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Inspection on 29/02/08 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 29th February 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

Some of the care staff had worked at the home for a long time and provided good care and knew their residents well. The lounge is large and airy, with fine windows giving lovely views of the garden. The dining room is an elegant and attractive room. Good meals are provided, using fresh and local food. People said they enjoyed their meals.

What has improved since the last inspection?

Special beds and mattresses had been provided, for residents` comfort and good skin care. No fire doors were seen to be pegged open. Where needed, hold-open devices had been fitted, so that the doors would shut automatically when an alarm sounded. Moveable ramps had been provided to improve access to bedrooms on mezzanine floors. Staff training resources had been provided. A maintenance worker had been appointed, and had started work on redecorating.

What the care home could do better:

The home`s manager needs to be qualified and competent in management skills, in order to provide strong leadership within the home and implement good care practice. Fuller information should be gathered when considering the care needs of a prospective resident, in order to be sure that the home has the resources to meet their needs, and they should be better recorded in order to ensure that staff know what is needed. Recording of personal and health care needs and care given needed to improve to be of a satisfactory standard. Provision and maintenance of equipment, training and practice in moving and handling residents and promoting their mobility all needed to improve. Care planning had not been done on a personal basis, recording the person`s preferences for how their health care and social needs should be met. Recoding of medication must be clearer, so that staff are aware of and fully understand any variation. There had not been a full record kept of complaints made to the home, and action taken in response. Staff should be available in or near the lounge when residents are there, to give attention when needed, as residents have not always been able to summon help. Staff should develop their skills in providing social engagement and activities for residents, to be able to offer a choice in what they do. Training should be provided to enable staff to meet the particular needs of residents. Supervision sessions should be provided for staff, to give them feedback on their performance and an opportunity to discuss any problems, and their training needs, in order to develop good practice in the home. The Home owners need to promote good relationships with their staff, to support good morale in the home.

CARE HOMES FOR OLDER PEOPLE Camellia House Nursing Home Ltd 5 Oak Park Villas Elm Grove Road Dawlish Devon EX7 0DE Lead Inspector Stella Lindsay Unannounced Inspection 29th February 2008 10:00 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.V360079.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.V360079.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 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 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.V360079.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 1st November 2007 Brief Description of the Service: Camellia House is a Care home that is registered to provide personal and Nursing Care to a maximum of 30 Residents. 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. There is a shaft lift, and ramps have been fitted in order to reach mezzanine floors. There is a large lounge and an elegant dining room. The home has been adapted to meet the needs of residents. Grab rails and specialist equipment have been installed, including accessible shower and bathing facilities. There is a registered nurse on duty 24 hours a day. The Acting Manager is a registered nurse and is supported by a team of registered nurses and care staff. The Inspection report can be found in the Managers office in the home. The scale of charges at the time of inspection varied depending on care need and room. The Manager said that fees range from £420 to £510. The fees did not include: Hairdresser- £3.00-£25.00, Chiropody- £10-£12, Physiotherapist- variable, Papers- 20p-£1.20 and Taxis - which depended upon vehicle and distance of trip. Camellia House Nursing Home Ltd DS0000066799.V360079.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 Stars. This means the people who use this service experience poor quality outcomes. This inspection took place over two days, with a second inspector on the second day. We met with the Acting Manager, the Registered Nurses on duty, ten residents, four visitors to the home, and nine other staff on duty. We looked at care records, health and safety records, staff files and the medication system. We spent time with residents in the lounge and at lunch, and visited some residents in their rooms. We later visited to meet with the Home Owners and the Acting Manager. What the service does well: What has improved since the last inspection? Special beds and mattresses had been provided, for residents’ comfort and good skin care. No fire doors were seen to be pegged open. Where needed, hold-open devices had been fitted, so that the doors would shut automatically when an alarm sounded. Moveable ramps had been provided to improve access to bedrooms on mezzanine floors. Staff training resources had been provided. A maintenance worker had been appointed, and had started work on redecorating. Camellia House Nursing Home Ltd DS0000066799.V360079.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Camellia House Nursing Home Ltd DS0000066799.V360079.R01.S.doc Version 5.2 Page 7 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.V360079.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.V360079.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had good policies and procedures with regards to preadmission assessment, but it was not consistently well applied. EVIDENCE: The Acting Manager said that she visits prospective residents to make an assessment of their needs. We looked at information gathered before a person was admitted. Information had been provided by the hospital. There was not sufficient information to give guidance to staff on how best to care for the resident. Fuller information should be gathered in order to know what care is needed before a judgement can be made on whether the home has the resources to provide for any new resident. Intermediate care is not offered at Camellia House. Camellia House Nursing Home Ltd DS0000066799.V360079.R01.S.doc Version 5.2 Page 10 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 were not written to clearly show the care that was needed, nor written with the resident or their representative. Records were not good enough to know whether proper care had been given. There were some practices in the home that did not uphold peoples’ dignity. EVIDENCE: The Registered Nurses who work at the home are responsible for writing the care plans, and they are not written to a good standard. They were very basic and did not provide the level of information needed, or guidance to care staff as to how care should be provided. In writing a care plan the Registered Nurse is delegating their responsibility of caring to another person. It remains their responsibility to see that the person who is to deliver the care is sufficiently skilled to do so, and that they have delivered the care as it has been planned. The care plans also did not cover all the areas of care that needed to be addressed for holistic care to be provided. They encompassed only the Camellia House Nursing Home Ltd DS0000066799.V360079.R01.S.doc Version 5.2 Page 11 obvious, and the ones seen did not cover issues of mobility or social care, where it was evident that there were issues to address. The Acting Manager agreed with these findings. The daily record that should provide information about events that had happened to a service user were also basic with the term, “Evaluation unchanged” appearing with great regularity, but it was not clear what the ‘evaluation’ was. Above each bed was a list of care tasks, with highlighter pen used to show what the occupant of the bed needed. We did not see any record of how the person prefers their care to be given, for instance what time they like to get up in the morning. Staff did know some residents’ preferences for a male or female carer. The home owners showed us the new recording system that was being introduced, to be kept in each resident’s room. Staff were to record all care given at the time of giving it, but this was not yet fully implemented. The Acting Manager said she would hold a workshop for her trained staff to ensure the effective implementation of good record keeping. We looked at the risk assessments that are used to inform care planning. These were also unsatisfactory, being without detail that is necessary to evidence the action that is then to follow. An example is where bed rails were in use, there was no clear assessment why this had been decided. There was a signed agreement with the person’s advocate that the rails should be used with a sentence saying that the person was at risk of falling out of bed, but no explanation of why this was the case, or consideration of the risks that arise from the use of bed rails– simply a referral to the protocol. The home owner said that new documentation was being introduced to evidence assessment for the need for bedrails. Some residents were being nursed in bed, with no explanation on their care plan of the reason, and whether it was a short or long term necessity. There was not clear understanding that this may constitute a restraint of the person, and may lead to stiffness and muscle wastage through inactivity. Some bed rails in use were unsafe through not being padded, or that the pads were torn, thus presenting a hygiene risk. The home owners said that an audit of bed rails and protectors had been arranged, and this problem would be dealt with promptly. Fluid balance, diet, and turning charts were seen in people’s bedrooms. We did not know (at 11.30am) whether the resident had not been given a drink since 6.30am or if it had been given but not recorded. We did not see guidance for staff on peoples’ nutritional needs. The home owner told us that that residents causing concern had been referred to the hospital based dietician, and there were currently four awaiting a review by the Community Dietician. Staff said that the only bath in use by residents was the Parker bath. There was a book beside it to record baths given. Only seventeen baths had been recorded during February. The home owner said that some residents are Camellia House Nursing Home Ltd DS0000066799.V360079.R01.S.doc Version 5.2 Page 12 distressed by bathing, and are more comfortable with a bed bath. Choices and reasons should be recorded, and reviewed as part of the regular care plan review. One resident said that the staff had not had time to clean their teeth for them that morning, though they had cleaned their eyes. They also said that if they wake in the night and ring the bell, someone comes. A visiting relative said that they are happier now that their mother is nursed in bed, as they had felt she was unsafe when she was in the lounge, due to lack of staff attention, and during her visits she had seen residents needing help and having to wait. A staff member said that they had been told that each resident who needed a slidey sheet (piece of equipment to help staff move them safely in their bed) would have one to keep in their room. This had not happened at the time of this visit. The home owners said that they had been provided by 18th April. The records that we saw showed that there were instances where accidents had occurred, and were recorded elsewhere in the records, but were not referenced by the Registered Nurses in the daily record. This would be to make sure that staff coming on duty would know about it. We looked at the arrangements for supply, storage and administration of the medication, which are under the control of a Registered Nurse at all times. The medication is stored in a room that has locked cupboards and a locked trolley that is tethered to the wall. All prescription medication was put away, none left on view. The addition of a lock to the door of the room would improve the security of the arrangements. Administration charts were completed correctly and there are specimen signatures that help to provide an audit trail to the person administering medication at any given time. The specimen signature chart needs to be updated so that only Registered Nurses currently working at the home appear on the chart. We could not identify the name or signature for one trained nurse on the sheet although she has been employed at the home for a significant period of time. There were a few problems with recording the administration of medication that seemed to be due to the present design of the charts that are used by the home. The Manager said that she had already approached the supplying pharmacist about this problem. There was also confusion in one part of the controlled drugs register that had occurred as a result of a change in the dose of a medication and later the strength of tablet supplied. The Registered Nurses should follow their professional guidance relating to medication practices in the future to prevent the confusion recurring. Camellia House Nursing Home Ltd DS0000066799.V360079.R01.S.doc Version 5.2 Page 13 We found that a private bedroom was used for hairdressing, while an occupant was ill in bed. Their privacy and dignity had not been upheld. The home owners said that another venue has now been arranged for hair dressing. We saw moving and handling practices that did not uphold the dignity of the resident. A carer put one person into a sling, and then left the room to find a colleague. Another was lifted into a hoist then wheeled five metres to their wheelchair. We saw one carer move a resident into a hoist without putting on the brakes, which is not safe practice. Moving and handling training sessions have been provided since this visit. Only one of the wheelchairs that we saw had footplates, and those were folded back on their hinges. These are usually needed to prevent residents’ feet dragging under the wheelchair. The home owners said that the risk of using chairs without footplates had been assessed. The home owners said that the wheelchairs had been professionally assessed in January, and there was currently a shortfall because some had been found unfit and removed at this time. Applications for supply through the National Health Service had been tried unsuccessfully due to a long waiting list, and the home owners had decided to purchase the equipment. Camellia House Nursing Home Ltd DS0000066799.V360079.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. 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. Staff had not been able to organise their work in such a way as to meet individual choices or needs. There is little social stimulation. Good food is served. EVIDENCE: One resident who was sitting in the lounge at 10am said they were really pleased to be up at this time – ‘I’ve never been first before’, they said, ‘it’s usually around 11.30am’. Another said that after tea, residents are left in the lounge for a long time without attention. Staff were with the group of residents in the lounge during the afternoon, giving tea, cake and biscuits from a trolley. Residents would benefit if staff developed their skills in engaging residents in conversation and social activities. The home owners said that they employ a staff member as Activities Organiser from 2 – 4pm three days per week. Due to the need to cover for staff absences this person had been unable to fulfil this role recently. They were working in the kitchen during this visit. Camellia House Nursing Home Ltd DS0000066799.V360079.R01.S.doc Version 5.2 Page 15 Residents told us that they enjoy the musical entertainers who lead old time singing twice a month. They said they enjoy regular visits by Church members who give out sheets for hymn singing. Some were very fond of the cat. Staff said they would not be able to take residents out to the garden if the weather improved, as the wheelchairs are not fit, and they do not have time. Action to deal with the shortage of wheelchairs has been described in the previous section. Relatives were seen to visit during this inspection. The Manager made a request for professional help on behalf of one, which was supportive. We did not see evidence that a suitable nutritional assessment had been completed for the people whose notes were looked at. However the plan of care in people’s bedrooms did give advice as to how food should be prepared, such as pureed. Ten residents had their lunch in the attractive dining room. Seven had their meal delivered to their bedroom, and six stayed in the lounge. There was room for two more people in the dining room, but no more wheelchairs to take them. The people in the dining room did not have chairs they could suitably move into. There is a new Chef, but he was off duty during this inspection. We were told that he had met with residents to discuss their likes and dislikes. The kitchen staff told us that they have fresh meat and vegetables from local suppliers. They provided suitable diets for four residents with diabetes, and soft food for those who needed it. Camellia House Nursing Home Ltd DS0000066799.V360079.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Policies and procedures for safeguarding people had been obtained, but not yet specific to the home or shared with staff. Management had taken appropriate action when aware of issues. There was not consistently good understanding or practice in the areas of restraint and assessments for use of equipment were of limited practical use. EVIDENCE: The Acting Manager showed us the new set of policies recently purchased from the Registered Nursing Homes Association, including complaints and Protection of Vulnerable Adults. They had not yet been checked or been made specific to Camellia House. A policy on Whistle Blowing was seen in a file with reports of incidents which are sent to the Commission for Social Care Inspection (Reg 37 reports), so clearly the Manager was aware of it. There was a book to record complaints. There was one record made, on 30/12/07, by a member of staff making a complaint to the home owner about staff wages not being paid on time. The Manager said that a relative had made a verbal complaint about food which had been dealt with immediately. She said she had made a record on the computer, but was unable to access this at the time of this inspection. Camellia House Nursing Home Ltd DS0000066799.V360079.R01.S.doc Version 5.2 Page 17 An allegation of verbal abuse had been made against a member of staff. These were upheld, and they were given written warnings and finally dismissed. An alert was made to the Commission for Social Care Inspection in February 2008 from an anonymous source. The alerter(s) said that they had raised issues with the Acting Manager and the home owners but nothing had been done to improve the situation, but the management said the issues in question had not been previously raised. The Safeguarding Team was involved and a full investigation was being implemented. The Acting Manager and home owners were co-operating in the process. Some staff had received training about protection of vulnerable adults and another training session had been arranged in the near future. There was inconsistent understanding around restraint issues, including use of equipment such as bedrails. Camellia House Nursing Home Ltd DS0000066799.V360079.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Camellia House provides a pleasant environment. Attention to equipment and furniture is necessary to promote residents’ mobility around their home. Residents do not all have the choice of a single room. EVIDENCE: The house was in a generally clean and in a good state of repair. The Acting Manager said that the new maintenance worker was starting to redecorate the paintwork. At the previous inspection the then Manager had said that the hall carpet was due to be replaced soon, but this had not yet happened. The lounge is two rooms joined together. The Acting Manager said that she had brought the television to the inner room, to give an open view across the garden from the long windows at the end of the lounge. The dining room is a pleasant and well-lit room. The use and provision of chairs should be Camellia House Nursing Home Ltd DS0000066799.V360079.R01.S.doc Version 5.2 Page 19 reviewed. During this inspection ten residents came to the dining room for lunch. Six stayed in the lounge because there were no more wheelchairs to bring them in, though there was room for two or three more people. The garden was looking attractive and well cared for. Three bathrooms were seen. One has a Parker bath, and staff said that this is the bath used by residents. The bathroom was clean and all surfaces were sound. There was a bare light bulb, and no decoration or design features to make bathing a more pleasant experience. At the previous inspection the then Manager advised that there were plans for a ground floor bathroom to be up dated, to give people more options for showering, as the room would allow hoist access into the shower room. The purchase of specialist beds for people who require nursing has continued. Ten of the 23 residents were in double rooms at the time of this inspection. We could not be confident that this was by positive choice, as the home owner said that one person wanted a bright light, while their room-mate wanted it turned off, and we did not see any records of discussion with regards to sharing. We found that water in hot taps of baths was at the regulated temperature, and that radiators had been covered to protect residents from potential harm, except for one radiator in the dining room. The laundry area is situated away from the food preparation areas. Washing machines have the ability to meet disinfection standards. Sluice machines are provided for disposal of bodily waste and clearing commode pots. The laundry was seen to be in good order during this inspection. The laundry assistant was on duty. Camellia House Nursing Home Ltd DS0000066799.V360079.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. 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. The level and organisation of staff restricted the ability of the service to deliver care in a person centred way. The recruitment procedure had not been adhered to as staff had started working without references and other important documentation, thus allowing risk of potential harm to residents. Not all staff were trained and able to meet specialist physical and emotional needs of residents. EVIDENCE: A written rota is kept, which shows that normally a Qualified Nurse works with five care staff during the mornings, and with three from 2 – 8pm. The Manager is normally additional during office hours. At night the Qualified Nurse works with two care staff. There is also a chef from 8 – 4pm, and kitchen assistant until 3pm, a laundry assistant Monday to Friday, and a cleaner except on Sundays. We found that senior staff had experienced problems in arranging cover for absence, which had resulted in low levels of staff. On more than one occasion they had only one Nurse and one carer. The Manager said that they did not get enough notice to get a worker from an agency. Camellia House Nursing Home Ltd DS0000066799.V360079.R01.S.doc Version 5.2 Page 21 Residents were not always getting attention when they needed it, whether this was due to there being not enough staff, or poor organisation and leadership. Evidence has already been included in the sections on Health and Personal Care, and Daily Life and Social Activity. In particular, the period after tea was unsafe as residents had been left in the lounge for long periods without attention. Care staff had kitchen duties at this time, washing up after tea. One resident had fallen in the lounge after tea, and while a staff member present may not have been able to prevent a fall, the distress following would be less if someone were on hand. One resident said that there are no staff in the lounge after tea, as staff are helping the more frail residents into bed - ‘the reasonable ones, we have to wait’, they said. Staff expressed the view that some problems had occurred because although they knew that some residents did not like to receive personal help from a male worker, there were not always enough staff available to give this choice. At the beginning of this inspection we found the entire staff upset because the home owner was withholding some staffs’ pay. This seriously affected some people due to their particular circumstances. They said this had happened before, which was borne out by the complaint recorded in December. This was having an adverse affect on residents by taking up the Manager’s time and diverting attention from meeting care needs. Experienced staff told us they were considering resigning, as they could not continue with this uncertainty. The home owner was not satisfied that all pay claims were accurate. We saw that some staff were giving good care and relating well with the residents. We saw that some of the overseas staff had very good communication skills, though others still needed to work on their language. Not all of the Qualified Nurses had leadership skills. Files of two recently appointed staff were examined. We did not see any personal references, and though the Criminal Records Bureau clearances had been sent for they had not been cleared and the POVA first checks were not on file. These are checks against the list of former care workers who have been found not safe to work with vulnerable adults. An Immediate requirement was made that the Manager must ensure these workers are not allowed unsupervised access to residents until these clearances have been received, to ensure protection from potential harm. One of these employees was from outside the European Union, and there was no evidence that they had permission to work in this country as a domestic. Training provided at the home was discussed with the manager. At the previous inspection it was found that 42 of the care staff had achieved an NVQ level 2 or above in care and one member of staff was working towards this qualification. Camellia House Nursing Home Ltd DS0000066799.V360079.R01.S.doc Version 5.2 Page 22 A recently appointed carer was doing a basic induction programme. The Acting Manager said she was devising a full induction programme. A system of in-house training had been purchased, and was being introduced. Some staff had worked on Health and Safety, control of infection and moving and handling theory. A trainer had been booked to deliver practical instruction on moving and handling during the week of this inspection, and came at other times to enable staff from different shifts to attend. The training covered theory and good practice in the use of handling belts and slide and glide sheets, use of turntables, and advice about when hoists should be used and the checks that should be carried out with regards to the safety and suitability of the equipment. It would be advisable to continue with a specialist training session on the specific use of hoists in the home, as so many of the current residents were not able to weight bear. It had been arranged that the Continence Advisor would visit during the week following this inspection for a staff training session. A training session by the Community Nutritionalist had been arranged. No Dementia care training had been provided since the last inspection. Not all staff demonstrated awareness of the knowledge and skills needed for good care of people with dementia. At the time of this inspection, at least one third of the residents had a dementia but the manager could not provide the evidence that the staff, including the registered nurses, had sufficient current knowledge, through training or experience, which gave them the skills to manage the complexities of caring for those who have dementia. The Acting Manager said that a member of the Community Mental Health Team had offered training for staff. Camellia House Nursing Home Ltd DS0000066799.V360079.R01.S.doc Version 5.2 Page 23 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): 31,32,36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There had been a lack of effective leadership in the home, resulting in an inconsistent quality of service to residents. 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 last Registered Manager resigned shortly after the last inspection by the CSCI. An Acting Manager had been appointed, who is a qualified nurse with experience of senior posts caring of older people in several care settings. She has no management qualification. Camellia House Nursing Home Ltd DS0000066799.V360079.R01.S.doc Version 5.2 Page 24 There is a trained Nurse on duty at all times, to oversee care of the residents, though they do not all have leadership and management skills. There was no Deputy Manager, but the home owners said they are planning to recruit a Deputy. We found that staff were not feeling supported by the employers, and that there was no strong leadership in the home, capable of driving forward improvements needed to ensure good standards of care. The Acting manager had a plan to introduce supervision sessions in the home, with suitable Qualified Nurses providing supervision for care staff, while she maintained responsibility for supervision of all other staff. The only records of supervision that we saw were dated June 2007. The home owners had shown commitment to providing a safe environment. The Fire precaution system had been maintained professionally on 29/05/07, and the certificate was seen. However, fire risks assessments had not been reviewed or up-dated since May 2006 and safety lighting had been found to be defective ion 08/12/07, and was still awaiting attention. The home owner had gathered estimates from firms for this work. Professional fire safety training had been provided on 26/06/07, and the Acting Manager had led monthly drills since her arrival. Not all staff had received training in safe working practices for first aid, food hygiene and infection control at the time of this inspection. However, Mrs Nugent said that she was taking control of the training plan for the home. Camellia House Nursing Home Ltd DS0000066799.V360079.R01.S.doc Version 5.2 Page 25 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 3 2 X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 X X X 2 X 2 Camellia House Nursing Home Ltd DS0000066799.V360079.R01.S.doc Version 5.2 Page 26 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) Requirement The Manager must ensure that a full assessment of care needs is carried out before offering accommodation, in order that the home is aware of the extent of the persons needs for care and rehabilitation, and only admits people whose needs can reasonably be met there. Care plans must be written to a standard that provides good information to those providing care, from a person centred view. Management must ensure that personal care and health care are given to a good standard, at the time that suits the resident, with good records kept. This includes safe use of equipment, with particular reference to wheelchairs, bed rails, slings and slidey sheets. It includes nutritional assessment, and best practice for each person with respect promotion of their health and well being. Camellia House Nursing Home Ltd DS0000066799.V360079.R01.S.doc Version 5.2 Page 27 Timescale for action 04/06/08 2. OP7 15(1) 12(2) 04/06/08 3. OP8 OP22 OP12 12(1)a 12(4)a 13(5) 04/06/08 4. OP9 13(4)c 5. OP16 22 Recording of medication must be sufficiently clear so that staff understand the reason for any variations. The Management must ensure that any complaint is recorded and given a proper response. The management must ensure that staff understand the implications of practices within the home which involve restraint. 04/06/08 04/06/08 6. OP18 13(7) 04/06/08 7. OP27 18(1)a 8. OP30 18(1)c The Registered Person shall, 04/06/08 having regard to the size of the care home, the Statement of Purpose and needs of service users, ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. 30/09/08 The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users Ensure that the persons employed by the registered person to work at the care home receive (i) Training appropriate to the work they are to perform; and (ii) suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. Previous time scale 30/06/07 not met. The Manager must complete the training programme for staff in respect of: First Aid Infection Control Food hygiene. DS0000066799.V360079.R01.S.doc Version 5.2 Page 28 Camellia House Nursing Home Ltd 9. OP31 9(b)1 Dementia care Communication skills Use of the hoist. The home must have a manager who is qualified and competent in management skills, in order to implement and oversee good practice in the home. The registered provider must maintain good personal and professional relationships with staff, in order to promote good morale in the staff team. 30/09/08 10. OP32 12(5)a 30/05/08 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. Refer to Standard OP36 Good Practice Recommendations The Manager should implement the planned programme of supervision. The Manager should implement the planned programme of induction. The Manager should enable staff to provide residents with some stimulation on a day to day basis and have a choice of what activities they participate in. 2. OP30 3. OP12 Camellia House Nursing Home Ltd DS0000066799.V360079.R01.S.doc Version 5.2 Page 29 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.V360079.R01.S.doc Version 5.2 Page 30 - 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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