Inspection on 17/06/09 for Camellia House Nursing Home Ltd

This inspection was carried out on 17th June 2009.

CQC 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.

Other inspections for this house

Camellia House Nursing Home Ltd 17/02/09

Camellia House Nursing Home Ltd 20/08/08

Camellia House Nursing Home Ltd 29/02/08

Camellia House Nursing Home Ltd 01/11/07

Camellia House Nursing Home Ltd 27/02/07

Camellia House Nursing Home Ltd 21/06/06

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report 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 Key Unannounced Inspection 17th June 2009 09:30 DS0000066799.V376631.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Camellia House Nursing Home Ltd DS0000066799.V376631.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Camellia House Nursing Home Ltd DS0000066799.V376631.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.V376631.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 17th February 2009 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 £381 to £545 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.V376631.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 8 hours, one day in the middle of June 2009. Two inspectors were present throughout the visit. The home had previously completed and returned an AQAA (Annual Quality Assurance Assessment) which 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. Throughout the report there is reference to what we found and what we were told. This is because the report is written on behalf of the Care Quality Commission (CQC). 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. During the inspection 4 people living at the home were spoken with individually in depth. Everyone else living in the home was seen in their rooms or the lounge. We also spoke with 2 representatives, 4 staff, a District Nurse and the acting manager. A full tour of the building was made and a sample of records was looked at, including medications, care plans, the fire log book and staff files. All key standards were inspected. Some people living at the home have limited verbal communication skills, and as we are not skilled in their other methods of communication it was difficult for us to have any meaningful communication with these people. However, the interaction between the people living at the home and those who care for them was closely observed. Concerns about the quality of care at the home are ongoing and no new admissions have been made at the home due to Devon County Council having placed a Serious Default Notice on the home. This will be the fourth key inspection visit that has resulted in a poor rating. Following each previous visit the providers had given us assurances that they were working to improve the quality of care at the home, and had asked a company to manage the home on their behalf. Since this key inspection visit the home has gone into Camellia House Nursing Home Ltd DS0000066799.V376631.R01.S.doc Version 5.2 Page 6 administration. A company has been appointed on behalf of the administrators to manage the home. A Random Unannounced visit was made to the home on 08 May 2009 to check on the progress made by the registered providers towards meeting the requirements made at the previous visit. A copy of this report is available from CQC on request. There has been no registered manager at the home for almost 2 years. The current acting manager for the home is employed by the company that is managing the home on behalf of the registered providers. What the service does well: There are good admission procedures in place that would ensure 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 staff respect the privacy and dignity of the individual. Care staff were aware of the needs of the individuals and said that they were keen to do a good job. The representatives of people living at the home told us that they were always made to feel welcome. 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 Camellia House Nursing Home Ltd DS0000066799.V376631.R01.S.doc Version 5.2 Page 7 met, this is aggravated by low staffing levels at certain times and a lack of relevant training. Risk assessments must be completed and show control measures in place for all relevant areas. There must be a full programme of refurbishment for the building and particular attention needs to be paid to bedrooms and bathrooms to make them more comfortable for 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. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Camellia House Nursing Home Ltd DS0000066799.V376631.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.V376631.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6. People using the service experience good quality outcomes in this area. We have made this judgement using a range of 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: There is a Statement of Purpose, Service User Guide and Brochure available to people thinking of moving into the home. These documents have not changed since the last visit. No new admissions have been made to the home for quite some time, so it was not possible to see if the homes stated procedures have been followed. However, previous admissions had followed the homes procedures and the Camellia House Nursing Home Ltd DS0000066799.V376631.R01.S.doc Version 5.2 Page 10 acting manager assured us that the same procedures would be followed if there were any referrals. The home does not provide intermediate care. Camellia House Nursing Home Ltd DS0000066799.V376631.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of 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 management of medication has improved to a satisfactory level, but still needs further improvement. EVIDENCE: Care planning and assessment of peoples needs was poor. Care staff did not have the information they needed, in an easily accessible format, in order to provide consistent care to fully meet peoples complex care needs. The acting manager said that a new care plan system was in the process of being introduced. One care plan had been updated into this new system. The remaining care plans were very general, gave very little specific information on Camellia House Nursing Home Ltd DS0000066799.V376631.R01.S.doc Version 5.2 Page 12 how peoples needs were to be met and were not consistently completed. For example one care plan stressed the importance of increased fluids, but there was no ongoing consistent record of how fluids were given, which fluids they preferred, or if fluids had been consistently given. This meant that staff could not be certain that this person had received enough drinks to help them remain hydrated and lessen the chance of urine infections. Care plans and assessments had not been reviewed and updated to reflect ongoing changes in people care needs. For example one care plan said in the review section no changes. However, when speaking with staff they described a number of changes which were recorded briefly in other documents, such as a diary. At the previous site visit to the home, in May 2009, when a random inspection was carried out, the acting manager agreed that care planning and assessment records were poor and in need of updating. At this site visit she said she had been unable to update the care plans and assessments as planned, as she had been working as the nurse in charge of the day to day running of the home. She also said she had also been spending time working on staff contracts of employment so that she had not had the time to introduce the new care planning system. One relative said that the care and attention people received had improved since the acting manager had introduced routines into the home that staff seemed to follow. Staff spoken with clearly had a good knowledge of peoples care needs and how to meet peoples individual needs. They described peoples personal preferences and how people liked to be cared for. It was observed that one person remained in bed until 11.55 a.m. without their personal care needs being met. Staff told us that sometimes they had no choice but to leave one persons personal care until later in the day, as they did not have the time to address everyones personal care needs at the time that suited them. Staff said that they tried to make sure it was not always the same person left until later. Information about visits from and to health care professionals had been recorded in individual care plans, showing clear evidence that people are supported to maintain access to specialist medical services including dentists and GPs. One District Nurse was spoken with during the visit, they told us that they only visit the home to see one person, who is always tip top when they see them. They told us that they dont see staff very often but that they have always been helpful. They also said that although the individual they visit is generally in bed when they see them they think this is the persons preference. Medication administration, storage and recording were adequate. At the previous site visit discussion took place on the use of homely remedies such as Camellia House Nursing Home Ltd DS0000066799.V376631.R01.S.doc Version 5.2 Page 13 olive oil. Staff were not recording how or why this was used, and there was no homely remedies policy for staff to follow. The concerns raised had been addressed, as care staff were able to describe the introduction of a new policy and procedures in this area. The storage of medication could be improved as there were a number of out of date medications stored in the medication trolley, a small stock pile of some medication was beginning to build up needlessly and creams were left in peoples rooms, for no specific reason. Camellia House Nursing Home Ltd DS0000066799.V376631.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social interaction and activities are not readily available and there is no daily variation and stimulation for people living in the home. EVIDENCE: There is no activities organiser employed and care staff provide activities as and when they are able. We saw an activities timetable, but this was blank. We also saw that each person has a separate activities folder, however, the level of information recorded in each folder was variable. One file contained regular recordings of activities that the person had participated in. Another file contained some recordings, but none since February of this year and another contained no recordings at all. Camellia House Nursing Home Ltd DS0000066799.V376631.R01.S.doc Version 5.2 Page 15 The recordings that were seen evidenced that people had access to a range of activities, although they did appear to be provided only sporadically. Types of activities on offer included Bingo, manicures and armchair gardening. One relative told us that they were always welcomed into the home and that they had been part of a relatives meeting with a small number of relatives, the acting manager and the management companys representative. The acting manager said that efforts were made to speak with relatives on a regular basis, sometimes daily, to reassure them and update them on events in the home. Menus that were seen in the kitchen showed that people were offered a variety of food that was balanced and nutritious. We were told by staff that they know peoples likes and dislikes and there is always an alternative available if people do not like the main choice. Camellia House Nursing Home Ltd DS0000066799.V376631.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a clear and simple complaints procedure and people feel assured that their concerns will be responded to promptly with satisfactory outcomes. Not all staff have received training in adult protection procedures, which potentially places people at risk. EVIDENCE: There is a clear and simple complaints procedure that is displayed in the front hallway. The details of the Commission need to be changed to show the new name and contact details, so that people can contact us at any time. A file of all complaints is kept with each complaint being recorded separately and the outcomes of the investigation clearly recorded. People said that they felt able to raise concerns with staff and that they felt listened to. One relative said that the recent relatives meeting had helped to raise concerns with the management of the home, which had improved communication and care. Camellia House Nursing Home Ltd DS0000066799.V376631.R01.S.doc Version 5.2 Page 17 Staff spoken with had a clear understanding of how to deal with concerns and complaints and what to do if any issues could be abuse issues. However, records show that not all staff have received training in POVA (Protection Of Vulnerable Adults) issues. Staff were not sure where to record complaints and concerns as they said they would pass them to the manager to be resolved and recorded. Staff said that they were sure that any concerns and complaints would be addressed by the acting manager promptly. Camellia House Nursing Home Ltd DS0000066799.V376631.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23 and 26 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of 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: On touring the premises the home appears clean and tidy and there were no unpleasant odours. Rooms had been personalised with individual personal effects such as photographs and ornaments. The standard of decor, furniture and equipment throughout the home was poor. Camellia House Nursing Home Ltd DS0000066799.V376631.R01.S.doc Version 5.2 Page 19 The acting manager said that the maintenance and repair of the home was limited, as the maintenance person was part time and had been working at another home. Furniture and fittings had not been replaced or repaired for a long time, so some furniture was worn, some carpets were thread bare and equipment such as commodes were worn and rusty. It was observed that there was water damage in the hall and stairs from water leaking though the roof, indicating that the roof is in poor repair. The acting manager said that she had made the area safe but was concerned at the age of electrical wiring in the home, which she could not be sure had been checked for some time. She also was concerned that other parts of the roof and guttering were in a poor state of repair. The acting manager was unable to provide evidence of maintenance of equipment such as boilers, cookers, heating appliances, hoists and electrical equipment. The manager was unable to provide written risk assessments for the premises, or written evidence of measuring water temperatures. The lack of maintenance and poor recording is in breach of Health and Safety regulations and puts the people who live there and the staff who work there at risk of scalding and injury. It also means that equipment could breakdown so that the home would be without heating, a cooker or the means to move people around the home safely (there was no evidence of hoist equipment and the lift being serviced). Equipment such as hoists, specialist beds, reclining chairs and bed tables had not been assessed on an individual basis. So that it was not clear if they were appropriate to be used for the people who were using them or if they required different types of equipment. Specialist assessments for individuals chairs had been undertaken some while ago, and the necessary equipment identified. None of the recommendations have been addressed. Camellia House Nursing Home Ltd DS0000066799.V376631.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are low, which means that peoples health and social care needs are not being met at all times. Not all staff are trained appropriately and able to meet the specialist physical, social 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: On the day of the visit there were 5 care staff on duty with the acting manager being the registered nurse on the rota. As previously stated (see Health and Personal Care), one person remained in bed until 11.55 am, without their personal care needs being met. Staff told us that sometimes they had no choice but to leave one someones personal care until later in the day, as they did not have the time to address everyones personal care needs at the time that suited them. Staff said that they tried to make sure it was not always the same person left until later. Staffing levels have been an ongoing issue for some time as people have consistently told us that they have to wait for some time for their needs to be met. Camellia House Nursing Home Ltd DS0000066799.V376631.R01.S.doc Version 5.2 Page 21 Staff said that they felt supported by the employment of the acting manager, who was approachable and knowledgeable. Staff also said that they had not received formal recorded supervision, but felt able to approach the nurse in charge or the acting manager with any day to day issues. Staff were unable to remember completing a formal induction period of training when starting employment in the home. They said that they had been shown around the home and introduced to the people living there, this had not been recorded and therefore there was no evidence to support this. Staff told us that they had received some refresher training in manual handling and first aid and that further training was planned for the future. Staff appeared to have varied levels of experience and knowledge in caring for older people. Some staff had worked at the home for years, while a new member of staff had never worked with older people in a care home setting. The acting manager told us that some staff had received training in caring for people with a Dementia from a member of staff that previously worked at the home. She also told us that no-one at the home had received training on the Mental Capacity Act or the Deprivation of Liberty Safeguards. This means that staff may be unaware of their responsibilities under these pieces of legislation. The lack of consistent training, induction and supervision of staff means that people can not be sure that all staff had the knowledge and skills to care for them safely and to meet their needs consistently. Staff could not recall receiving any fire training that included a fire drill or checks of fire equipment. Poor fire safety puts people at risk in the event of a fire. Three staff files were looked at. One file contained all the required information, including two written references, proof of identity and satisfactory CRB (Criminal Records Bureau) checks. However, two files contained only one written reference and one file showed that the person had started work before either a satisfactory CRB check or POVA First (this allows people to work at the home, under supervision, without a full CRB check) verification had been obtained. These practices put people at risk from staff who are unsuitable to work with vulnerable adults. Camellia House Nursing Home Ltd DS0000066799.V376631.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of 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: We were unable to determine the fitness of the manager to run the home affectively, as we have not received an application to register this person with the Commission. This means that police and reference checks had not be Camellia House Nursing Home Ltd DS0000066799.V376631.R01.S.doc Version 5.2 Page 23 obtained and the suitability of the person to work with vulnerable people had not been explored. The acting manager told us that she had a range of experience and skills in working in care homes and care settings. She also said that she was a registered nurse. Staff, relatives and the people living at the home praised the acting manager for the changes that had been made since her employment in the home and felt confident that she had the skills to run the home affectively. The acting manager told us that informal staff meetings are held about every two months and that a relatives meeting is planned for the middle of July 2009. 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. There have been no visits to the home by the Responsible Individual (the representative of the Registered Providers) since our last visit. The Responsible Individual must visit the home at least monthly to determine the quality of care being provided, a report must be written following this visit. The acting manager said that she continued to work as a staff team member as part of the roster. This means that she is unable to complete management tasks such as induction and supervision for staff, risk assessments, updating care planning and assessments and maintenance of equipment. There continues to be problems with the home dealing with the personal monies of 2 people living there. A care manager from Devon Social Services is investigating this matter. There was no evidence that Health and safety in the home had been assessed or regulated. This means that health and safety concerns about unguarded radiators, unchecked electrical equipment, equipment in a poor state of repair and poor maintenance of equipment places people at risk. The manager told us that there was no-one living at the home that is subject to a deprivation of liberty authorisation. We saw no evidence to show that anyone living at the home is having their liberty deprived without an authorisation. Camellia House Nursing Home Ltd DS0000066799.V376631.R01.S.doc Version 5.2 Page 24 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 X X X 1 X X 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.V376631.R01.S.doc Version 5.2 Page 25 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 timescales of 31/12/08, 13/02/09, 04/05/09 and 17/06/09 not met) Medication must be stored securely to ensure no-one has unauthorised access to medication. The premises must be kept in a good state of repair internally and externally. (previous timescales of 24/07/08, 31/12/08, 13/02/09, 04/05/09 and 17/06/09 not met) Staffing levels must be sufficient to meet the needs of individuals at all times. (previous timescales of 24/07/08, 31/12/08, 13/02/09, 04/05/09 not met) The home must ensure that all records relating to the correct recruitment of staff are of DS0000066799.V376631.R01.S.doc Timescale for action 29/08/09 2. OP9 13(2) 29/08/09 3. OP19 23(b) 29/08/09 4. OP27 18(1)(a) 29/08/09 5. OP29 19 29/08/09 Camellia House Nursing Home Ltd Version 5.2 Page 26 obtained before they begin work at the home. (previous timescale of 04/05/09 not met) 6. OP33 26 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 timescales of 13/02/09, 04/05/09 and 17/05/09 not met) Arrangements must be made to ensure individual’s money is paid into an account in their own name. (previous timescales of 30/09/08, 13/02/09 and 04/05/09 not met) Arrangements must be made to ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. 29/08/09 7. OP35 20(1)(a) 29/08/09 8. OP38 13(4)(c) 29/08/09 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 OP33 Good Practice Recommendations 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. Camellia House Nursing Home Ltd DS0000066799.V376631.R01.S.doc Version 5.2 Page 27 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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