they had now left. When we spoke with staff they said that people were only in bed till lunch time if that was their choice. However, this does not seem to be the perception of people living in the home, who feel they have to wait too long to be got up or go to the toilet. There were however, some comments received from representatives through reviews that were positive. They felt that the care received was satisfactory and they spoke positively about the staff and acting manager. Concerns had also been raised through reviews and the relative’s meeting, about people being able to have a bath. It seems that this is partly because of staffing levels and partly because there is only one bathroom in use. Medication administration was generally well managed and records show that medicines are counted when received into the home and records relating to Controlled Drugs were well maintained. However, the member of staff that was administering the medication was seen to leave the trolley unattended with medication accessible to anyone passing by. The acting manager was told about this and she spoke with the member of staff concerned. All bedroom doors have locks fitted to them. The doors lock when they are closed from the outside and need a coin to gain access, but the person inside can still open them easily to get out. Screening is provided in the shared rooms at the home, protecting peoples’ privacy. Personal care was offered to people in a discreet manner. Staff told us how they respect peoples’ privacy when helping them with personal care, assisting them to bath or dress or assisting them with personal needs when in the lounge or dining room. We heard staff speaking to people in a kindly, friendly way. There are a number of ongoing concerns relating to the home which have resulted in ACS staff reviewing people who live at the home. There has also been a meeting between the management and relatives where their concerns about poor care were raised. One person had found their relative stuck between bedrails and had been unable to find any staff. The issue of call bells not being available was also discussed at the meeting. During the visit, one person who was in bed, said that they had to shout for assistance as they did not have a call bell. We could not find one in the room Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 14 so asked the acting manager if one was available. After looking in the room for sometime the call bell was found behind the wardrobe. We were told that the layout of the room had been changed so that the bed was accessible on both sides, but the call bell had not been adjusted so that it was accessible by the individual. We were assured that an extension to the lead would be found for this individual. One person made a disclosure to us during the visit and this was reported to the Safeguarding Adults Team and has been investigated. No evidence was found to support the allegation. Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Social interaction and activities are more readily available and there is more daily variation and stimulation for people living in the home. EVIDENCE: When we first arrived at the home there was no one in the lounge and we were told this was because people were still getting up. During the course of the day some people came to sit in the lounge, but most people stayed in their rooms. Since the last key visit an activities co-ordinator has been employed. This was originally for 5 days per week, but has now been reduced to 2.5 days per week. Activities now include cookery and exercise sessions. Communion is provided each month, but it is hoped to increase this to every two weeks. The activities coordinator has started completing social activity goal plans, that set out the social and emotional care needs of the person. They give directions to staff on how these needs can be met and include the individual’s means of Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 16 communication and how staff can help develop the person’s communication skills. We saw the activities coordinator with one individual helping collate photographs and other mementoes of their past into a life history book. We were told by the acting manager and staff that people are very frail and generally are not able to make many decisions about their lives at the home. However, we were told that whenever possible people were offered choices. We were told by staff that daily routines, including getting up and going to bed and mealtimes, were flexible. However, this was not the perception of people living in the home or their relatives (see also Health and Personal Care outcome group). People that we spoke with said that they were not offered a choice of food, nor did they know in advance what they would be eating. When asked what would happen if they didn’t like what was on offer one person said that they just had to leave it and make up with pudding. At lunch during this visit, there was only the option of sausages, mashed potato, mashed parsnip and carrots. Those meals that were liquidised had separate identifiable portions of each food. One person had egg sandwiches, which would seem to be a normal occurrence. Most people were served automatically and there was little conversation between staff and the people they were serving, although one person was asked how many sausages they would like. Relatives at their meeting raised concerns that food at tea-time was occasionally delivered without any explanation of what it is. The suggestion was raised that it might be possible to ask people at lunch time what they would like for tea. Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a clear and simple complaints procedure but complaints are not always responded to promptly with satisfactory outcomes. Adequate procedures are not in place to ensure that people are protected from abuse. EVIDENCE: There is a formal complaints procedure for the home that is displayed in the hallway. There is now a complaints file that shows individual complaints have been recorded separately. Three complaints have been received since the last key visit. These had been dealt with appropriately. Relatives raised concerns at their meeting that complaints did not seem to be ‘getting through to the appropriate person’. However, through ACS reviews several comments were received from representatives who were fully aware of the complaints procedure and felt that the acting manager could be approached at any time. Several concerns have been raised with the Commission over a period of 12 months, these have resulted in a number of Safeguarding Adult meetings taking place which have not yet been finalised. Another concern was raised during this visit which was also looked at through the safeguarding procedure. Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 18 One Random visit was made to the home since the last Key visit to check on compliance with previous requirements. None of the previous requirements had been met. Records show, and staff told us that they had received training in Protection Of Vulnerable Adults (POVA) issues. All staff that we spoke with were able to discuss different forms of abuse and said that they would report any suspicions they had to the acting manager. They were also clear about who they would report any concerns to, outside of the home if they needed to. Staff files do not contain all the necessary checks to ensure individuals are protected from people who may be unsuitable to work with vulnerable adults (see also Staffing). Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24, 25 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home does not provide a comfortable and safe environment for those living in, working at and visiting the home. EVIDENCE: A full tour of the communal areas of the home was made and many of the bedrooms were looked at. The house was generally clean and free from unpleasant odours though some areas were in a poor state of repair, particularly bedrooms. The Acting Manager said that the maintenance worker who had started to redecorate the home had been let go and that the home now shared a maintenance worker with another home. This means that the redecoration programme has been stopped. Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 20 At a previous inspection we were told that the hall carpet was due to be replaced soon, but this has still not happened. The lounge is very large and is pleasantly decorated, with two separate seating areas, one with a TV and the other a quiet area. The dining room is very dark and there are not enough tables and chairs for everyone to have their meals there if they chose. The home covers two main floors and a mezzanine area. Ramps have been purchased that fit across steps to enable easier access to the differing areas. Two bedrooms have two doors giving off to different hallways and one ground floor room has a poor view onto a very small patio area that is still in great need of tidying up. Several bedrooms were looking shabby, with mismatching old furniture and chipped paintwork, and one had a cracked window pane. Many of the bedrooms are for double occupancy and there was no indication that people had chosen to share with someone else. We noticed that there were several notices containing personal information taped to walls and doors in bedrooms. This does not promote privacy or dignity for the individuals in the rooms. We noticed that two doors down to the basement area that opened onto stone steps were unlocked. There were notices on both doors saying that they should be kept locked at all times. However, anyone going down into the basement cannot lock the door behind them. An immediate requirement was made that suitable locks should be fitted to the doors so that people living at the home cannot access the area. The kitchen area was very shabby and the cooker was very dirty. The acting manager told us that the telephone system is not working correctly and that it is difficult to hear people or to transfer calls. This problem was also raised at the relatives meeting. We were also told that there was a problem with the boilers which meant that sometimes there was no hot water in some parts of the building. Also there have been problems with the lift that have resulted in people having to stay downstairs overnight. There are several bathrooms around the home but only one is in use. This has an ‘assisted’ Parker bath and it was clean and all surfaces were sound. However, there were no curtains or blinds to the window, there was a bare light bulb, and no decoration to help make bathing a pleasant experience. We also found cleaning materials on a chair that were easily accessible to people using the bathroom. An immediate requirement was made that the items were removed. We were told by the acting manager that there are plans to turn one of the ground floor bathrooms into a large shower room. Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 21 The home has a mobile hoist and staff were seen using this. Disposable gloves and aprons were seen in various places around the home and staff were seen wearing them as needed. The laundry area was clean and tidy and has an impervious floor covering that helps prevent cross contamination from soiled articles. Washing machines have the ability to meet disinfection standards and sluice machines are provided for disposal of bodily waste and clearing commode pots. Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels are variable, which does not ensure that peoples health and social care needs are being met at all times. Not all staff are trained and able to meet the specialist physical and emotional needs of people living at the home. The procedures for the recruitment of staff are not robust and therefore do not ensure protection for people living at the home. EVIDENCE: There were 15 people living at the home when we visited. On the morning of the visit there were four care staff on duty, a registered nurse, plus the acting manager. There were also two people in the kitchen, the maintenance person the laundry assistant and the activities organiser. During the afternoon and evening there were three care staff a registered nurse and the acting manager, plus a domestic. A kitchen assistant returned in the early evening to prepare tea. During the night there is a registered nurse and a care assistant on duty. The three care staff that were spoken with said that they felt staffing levels were a little better especially in the evening now that there was someone in the kitchen to prepare tea. They also said that they felt they had enough time to meet the needs of the individuals. All staff said that they never told people Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 23 they were too busy to take them to the toilet, nor had they ever heard anyone else say this (see also Health and Personal Care section). Staff were aware of the needs of the people they were caring for and were keen to provide a good service. The files of five staff were looked at, all contained satisfactory CRB (criminal Records Bureau) checks. Three also contained full employment history and proof of identity. However, two files of overseas staff contained only CRB checks. The acting manager told us that she regularly has overseas staff brought in to work at the home, she has no work history or references for these staff and is just told by the management that the checks have all been made. These staff spend only a limited time at Camellia House and then are moved on and different staff brought in to work at the home. Staff said that there had been little training available to them and that dementia training had been cancelled. This is especially concerning as there is a high number of people living at the home who have a dementia type illness. Moving and handling training has also been cancelled and one member of staff told us that she couldn’t remember the last time she had had this type of training. Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home lacks robust management systems to check the quality of the services and facilities provided, resulting in practices that do not always promote and safeguard the health, safety and welfare of people who live and work in the home. EVIDENCE: Mr Sunil Koomkwha is Responsible Individual for the company, Camellia House Nursing Home Ltd. He is a Qualified Nurse. He does not live close to the home, and has not been visiting the home as required by Regulation 26, that is monthly. The owners of the company have entered into an agreement with Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 25 another company to manage the home on their behalf and this was effective from 15 September 2008. There have been a number of concerns raised about the care of people at the home and there have been several safeguarding meetings as referenced elsewhere in this report. While the owners have sought to address some of the concerns, similar concerns have been raised subsequently and none of the requirements from the previous report have been addressed. There is no registered manager at the home at present, the application to register by the acting manager was withdrawn by them. She is a qualified nurse with experience of senior posts caring of older people in several care settings, but has no management qualification. There have been problems in recruiting registered nurses and this has meant that most times the acting manager is at the home she is the nurse on duty. This means that she has little time to undertake her management duties. The acting manager told us that she continues to feel unsupported by the owners. However concerns were raised at the relatives meeting about her ability to manage the home. There is no formal quality assurance system in place at the home that shows that people have been consulted about the quality of care provided by the home. Concerns were raised at previous visits about the financial affairs of two people living at the home. This is because their money was being held by the Responsible Individual and the manager was unable to access it on their behalf. It had been reported to us by the Responsible Individual that this arrangement was changing and that separate bank accounts would be set up for these individuals. However, this has not happened. We were told that a bank account has been set up for the two individuals and the Responsible Individual pays some money into this account, but that they still cannot access the money themselves. Adult and Community Services are currently looking into the handling of the individual’s money. The AQAA (Annual Quality Assurance Assessment) submitted prior to the visit, provided evidence that Camellia House complies with health and safety legislation in relation to maintenance of equipment, health and safety checks and some risk assessments. Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 26 Policies and procedures are not always inspected during the visit but the information provided on the AQAA helps us form a judgement as to whether the home has the correct policies to keep people living and working at the home safe. Information provided by the home, evidenced that policies and procedures are in place and are reviewed regularly and updated where necessary, to ensure they remain appropriate and help reduce risks to people living and working at the home. However, in practice it would seem that staff do not always follow the procedures as evidenced by the doors to the cellar not being locked. So that the risk of burning from hot surfaces is minimised, radiators within the home are covered. All windows above ground floor level are fitted with restrictors, in order to minimise the risk of anyone falling from these windows, and so that the risk of burning from hot water is minimised temperature controls are fitted to bath taps. Two immediate requirements were made in respect of health and safety. One was that hazardous substances should be removed from the bathroom and locked away. The second was that the doors to the cellar should be fitted with suitable locks to prevent people living in the home accessing the basement. Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X 2 X 1 1 1 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 1 X X 1 Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Care plans must provide sufficient information to staff to ensure people’s needs can be met. (Previous timescale of 31/12/08 and 13/02/09 not met) The home must make arrangements to ensure that individuals receive any prescribed medication as soon as possible. The home must ensure that all individuals can access call bells as required. The home must ensure that the dignity of people living at the home is maintained at all times. This relates in particular to people not being able to go to the lavatory when needed. The home must ensure that individuals have choice in all aspects of their life at the home. This relates in particular to DS0000066799.V374667.R01.S.doc Timescale for action 04/05/09 2. OP8 12 (1)(b) 04/05/09 3. OP8 23 (2)(a) 04/05/09 4. OP10 12 (4)(a) 04/05/09 5. OP14 12 (3) 04/05/09 Camellia House Nursing Home Ltd Version 5.2 Page 29 getting up times/bathing/food. 6. OP19 23(b) The premises must be kept in a good state of repair internally and externally. (previous timescale of 31/12/08 and 13/02/09 not met) The home must ensure that all records relating to the correct recruitment of staff are of obtained before they begin work at the home. Staffing levels must be sufficient to meet the needs of individuals at all times. (previous timescales of 24/07/08, 31/12/08 and 13/02/09 not met) Staff must receive sufficient training to enable them to safely meet the needs of individuals. (previous timescales of 24/07/08 and 31/12/08 not met) The Responsible Individual must visit the home unannounced at least monthly and prepare a report of the visit. A copy of this report must be sent to the Commission. (previous timescale of 13/02/09 not met) Arrangements must be made to ensure individual’s money is paid into an account in their own name. (previous timescale of 30/09/08 and 13/02/09 not met) All unnecessary risks to the health and safety of individuals must be identified and as far as possible eliminated. (This relates to the immediate requirements made during the DS0000066799.V374667.R01.S.doc 04/05/09 7. OP29 19 04/05/09 8. OP27 18(1)(a) 04/05/09 9. OP30 18(1)(c) 04/05/09 10. OP33 26 04/05/09 11. OP35 20(1)(a) 04/05/09 12. OP38 13 (4)(c) 24/02/09 Camellia House Nursing Home Ltd Version 5.2 Page 30 visit) 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 OP16 Good Practice Recommendations People must feel able to raise concerns and complaints and be assured that they will be dealt with appropriately. The quality assurance system at the home should be formalised to ensure that people are consulted on the quality of care provided at the home. 2. OP33 Camellia House Nursing Home Ltd DS0000066799.V374667.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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