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Inspection on 20/08/08 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 20th August 2008.

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 and a `blue folder` where information is recorded. All bedrooms are lockable and staff respect the privacy and dignity of the individual. 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. Communal areas are well maintained and laundry is well managed.

What has improved since the last inspection?

An activities organiser has been appointed and there are now some activities on offer. Menus have been altered in line with requests from individuals at the home. There has been some improvement to medication administration and MAR (Medication Administration Records) had been signed as required. There has been some improvements to staffing levels, and a kitchen assistant now prepares tea, which gives care staff more time to spend caring for people living at the home.

What the care home could do better:

During the course of the visits 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. People`s choice should be respected, especially relating to bedtimes. Risk assessments do not always identify any control measures that are in place to minimise risks and handwritten entries on MAR (Medication Administration Record) sheets are not double signed as is good practice. The facilities and services are not as described in the brochure and in particular there is a lack of social stimulation. People thinking of moving into the home should receive written confirmation that the home can meet their needs. The recording of complaints should be in line with the Data Protection Act. People should feel able to raise any concerns they may have and be confident that they will be listened to. 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. 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.

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 20 August 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Camellia House Nursing Home Ltd DS0000066799.V366794.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.V366794.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 Miss Susan Edey 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.V366794.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 29th February 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 acting. Current fees range from £433 to £520 per week, depending on the room and the level of care needed. Fees did 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.V366794.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 towards the end of August 2008. The home had been notified that a review of the home was due and had been asked to complete and return an AQAA (Annual Quality Assurance Assessment). 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. 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. As part of the inspection process CSCI likes to ask as many people as possible for their opinion on how the home is run. We sent questionnaires out to some people living at the home, and some staff. At the time of writing the report, responses had been received from 3 people living at the home. Their comments and views have been included in this report and helped us to make a judgement about the service provided. During the inspection 3 people living at the home were spoken with individually and 3 in a group setting, as well as observing staff and people living at the home throughout the day. We also spoke with 2 representatives, 4 staff and the 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 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. A number of concerns have been raised with the Commission since the last Key Inspection Visit and a number of safeguarding adults referrals have been made. These have included unexplained bruising and poor health care. Because of these serious concerns Devon County Council have place a ‘Serious Default Notice’ on the home and no admissions have been made. Camellia House Nursing Home Ltd DS0000066799.V366794.R01.S.doc Version 5.2 Page 6 Two Random unannounced visits have been made to the home since the last Key visit, one concerned a complaint that had been received relating to low staffing levels, which was found to be upheld. The second was made to seize records relating to a person living at the home following a complaint about their care. Both reports on these visits are available from the Commission on request. What the service does well: What has improved since the last inspection? What they could do better: Camellia House Nursing Home Ltd DS0000066799.V366794.R01.S.doc Version 5.2 Page 7 During the course of the visits 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. People’s choice should be respected, especially relating to bedtimes. Risk assessments do not always identify any control measures that are in place to minimise risks and handwritten entries on MAR (Medication Administration Record) sheets are not double signed as is good practice. The facilities and services are not as described in the brochure and in particular there is a lack of social stimulation. People thinking of moving into the home should receive written confirmation that the home can meet their needs. The recording of complaints should be in line with the Data Protection Act. People should feel able to raise any concerns they may have and be confident that they will be listened to. 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. 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. 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.V366794.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.V366794.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): 1, 3 and 6 Quality in this outcome area is adequate. 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. However, they cannot be assured that the facilities and services detailed in the brochure will be available. EVIDENCE: There is a Statement of Purpose, Service User Guide and Brochure available to people thinking of moving into the home. However, two people commented via survey forms that they felt the brochure was inaccurate. One said “Some of the information set out in the brochure is misleading, ie ‘regular activities and Camellia House Nursing Home Ltd DS0000066799.V366794.R01.S.doc Version 5.2 Page 10 outings’. None of this is available”. Another said ‘The home is not really like the brochure’. No one has been admitted to the home for some time. However, 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 person moving into the home. However, the home did not write to them to confirm that their assessed needs could be met before they moved in. The home does not provide intermediate care. Camellia House Nursing Home Ltd DS0000066799.V366794.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 adequate. 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 people’s health and social care needs on a day to day basis. The management of medication has 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. Care plans have improved since the last visit and there was some evidence that people and their representatives had been involved in updating them. ‘Blue folders’ are now being kept in people’s bedrooms. These folders contain details on moving and handling and are used to record information on what care has been delivered as well as recording nutritional information. Camellia House Nursing Home Ltd DS0000066799.V366794.R01.S.doc Version 5.2 Page 12 However, the information in these folders is limited and the forms held within them are not always being completed. For example, one folder stated that the person should be weighed on certain days, but there were no records to show this had been done. The acting manager said the weights were being recorded in the diary. Care staff record some information in these blue folders about what care has been given, this information is then transferred by a registered nurse onto the main care plan. Recordings were generally non-judgemental and showed that people are thought of as individuals. However, the information recorded in the blue files does not evidence that needs identified on the care plan have been met, as there is no reference in this file as to what the care needs are. This also means that when information is transferred to the care plan there is still no reference as to identified needs being met. There is no record in the care plan of the person’s individual methods of communication, which means that one staff member may understand what someone is trying to communicate while another may not. It is particularly important with people who have a dementia type illness that individual methods of communication are recorded as they may not be able to communicate verbally. However, a notebook was seen by a person’s bed that was used to write in to communicate with this person. The main 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. The ‘blue folders’ do not give basic instructions to staff on how people’s needs are to be met. However care staff told us that they did find the care plans useful when they looked at them. They told us that they generally found out about any changes in care through a verbal handover from the nurse on duty. Care plans also 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, several of these tools highlighted a high risk, but 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. Camellia House Nursing Home Ltd DS0000066799.V366794.R01.S.doc Version 5.2 Page 13 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. All people we saw during this visit looked well cared for. They were all wearing their own clothes, which were clean and well ironed. Representatives commented during the visit and on survey forms that they felt the shortage of staff often impacted on the care people received. We were told that while staff did not rush people when they were giving care, there could be a long wait for staff to arrive. We were also told by one relative that they were happier now their relative was nursed in bed, as they were monitored more frequently than when they were up and sitting in the lounge. Others commented via survey cards that ‘There have been times when residents could not come out of their rooms because there have not been enough staff. The reverse has happened when residents have felt unwell and could not be returned to bed’. 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, there were several hand written entries on the MAR (Medication Administration Record) sheets from when extra medication had been prescribed. The entries had not been signed by two members of staff, which is recommended good practice. The MAR sheets showed that several people had been prescribed creams and ointments, but there is no record kept of the application of creams. This means that people are at risk of not receiving their prescribed treatment. However, containers are now marked with the date of opening, which reduces the risk of people having creams applied that are past their expiry date and therefore ineffective. 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. All of the people seen during this visit were treated with respect by the staff and their right to privacy was upheld. Personal care was offered 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 saw staff speaking to people in a kindly, friendly way. A number of serious concerns have been raised since the last Key visit, which have included unexplained bruising and poor health care and there have been Camellia House Nursing Home Ltd DS0000066799.V366794.R01.S.doc Version 5.2 Page 14 a number of Safeguarding Adults meetings. One of the complaints resulted in a Random visit being made to the home to seize records. A number of measures have been introduced to assure these matters do not arise again, one of which was better recording methods, including new care plans. However, as stated above these methods are confusing and there is still the potential that people are at risk of not having their needs met. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to introduce lifestyle diaries to ensure an individual, holistic approach to care is promoted. Camellia House Nursing Home Ltd DS0000066799.V366794.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 poor. This judgement has been made using available 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: 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. 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, we saw a staff notice in the office stating that people were to be asked if they wanted to go to bed as early as 3pm. Staff assured us that people only went to bed at this time if they wanted to. Camellia House Nursing Home Ltd DS0000066799.V366794.R01.S.doc Version 5.2 Page 16 We received comments on survey forms that there were very little activities available to people. These included ‘an entertainer comes occasionally, but more stimulation would be welcomed’, ‘A lady did some things (activities) but when I say now, they say ‘too busy’, not enough staff’ (also see Standard 1). One person living at the home told us that they ‘don’t do anything all day, nothing to do, no one to talk to’. There is very little information relating to peoples’ interests and preferences recorded in their care plans, which means that staff did not have information with which to engage people in conversation or activities relevant to their likes and dislikes even if they have the time. However, a member of staff has recently been allocated to arrange and undertake activities at the home. This staff member was on duty during the visit and they told us that people enjoyed Bingo and making cards. During this visit we saw several people taking part in a card making session in which people seemed to be happy to be taking part. One lady had had her fingernails manicured and painted by a member of staff. However, staff said that it was only when there were sufficient staff on duty that activities could be offered. They said that although things had improved recently, there were times when they were very rushed and did not have time to spend with people other than when performing tasks with, or for them. We were told by the acting manager that one of the local churches visits the home regularly and that entertainers often visit as well. The representatives of two people living in the home were spoken with, both said that they were always made to feel welcome and were kept informed about all aspects of their relative’s care. 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 people’s likes and dislikes and there is always an alternative available if people do not like the main choice. However, one person commented on their survey form that ‘It would be nice, in future, if there was a menu, or the days meals were given out in the morning in case there is something I don’t like’ and another person commented ‘I would like more choice (food) but the owner says we have to cut down’. The acting manager told us that some concerns about the food had been highlighted through questionnaires that had been sent out, and that these concerns had been addressed through the new menus. One person told us that the food was now much better than it had been when they had first moved in. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to Camellia House Nursing Home Ltd DS0000066799.V366794.R01.S.doc Version 5.2 Page 17 ‘promote a happy, safe environment and improve the day to day quality of life for service users’. Camellia House Nursing Home Ltd DS0000066799.V366794.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 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. Not all staff have received training in adult protection procedures, which potentially places people at risk. EVIDENCE: There is a formal complaints procedure for the home that is displayed in the hallway. A hardback book is maintained that records any complaints that have been made, how the home has dealt with the complaint and what the outcomes were. However, The records were confusing and the information was not easy to read. Several complaints were recorded on the same page. This means that people would not be able to see information about themselves without seeing information about others and thus contravenes the Data Protection Act. People living at the home who were spoken with during this visit were unable to tell us whether they knew about the home’s complaint procedure or whether they would feel comfortable making a complaint. However, one person commented via a survey form that ‘I have spoken out, the big lady says not to Camellia House Nursing Home Ltd DS0000066799.V366794.R01.S.doc Version 5.2 Page 19 make a fuss’. One representative that we spoke with said that they had not been very happy about the way one complaint they made had been handled, but another said that they had been happy with the response they had received. Two of the four staff that were spoken with had not received formal training in POVA (Protection of Vulnerable Adults) although they were able to discuss different forms of abuse and said that they would report any suspicions they had. They were not all clear however, about who they would report any concerns to, outside of the home. Several concerns have been raised with the Commission since the last Key visit, these have resulted in a number of Safeguarding Adult meetings taking place, these have not yet been finalised. Two Random visits were made to the home since the last Key visit. One related to a complaint about staffing levels (see Staffing section) and another was to seize records following a complaint about poor care (see Health and Personal Care section). The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to ‘address all issues raised with a mutually agreed and satisfactory outcome’. Camellia House Nursing Home Ltd DS0000066799.V366794.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home generally provides 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 though some areas were in a poor state of repair, particularly bedrooms. The Acting Manager said that the new maintenance worker was starting to redecorate the paintwork and they were also seen working in the garden. At a previous inspection we were Camellia House Nursing Home Ltd DS0000066799.V366794.R01.S.doc Version 5.2 Page 21 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. There are two staircases and each had a ‘baby-gate’ fitted to the top and bottom. These gates can be used as a means of restraint, and the acting manager said that she would get the maintenance man to remove them straight away. 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 was 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. One representative told us that their relative was much happier now they were in the room on their own, but they were worried about who the next occupant was going to be. Another person commented via a survey form that ‘I don’t think people should be made to share especially if they are noisy’. There are several bathrooms around the home but some are not in use. One bathroom has a hoist fitted by the side of the bath. Another has an ‘assisted’ Parker bath, and staff said that this is the bathroom that is most used. The bathroom 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 were told by the acting manager that there are plans to turn one of the ground floor bathrooms into a large shower room. The home has a mobile hoist and staff were seen using this. Staff were also seen using a wheelchair without footplates. This was raised as a concern at a previous visit and two new wheelchairs had been purchased. However, we were told that there was still a shortage of wheelchairs. Disposable gloves and aprons were seen in various places around the home and staff were seen wearing them as needed. However, some staff that were spoken with had received training in infection control measures while others had not. This means that people may be at risk from cross infection. The laundry area was very clean and tidy and has an impervious floor covering that helps prevent cross contamination from soiled articles. Washing machines Camellia House Nursing Home Ltd DS0000066799.V366794.R01.S.doc Version 5.2 Page 22 have the ability to meet disinfection standards and sluice machines are provided for disposal of bodily waste and clearing commode pots. The laundry assistant explained good working procedures that ensure the laundry for people living at the home is satisfactorily managed. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to ‘commence a refurbishment programme’. Camellia House Nursing Home Ltd DS0000066799.V366794.R01.S.doc Version 5.2 Page 23 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 people’s 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 robust and therefore ensure protection for people living at the home. EVIDENCE: On the morning of the visit there were four care staff on duty, plus the acting manager as the registered nurse. There were also two people in the kitchen, the maintenance person, the laundry assistant and a cleaner. During the afternoon there were again four care staff and the acting manager, plus the maintenance person. A kitchen assistant returned in the early evening to prepare tea. The four care staff that were spoken with said that staffing levels were a little better especially in the evening now that there was someone in the kitchen to prepare tea. However, they all said that they felt this was because there were only 17 people living at the home at the moment. They also said that there Camellia House Nursing Home Ltd DS0000066799.V366794.R01.S.doc Version 5.2 Page 24 were still mornings when they were very rushed and one person said there were occasions when they did not have time to take a break. Staff were aware of the needs of the people they were caring for and were keen to provide a good service. However, they felt this was sometimes compromised by a shortage of staff (see also Health and Personal Care section). One person commented via their survey form ‘There is sometimes a long wait. So few staff. My pad is often wet. Sometimes the staff are too busy to listen too what I really want to say’. The files of three staff were looked at, all contained satisfactory CRB (criminal Records Bureau) checks, full employment history and proof of identity. One contained only one written reference and notes from one verbal reference. The acting manager told us that she had been put under pressure by the owners to have staff at the home who had not had satisfactory CRB checks, but that she had refused to allow them to work at the home. Staff said that there had been little training available to them, two had not received training in POVA (Protection Of Vulnerable Adults) or Infection Control and none had received training in caring for people with dementia. This is especially concerning as there is a high number of people living at the home who have a dementia type illness. The acting manager said that she was trying to source as much training as possible. The home has purchased the Red Cryier training system, which is an in-house training programme. This relies on staff being trained by other staff, but there is no-one trained at the home to deliver such training. Staff had received training in fire precautions. Four staff currently have NVQ (National Vocational Qualification) level 2 or above and a further 3 are working towards this. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to ‘continue with NVQ programme and encourage trained staff to impart and share knowledge’. Camellia House Nursing Home Ltd DS0000066799.V366794.R01.S.doc Version 5.2 Page 25 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: Mrs Elizabeth Nugent is Responsible Individual for the company, Camellia House Nursing Home Ltd. She and her partner are both Qualified Nurses. They do not live close to the home, but are in regular contact by phone, and visit at least once a month, staying for two or three days. The owners have entered Camellia House Nursing Home Ltd DS0000066799.V366794.R01.S.doc Version 5.2 Page 26 into an agreement with another company to manage the home on their behalf and this was effective from 15 September 2008. The matters of concern identified in this report occurred before this agreement was entered into. 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 the concerns, similar concerns have been raised subsequently. There is no registered manager at the home at present, though an application to register by the acting manager is currently being processed. 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 feels unsupported by the owners and that there have been problems with suppliers whose bills have not been paid. She said that she has had to deal with suppliers refusing to remove waste, supply agency staff or to deliver cleaning products. The acting manager told us that she had paid several bills herself, but was unwilling to do this any more. The company now managing the home has made arrangements with suppliers so that the home will have the items it needs and agency staff if required. 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. Although some questionnaires have been sent out to people living at the home. Responses to these highlighted concerns about food and these have been addressed through the introduction of new menus. On the day of the visit the hairdresser refused to see two people, as she had not been paid for the last time she did their hair. This was particularly concerning as we were told both of these individuals had money of their own, but this was held in the owner’s account and the manager could not access it. The acting manager has introduced supervision sessions in the home and staff reported that they received regular supervision. 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, storage of hazardous substances, health and safety checks and risk assessments. The record of fire safety training and accident and incident records were found to be accurate and up to date. However, the fire logbook showed that safety lighting and fire extinguishers are not being tested at the recommended intervals. Camellia House Nursing Home Ltd DS0000066799.V366794.R01.S.doc Version 5.2 Page 27 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 along with risk assessments are reviewed regularly and updated where necessary, to ensure they remain appropriate and reduce risks to people living and working at the home. 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. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to ‘promote holistic approach in the delivery of individual care. To review and update all policies and procedures and to move the home forward’. Camellia House Nursing Home Ltd DS0000066799.V366794.R01.S.doc Version 5.2 Page 28 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 1 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X X 2 X 2 X 2 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 1 X X 3 Camellia House Nursing Home Ltd DS0000066799.V366794.R01.S.doc Version 5.2 Page 29 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 OP3 Regulation 14(1)(d) Requirement No one should be admitted to the home unless the registered provider has confirmed in writing to the individual that their needs can be met. Care plans must provide sufficient information to staff to ensure people’s needs can be met. Proper provision must be made to ensure that the choices and health and welfare of individuals is promoted at all times. (previous timescale of 24/07/08 not met) All unnecessary risks to the health and safety of individuals must be identified and as far as possible eliminated. The premises must be kept in a good state of repair internally and externally. Staffing levels must be sufficient to meet the needs of individuals at all times. (previous timescale DS0000066799.V366794.R01.S.doc Timescale for action 31/12/08 2. OP7 15(1) 31/12/08 3. OP8 12(1)a, 12(2), 12(4)a 31/12/08 4. OP8 13 (4)(c) 31/12/08 5. OP19 23(b) 31/12/08 6. OP27 18(1)(a) 31/12/08 Camellia House Nursing Home Ltd Version 5.2 Page 30 of 24/07/08 not met) 7. OP30 18(1)(c) Staff must receive sufficient training to enable them to safely meet the needs of individuals. (previous timescale of 24/07/08 not met) Arrangements must be made to ensure individual’s money is paid into an account in their own name. 31/12/08 8. OP35 20(1)(a) 30/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP16 OP33 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. Camellia House Nursing Home Ltd DS0000066799.V366794.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. Extracts may not be used or reproduced without the express permission of CSCI Camellia House Nursing Home Ltd DS0000066799.V366794.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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