Random inspection report
Care homes for older people
Name: Address: Camelot Care Homes Ltd 1 Countess Road Amesbury Wiltshire SP4 7DW zero star poor service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Susie Stratton Date: 2 1 1 2 2 0 0 9 Information about the care home
Name of care home: Address: Camelot Care Homes Ltd 1 Countess Road Amesbury Wiltshire SP4 7DW 01980625498/549 01980624698 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Xcel Care Homes Ltd care home 57 Number of places (if applicable): Under 65 Over 65 57 0 old age, not falling within any other category physical disability Conditions of registration: 0 5 The maximum number of service users who can be accommodated is 57. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability (Code PD) - maximum of 5 places Date of last inspection Brief description of the care home Camelot is a 57 bedded care home with nursing. The home consists of two wings, Comilla Wing parts of which are listed, and Countess Wing a new-build home. The oldest part of Comilla Wing is on the main road into Amesbury, with a wing off this older building, leading to a linked area into the unit called the Lodge. Countess Wing is a purpose-built care home. Accommodation is provided over two floors with passenger
Care Homes for Older People Page 2 of 24 Brief description of the care home lifts in-between. The two wings are separated by a court-yard garden, which they share. The home is owned by Xcel Care Limited, a company which owns a range of care homes, mainly in the south of England. Xcel Care Homes purchased the home in February 2009. The managers post is currently vacant. A person is acting into the role. This person leads a team of nursing, care and ancillary staff. The home is situated near the centre of the small market town of Amesbury, in the middle of Salisbury Plain. Amesbury is on the A303, which links to the M3. There is a bus station in Amesbury. The closest railway station is in Salisbury, about 20 minutes drive away. There is parking on site. A copy of the service users guide is given to all new admissions. Fees range from 600 pounds to 750 pounds per week. Additional charges are made for chiropody, hairdressing, newspapers, optical requirements and toiletries. Care Homes for Older People Page 3 of 24 What we found:
This random inspection was performed on 21st December 2009, between 9:00am and 4:00pm. It was unannounced. It was performed by two inspectors, these people are referred to as we throughout the report, as the report is made on behalf of the Care Quality Commission (CQC). The deputy manager was on duty during the inspection and the providers also made themselves available for feedback at the end of the inspection. At the last inspection, in all areas apart from environment, outcomes for residents were judged to be poor. Outcomes for residents for the environment were judged to be adequate. Since that inspection, the provider has submitted an improvement plan to us. This was followed by an up-dated plan a month later. We have also held a formal meeting with the provider to discuss the situation in the home. We are aware that the providers have been supported by the local Social Service department developing services at the home. At this random inspection, we concentrated on reviewing pre-admission assessments and standards of nursing and care, assessing how residents privacy and dignity was up-held, the management of mealtimes, adherence to principals for health and safety and staff recruitment. Other areas will be reviewed at the next key inspection, which is due by 20th February 2010. During the inspection, we met with a range of residents in all parts of the building and observed nursing and care at different times of day. Very few new residents had been admitted since the previous inspection. Some of the residents were able to converse with us, but others were too frail and we relied on observations of their care, to assess how the home were meeting their needs. We met with some visitors and discussed their views about nursing and care provision. We also met with a range of different staff, including registered nurses, care staff, catering staff, the activities person and the maintenance person. We observed a mealtime in both parts of the home, including how people who choose to eat their meals in their room were supported. We reviewed equipment provision for people with complex needs. We also considered staff compliance with health and safety, including adherence to the principals of infection control, management of bed rails and manual handling practice. We looked at records relating to three recently employed members of staff. We found that some areas, such as pre-admission assessments showed improvement. Other areas such as assessment of residents needs, care planning, meeting the needs of people and ensuring residents privacy and dignity have not improved. We also noted new areas where the home needs to take action, including ensuring that advice from external professionals is followed in a prompt manner, that odour is prevented and ensuring that records of all bruising and skin damage to residents is documented. We are concerned that the home continues to have so many un-met requirements from the previous inspection, as residents may not be safeguarded by the homes systems. We discussed this with the providers at the end of the inspection, and advised that a key inspection will take place shortly and if improvements are not made in service provision by then, that we may consider taking enforcement action, to ensure that residents health, safety and welfare is met.
Care Homes for Older People Page 4 of 24 What the care home does well:
Camelot is situated close to the centre of the small town of Amesbury. As such it can be part of the local community and visitors are able to come and go, as they wish. following comments made by visitors, the provider has improved systems for entry to the home by regular visitors. Visitors commented on how more personal the home was for their relative than being in hospital. One visitor commented on how their relative had changed dramatically for the better after their admission to the home, a while ago. A person who had been recently admitted commented on how they lived locally, so knew about the home, that was why they had decided to be admitted to Camelot. They reported on how they appreciated staff helping them to get washed and dressed and that they enjoyed their nice bath. The reported that they were comfortable in their room and could go out to activities if they wanted to, but generally preferred to remain in their own room. This person understood about their nursing and care needs, including medical conditions that they experienced. The providers reported in their improvement plan that their pre-admission documentation had been reviewed to include more in-depth information. The new residents pre-admission assessment was dated and signed and generally documented their nursing and care needs, including their medical conditions, aids to mobility and risks presented by their condition, including how to avoid them. This documentation also noted their preferences for time of going to bed. The home have been supported in developing assessments for resident needs, from which they plan to develop care plans which will direct staff on how individuals needs are to be met. The deputy manager reported that the new systems had not yet been introduced for all residents. They did have plans as to how these were to be progressed. New monitoring charts, which are meant to be kept in residents rooms, had been introduced. These enabled documentation of when peoples positions had been changed, fluids taken in and meals eaten, all on one chart, to support staff in ensuring that documentation was completed. All personal records relating to residents were now kept confidentially. A care assistant we met with understood certain aspects of meeting residents needs, including the importance of not tucking in sheets when a resident was cared for on an air mattress, knowing that tucked in sheets reduced the effectiveness of air mattresses. This care assistant also reported that people at risk of pressure ulcers needed turning four hourly and that it was important to look at areas at risk. There was evidence that residents were referred for external health care advice. One resident had clear instructions from a speech and language therapist relating to their swallowing difficulties and how these were to be met, displayed in their room. Another person had been referred to the community physiotherapist promptly after their admission. Since the last inspection three residents seating needs have been assessed by an occupational therapist and advice given. The deputy manager reported that the occupational therapist service have plans to make assessments for all residents who need support in this area. All residents who were assessed as being at high risk of pressure ulceration were provided with equipment to manage the risk. Residents weights were being monitored, including residents who needed their weights monitoring weekly, due to concerns about their weight loss. Care Homes for Older People Page 5 of 24 Some staff fully understood residents needs to be treated as an individual. We observed one carer gently waking a resident up before lunch-time, giving the person time to understand why they were being woken up. This same carer very politely supported a confused person in going to the toilet before lunch-time, trying to do this in a discrete manner. One carer was observed to consistently always call residents by their own preferred name. This person appeared to know them well as individuals, discussing topics with them from the residents past and own interests. A visitor commented that the home kept closely in touch with them. They reported that their relative was prone to falling and that the home always contacted them when this happened. People commented on the meals. One person reported that the food was very good and that there was too much food, pointing to their stomach. Another person reported that the food was alright and that they didnt mind if there wasnt a choice. We observed that residents were offered a choice of what they would like to drink with their meal. People commented on the staff. One visitor described the laundress as wonderful. Another person reported Im quite happy with the staff that do for [my relative]. Another visitor described staff as nice people and another as very helpful. One person reported that if they rang their bell that staff always come. A registered nurse reported that the home had a full compliment of staff. We observed staff supporting each other, for example, one carer was observed to support another member of staff in performing correct manual handling, after previous manual handling had not been performed correctly. We observed that staff who were moving residents in wheelchairs into the dining room were very aware of the need to ensure the safety of residents feet when in wheelchairs. The maintenance person reported that staff now correctly handled clinical waste and we observed that this was the case in the external clinical waste store. It was reported that since the last inspection, meetings had been held with residents and visitors to outline plans for the future. The deputy manager reported that morale had improved in the home since the last inspection. We observed that staff files inspected had evidence of required police checks. The providers are ensuring that the deputy manager receives support from an experienced manager from a sister home twice a week. The provider has kept in regular contact with us to report on progress towards addressing requirements from the last inspection and works well with us. What they could do better:
While the home has made improvements in pre-admission documentation, as this has only recently been introduced, more work is needed to ensure that all areas relating to residents needs are fully considered prior to their admission. A person who had recently been admitted had sees poorly documented in their records, with no detail of how this affected them in their daily lives. Under their religious needs it stated none documented. The person was fully able to converse, so the persons own perception of their religious needs should have been documented. This persons admission assessment documented their assessed risk of pressure ulceration before admission but an assessment of their risk had not been performed within six hours of their admission to Camelot, which is advised by the National Institute for health Care and Excellence (NICE) in all clinical settings to ensure that prompt action is taken if people are at risk of pressure ulceration. We met with different residents, discussed their needs with staff and reviewed their
Care Homes for Older People Page 6 of 24 records. When we looked at assessments of nursing and care, we found limited change or improvement from the last inspection. Two peoples assessments for risk of pressure ulceration had been completed without including all factors, so their assessments of risk were lower than they should have been. Another person did not have a pressure ulcer risk assessment on file, although when we met with them it was clear that their condition indicated that they would be at risk. One person had an assessment for manual handling which differed from what was documented in their mobility assessment. A person was assessed as being at risk of falls, but there was no assessment of their footwear, which was observed to be ill-fitting. A person was observed to be restless and mobile in bed, however no assessment had been made of whether they could be at risk of coming out the end of the bed or coming over their safety rails in their bed rail assessment. We also found no improvements in care planning or records relating to clinical issues. Where people had a need, care plans were not always being put in place to direct staff on how the need was to be met. A person who was at risk of falls did not have all factors they told us about included in their care plan. When their condition changed, the plan was not up-dated. A persons continence care plan did not reflect what the resident told us about use of toileting facilities. A resident had a complex flexion contracture to their limb. which would make maintaining personal hygiene complex and could have put them at risk of pressure ulceration in the area. This flexion contracture was not documented anywhere in their records and there was no care plan about how the area was to be cleansed and pressure ulceration prevented. A resident was observed to have very dry skin and there were topical applications in their room, but there was no mention of this skin condition or of the topical applications observed. A person was observed to have very contracted legs, with their knees pressed tightly together. No intervention was observed to be given to them to reduce risk of pressure ulceration between their knees. Where care plans were in place, they needed development. Many of the care plans were standard care plans, stating actions to be taken for certain care needs or medical conditions. There were not individualised to the person and therefore did not take into account what the person wanted or needed. Some of the wording of care plans was unclear and did not explain actions to be taken to meet residents needs. For example one persons care plan stated that they were for regular checks at night and that bowels require management, without any description of how often the person was to be checked or what the persons bowel management needs were. Where residents needed continence aids such as pads there were references to their use, such as incontinence pads to be worn but there was no detail as to the type of pads to be used. Where people experience continence management issues, different types of pads are used, according to their individual circumstances, so the type of pad used should be documented in their records. Many records did not agree with each other. For example, one person had a care plan relating to their bowel care needs, which did not agree with their personal care plan, daily handover record, bowel record or daily record. Staff reported different matters verbally to us about this persons bowel care. Another person had visible scratches on their lower limbs. These skin care needs had not been included in any assessment or care plan and reports as to how this condition was to be managed using certain topical applications did not reflect the applications we observed in their room. Two people who were assessed as being at dietary risk had nothing in their care plans about what they liked to eat. Even where residents had care plans in place, there was limited evidence that staff were
Care Homes for Older People Page 7 of 24 following these care plans. The provider reported to us in their improvement plan that handover reports had been introduced. We discussed these handover reports with carers, one of whom reported that they were not told about residents needs but found out what to do during the morning while they were working, another that they did have a report but that this was limited to standard phrases and did not inform them of how they were to meet specific peoples individual needs. We observed a carer at lunch-time using a full dessert spoon to feed a person whose care plan stated that they needed to be fed with a teaspoon, due to their swallowing difficulties and risk of choking. We observed that two people who needed thickening agent in their drinks to enable them to swallow safely, did not have any of the agent in their drinks. A residents visitor showed us a plan from a Speech and Language therapist, which stated that they were not to be given peas, due to their risk of choking. This visitor reported that the resident had been given sweetcorn, which they considered presented a similar risk to peas. We observed that one person who was stated to need protectors on their safety rails as they were at risk of bruising if they were in contact with their safety rails, did not have any protectors on their safety rails and another person.who was stated to need two safety rails, only had one in place. A resident had a care plan which outlined a specific diet that they needed for a medical condition. We discussed diets with the cook, but the cook was only aware of people who needed diabetic diets for medical conditions but not this persons specific diet. We observed that peoples needs were not being met. We observed the care of a range of people who were at risk of pressure ulceration, malnutrition and/or dehydration who had monitoring charts in place to ensure their needs were met. The deputy manager reported that these charts were to be kept in individuals rooms, however when we came to the home at 9:00am, we observed that this was not the case. Staff reported that night staff sometimes took them out to keep in the office, this was not the homes policy. If charts are not readily available, there is a risk that they will not be completed accurately. We found evidence that this was the case during the inspection. We observed poor completion of such records. For example one persons chart documented for 3:00am that they were in bed on their left side and the same for 7:00am. When we visited them at 11:00am, they were observed to be on their back, but there were no records relating to this. At 12:35 the persons turn chart documented that they were on their left side, although the person was on their back. At 3:05pm when we visited them, the person remained on their back. No further records had been made on the persons records. This was not an isolated occurrence. Another resident, when we visited them at 9:15am, was on their right side, a monitoring chart was not available in their room. At 11:00am they were still on their right side, a monitoring chart was in their room, the last record on chart was for 3:00am, which stated the person was on their back. When we visited the person at 12:40, no further records had been documented on their monitoring chart; the resident remained on their right side. When we visited the person at 3:05pm they were observed to be on their right side, now the last record on their monitoring chart was for 9:00am; it stated that the person was placed on their back. Records relating to turns were not the only inaccurate records. We observed a carer assisting a resident to eat their meal, however when we visited the person later in the afternoon, their food intake had not been documented. Another residents fluid intake indicated that they had taken in very little fluids, however when we discussed this resident with carers, they reported that the person drank well. Another persons documentation stated that they needed to be given milky drinks to help them increase weight. Their fluid chart did not show any evidence that they had been given milky drinks. Fluid charts were not generally totalled every 24 hours, so it was not possible to
Care Homes for Older People Page 8 of 24 assess if people were being given sufficient fluids to maintain their hydration. The home continues not to up-hold residents privacy and dignity. When we visited people, we observed that many of them had long, broken fingernails, which showed debris underneath the nails, this was despite one person having a care plan which directed their nails were to be kept short and clean. Three of the people we visited were odorous. If people have difficulties in maintaining continence, personal care needs to be scrupulously performed, to prevent skin damage. Such odours also do not up-hold a persons dignity. A relative informed us that a resident had had incorrect continence aids used at times, so that the person became wet and needed to have their bed-linen and clothing changed more often than they would otherwise have needed. We observed two residents had full overnight drainage bags, which were visible from the doors of their rooms. Two people had unclean bed linen at the start of the inspection and the condition of their bed linen had not changed by the end of the inspection. As at the last inspection, with a few exceptions, we heard staff using general terms of endearment such as darling or love when addressing them, not the persons real names. When talking between themselves staff tended to refer to residents by their room number such as Room 10 or Room 22. Residents, particularly people with memory loss need to be addressed by their own names and use of room numbers between staff indicates an institutional approach by staff when thinking about residents and their needs. We observed that one person who had a urinary catheter in place, did not have the clinical indicator for use of the catheter documented, this was despite other records indicating that the person experienced frequent urine infections. As urinary catheters can increase risks of urine infections, they should only be used if they are in the best interests of the person. This matter was recommended at the last inspection. This persons records did not show that their urine drainage bag had been changed recently and their care plan relating to their overnight drainage bag was unclear. Where people had skin damage, records were not clear. One person had a body map which was dated in April 2009, which did not include any of the markings which were visible when we met with the person. Another person was observed to have marking to their hand which a registered nurse told us the reason for, however there were no records made relating to this in the persons records. Another person showed a bruise on their arm, which staff spoken to were not sure of how it had occurred or how long it had been there. No records had been made of any of these three observations of skin damage in the residents daily records. Similar matters were identified at the previous inspection. We observed a lunch-time meal, including in the dining room and supports given to residents who did not want to or were not able to leave their rooms. As that the last inspection, we observed that blue plastic aprons were being given out for residents to protect their clothes, rather than clothes protectors. We asked why this was and were given three different reasons staff. Just before lunch-time the laundress delivered enough clean clothes protectors for staff to use. As at the last inspection, we observed that tables were not served sequentially, so one resident had completely finished their meal before another resident had been given their meal. Staff again appeared to be busy and we observed one resident who needed verbal support to eat, loosing concentration while their meal became cold and less appetising in front of them. Another resident was asleep with their meal in front of them, so the meal was also gradually becoming cold. Staff did not appear to have time to support such residents when they needed it. Care Homes for Older People Page 9 of 24 Meals taken on trays to residents in their rooms continued to have both first course and dessert, so their dessert could become cold. One visitor commented to us that meals were often cold by the time they were served to their relative. We observed that carer was giving a resident their liquidised meal, the meal was all stirred together, so the different foods could not be identified. The carer appeared to be unaware that this might be an issue for the resident. Another residents tray had been left by their bed, presumably until a carer could come and assist the person. This persons meal was also mixed together. It was also growing colder. Liquidised meals loose food-stuffs texture, if meals are mixed together, flavour will also be lost and the meal will also not look appetising. When we toured the home, we observed that there was an unpleasant odour on the ground floor and parts of the first floor of one of the buildings. A visitor confirmed that this part of the home often smelt unpleasant, reporting that you notice it when you open the front door. We have also received informal reports from other professionals, including Social Services about such odours. Unpleasant odours, as well as not up-holding residents dignity also indicate that cleaning practice is not being performed correctly, equipment or chemicals are not available. Such odours can also indicate the growth of micro-organisms which will lead to risks of cross-infection. The carpet in one of the sitting rooms of the home remained stained, as at the last inspection. As at the last inspection, there was a lack of assessment of how people could summon assistance or be supported in their individual needs. One person we met with had not been left with access to their call bell; it was plugged in. The persons condition indicated that they would be unlikely to be able to use a call bell, but an assessment relating to this was not documented and there was no care plan relating to this in their records, apart from a night care plan which stated that their needed regular checks, with no written evidence that checks were made on this person at night. Two of the people we met with did not have their call bells connected. We discussed this with the deputy manager, who did not know why this was and took action to ensure that the call bells were connected, so that assistance could be summoned from these peoples rooms. We later observed another person who did not have a call bell connected to their call bell system in their room. Call bells are needed not just for the individual, but also by staff or visitors, so that people can be summoned quickly if needed. At one time we observed a resident in one of the sitting rooms trying to get up from their chair, they looked frail and gave the appearance of not being able to do this independently. As a call bell was not visible in the sitting room, we had to leave the resident to go out of the room and find a member of staff, which could have put the resident at risk. Part of the entrance to the home is via a conservatory-type sitting area. The random inspection took place on a cold winters day. The room was not warm; it was not being used by residents. A thermometer was not visible in the seated area. A visitor informed us that the home could be cold at times. They were particularly concerned that if a window was opened in a residents room for any reason, that it was not always promptly closed. We observed that an unoccupied bedroom window was open and asked that it could be closed, the member of staff was unaware that it was open or how long it had been so. The en-suite in one residents room was cold. The resident informed us that they were not able to use it because of that, remarking I call it the fridge. A toilet close to the sitting room was also very cold. We asked the maintenance person about this, they reported that they had not been able to find a successful means of heating the room. Carers informed us that they used a toilet in the bathroom next to the cold toilet. This
Care Homes for Older People Page 10 of 24 meant that there was only one usable toilet close to the sitting room. The deputy manager reported that since the previous inspection, three residents had now been assessed by an occupational therapist for their seating needs and more such assessments were planned. The occupational therapist had made recommendations about furniture and equipment for two of these residents. This would involve moving different pieces of furniture and equipment from other areas of the home. The maintenance person reported that because some equipment would not go in the lift, the furniture would need to be bodily lifted up the stairs. The deputy manager reported that they were waiting to find an available member of staff to assist the maintenance person in moving the equipment. They reported that the providers were aware of the need to do this. The effect of this was that the two residents remained using furniture and equipment which did not meet their needs. The home needs to ensure that prompt action is taken, ensuring safe manual handling practice, to ensure that residents needs are met. We advised that in similar situations, homes have used a removal firm for a short period to move such equipment and furniture, as they have been trained to perform such actions safely. As at the last inspection, practice to prevent risk of cross infection continues to need improving. We observed a member of staff who did not have a uniform performing some personal care not using a disposable apron. We also observed another carer using a blue plastic apron, which is generally used for serving meals, to perform personal care. We observed red alginate bags which are used for infected laundry left in a pile on the floor, this was despite policies which stated that they must be placed in a red linen skip. We also observed laundry bags which were full to overflowing, despite a notice placed above the bags which stated that they must only be filed to half full. We observed that one carer had placed used bed linen on the floor of a persons room, and had not placed it in a linen skip. We also observed a carer who was presumably looking for something, take out a range of different items of clean bed linen from a laundry cupboard and put them on the floor. This was in an corridor of the home where odour was detectable. Unsafe practice in use of disposable equipment and laundry can lead to a risk of cross infection. Observations of care and of mealtimes documented above, indicate that the home may continue to be short of staff. We also observed that during the morning, staff were generally not with residents in sitting rooms, although they were during the afternoon. One visitor advised us that observing a member of staff in the sitting room during the afternoon was an unusual observation and that generally during the afternoons they observed that staff were not available and they had had experience of having to go and find a member of staff to support a resident in getting assistance. Where staff were available, they had other roles. For example during the afternoon a registered nurse was in the sitting room, completing records. On one occasion, a resident needed assistance to get from a wheelchair to their easy chair. The resident had to wait until the registered nurse was free to assist the care assistant in using the hoist. The deputy manager is currently managing the clinical services in the home, as well as doing this, they are also one of the registered nurses in charge at times when on duty and are trying to introduce change management in the care planning process. This means that they may be performing three roles. We discussed this with the provider, who felt that because the home was not up to their full compliment of residents, that the staffing levels were adequate. We advised that residents needs for staff related also to an assessment of their individual nursing and care needs, including their dependency and staffing levels did not only relate to numbers of residents in the home. We also advised that if the home is
Care Homes for Older People Page 11 of 24 trying to change practice, that this is something which means that the person doing this needs to be able to concentrate on this area, without performing different roles. We looked at records relating to three members of staff who had recently been employed. One person had three references on file, but none of them were from their previous employer, two were from colleagues and one from a former employer. This had not been probed at interview. Another new member of staff had one reference on file. They also had three references entitled to whom it may concern, none of which related to the role for which the person was applying. Such reference are not acceptable, as the employer does not know where they have been sourced from. The person also showed evidence of having two employers within a short space of time. None of these matters had been probed at interview. A third person had only one reference on file, this was from a personal E-mail, not a company E-mail. Two other references were documented on the persons application form, but there was no evidence on the persons file of what capacity these people had known the person in or that that they had been applied for. One newly employed registered nurse did not have evidence on their file that their pin number had been verified with the Nursing and Midwifery Council, to ensure that they were able to practice as a registered nurse. Practice in relation to bed rails continues to be unsafe. The maintenance person reported that they had accessed training for themselves and understood how they were to be used safely. They were not sure if other staff had been trained and they considered that many of them may not know how to use them safely, for example they did not understand that bending over rails, rather than lowering them to provide care, loosened them in their fixings, making the rails mobile. They also did not understand that they must not be moved from where they had been set, to prevent a gap between the head of the bed and the rail, where a resident may entrap themselves. During the inspection, we observed at least four occasions where there were gaps between the rail and the head of the bed where a persons limb or head might be entrapped. Many of the bed rails we examined were loose in their fixings. After lunch, we observed that more than one resident needed assistance to transfer from their wheelchair to an easy chair in the sitting room. A carer advised another member of staff that these residents would need handling belts to assist in doing this. No lifting belts were observed in or near the sitting room. The care assistant went away for an extended period of time to find the equipment, while residents waited for assistance. The home needs to ensure that it has enough manual handling aids, which are readily available, to meet residents needs, so that residents do not have to wait to receive the care that they need. We observed manual handling practice. As at the last inspection, we observed that improvements in manual handling practice were needed. We observed two members of staff moved a resident from their wheelchair to their easy chair, using a hoist. Once the person was in their chair. They both placed their arms under the persons arms and lifted them up bodily to place their back against the chair. This is unsafe practice as it can injure the persons arms or the member of staffs back. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 12 of 24 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 12(1) Where a resident is not able 30/09/2009 to perform activities of daily living such as changing their position or giving themselves a drink or a meal, monitoring charts must be accurate and provide evidence that care plans are being followed. Requirement in progress. Frail people who are unable to support themselves in activities of daily living need to have them met by staff. Records are needed to show how and when staff have met these needs and to ensure that care plans can be accurately reviewed. 2 7 12(1) The home must ensure that 30/09/2009 staff are fully aware of residents individual and health care needs, as set out in their plans of care and that they comply with the directions in plans of care. Requirement not addressed If nursing and care staff are not aware of residents plans of care and individual needs, they will not be able to properly support the Care Homes for Older People Page 13 of 24 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action resident. 3 7 15 Where a person is assessed 30/09/2009 as having a risk or a need, a care plan must always be put in place. The care plan must include all relevant matters for the individual, including recreational activities, as well as personal and health care needs. Care plans must be reviewed and up-dated when a persons condition changes. Requirement in progress. Care plans direct staff on how a persons individual needs are to be met, therefore they need to be completed in full. Care plans need to be up-dated, to ensure that staff are directed on how to meet a persons changed needs. 4 9 13(2) Controlled drugs must be stored in a cupboard that complies with the current Misuse of Drugs legislation. Requirement not addressed. This is to ensure the safety of residents. 5 26 13(3) The home must ensure that all potentially infected laundry and general laundry is correctly managed. Requirement met in part. This is to prevent risk of
Care Homes for Older People Page 14 of 24 15/12/2009 30/09/2009 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action infection and cross-infection. Clinical waste is now being correctly managed but potentially infected and general laundry are not being handled in accordance with the homes own policies and infection control guidelines. 6 27 18(1) The home must ensure that 31/10/2009 there are enough staff on duty at all times to meet residents nursing and care needs and that residents are supervised when in communal rooms, so that they are fully supported and not put at risk. Requirement not addressed. Enough staff need to be on duty to meet resident nursing and care needs and to ensure their safety. 7 29 19(1) The home must ensure that 30/09/2009 it follows standards and regulations on the employment of staff in full at all times, including the employment of registered nurses. Requirement nearly addressed in full. By following standards and regulations, the home will be able to ensure that it will not recruit people who are unsafe to work with the client-group.
Care Homes for Older People Page 15 of 24 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 8 30 18(1) The home must ensure that 30/11/2009 it can demonstrate that all staff have been trained in all relevant areas relating to meeting the range of different residents nursing and care needs. Requirement in progress. Residents nursing and care needs will not be met if staff have not been trained into how to meet their needs. 9 30 18(1) The home must ensure that 30/09/2009 it can provide evidence that all newly employed staff, including agency staff, have been fully inducted into their role. Requirement in progress. This is to ensure that all staff are supported in taking up their roles and responsibilties after employment. 10 31 8(1) The provider must ensure 31/10/2009 that they apply to us for a fit person to be the registered home manager. Requirement in progress. A suitable person needs to manage the home to ensure that the needs of the residents are met. 11 33 24(1) As Camelot is a care home with nursing, systems for audit of quality of clinical 30/11/2009 Care Homes for Older People Page 16 of 24 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action outcomes for residents must be developed. Requirement in progress. In a nursing home clinical outcomes for residents are a key area, therefore these need to be audited, to ensure that residents clinical needs are being met. 12 37 17(1) The home must ensure that records required by us are always available in the home. Records relating to nursing and care must be dated and signed by the person completing the record. Requirement addressed in part Records are required by us so that we can ensure that the home is being managed in a safe and effective manner. As such records may be considered legal documents, they need to be dated and signed. 13 38 13(4) Where bed rails are used, there must be a full written assessment of the need for their use, which is regularly reviewed. All bed rails must be safe and not present a risk to the resident. Requirement in progress, assessments are now in place but rails are not safe.
Care Homes for Older People Page 17 of 24 30/09/2009 30/09/2009 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action The use of bed rails presents a risk of injury to residents, therefore they must only be used if they are assessed as being in the residents best interests and if they are correctly used. 14 38 13(4) All staff must perform safe manual handling practice at all times. Requirement not addressed. If staff do not perform safe manual handling, residents, themselves and other members of staff may be put at risk of injury. 15 38 17(1) The home must ensure that all accidents are fully documented in accident records. Not reviewed at this inspection. Records of accidents are needed to be maintained so that the home can identy any trends and use information to further reduce risk of accidents to residents. 16 38 13(4) The home must develop full 30/11/2009 environmental risk assessments for practice and management of the home. Where risks are identified, a plan must be put in place to demonstrate how risks presented by the home
Page 18 of 24 30/09/2009 30/09/2009 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action environment have been reduced to a minimum. Requirement in progress. Managers have a duty to identify any risks associated with the home environment to document how risk to residents, visitors and staff is to be reduced. 17 38 23(4) The home must be able to 31/10/2009 evidence that it is complying with regulations from the fire brigade. Requirement in progress. The home needs to protect all residents, visitors and staff from risk of fire and ensure that it had robust plans to identify actions to be taken in the event of a fire. Care Homes for Older People Page 19 of 24 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 18 13 Call bells must always be available for residents, their supporters or staff to use. People need to be able to summon prompt assistance when they need it. 27/01/2010 2 19 23 Management must ensure that all parts of the home used by residents are warm enough for them to use. This is to prevent risk of discomfort or hypothermia. 26/02/2010 3 26 23 Management must identify reasons for odour in the home, and ensure that all parts of the home are clean and smell fresh. If a home is odorous, residents dignity will not be up-held. Odour can indicate a lack of cleanliness, including micro-organism growth. 10/02/2010 4 37 17 Records relating to the 27/01/2010 provision of nursing and care
Page 20 of 24 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action must be accurate and completed at the time nursing and care is given. Full records of all bruising and other injuries to residents must always be documented. This is to ensure that staff at all levels have accurate information and that correct actions can be performed to meet residents needs. 5 38 13 Management must ensure that staff use correct personal protective equipment at all times. This is to prevent risk of infection. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 27/01/2010 1 2 3 3 Admissions assessments should detail how a disability will affect a persons ability to perform activities of daily living. The home should follow relevant NICE guidelines when making assessments of clinical need after the persons admission. Assessments and care plans should use clear and measurable language. Recommendation un-met from the previous inspection. 3 7 4 7 Records relating to changes of position, giving of meals and fluids should always be kept in the residents room as per the homes policy Care Homes for Older People Page 21 of 24 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 5 6 7 8 7 7 8 8 Standard care plans should be avoided as much as possible. Care plans should relate to the individual. The specific type of continence aid for the resident should always be documented. Fluid balance charts should always be totaled every 25 hours The clinical reason for use of a urinary catheter should always be documented. Recommendation un-met from the previous inspection. 9 9 Registered nurses should not be responsible for answering phone-calls when performing a medicines administration round. Staff should always call residents by their proper or preferred name, when addressing residents, generic terms of endearment should be avoided. Recommendation un-met from the previous inspection. 10 10 11 12 13 12 15 15 Admission assessments should detail the persons own perception of any religious needs. Residents who eat in their rooms shoud not be given cold meals Liquidised meals should not all be mixed up together, to ensure that residents are able to distinguish flavours and to ensure attractive presentation of meals. When residents are served meals on a tray, their desserts should not be served with their main meal, to ensure that their dessert reamins warm or cold, depending on the dessert provided. Recommendation un-met from the previous inspection. 14 15 15 15 When serving meals in the dining room(s), meals should be served table by table by table. Recommendation un-met from the previous inspection. 16 19 Thermometers should be provided in colder areas of the home and regular written observations of the temperature documented.
Page 22 of 24 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 17 19 All staining should be removed from carpets in residents rooms and communal areas. Recommendation un-met from the previous inspection. 18 19 38 38 The home should ensure that it has enough lifting belts to meet residents needs. All people who use, fit and check safety rails should be fully trained in their use. Recommendation not reviewed at this inspection. Care Homes for Older People Page 23 of 24 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
