Inspection on 28/01/10 for Camelot Care Homes Ltd

This inspection was carried out on 28th January 2010.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Camelot Care Homes Ltd 21/12/09

Camelot Care Homes Ltd 14/07/09

Similar services:

The Vicarage

Fairfields Country Rest Home

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5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Key inspection report Care homes for older people Name: Address: Camelot Care Homes Ltd 1 Countess Road Amesbury Wiltshire SP4 7DW     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Susie Stratton     Date: 2 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 45 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 45 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: Xcel Care Homes Ltd care home 57 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: 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. Accommodation is provided over two floors with passenger lifts in-between. The two wings are separated by a court-yard garden. 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. Care Homes for Older People Page 4 of 45 0 5 Over 65 57 0 Brief description of the care home 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 5 of 45 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: As part of the inspection, 30 surveys were sent out and 14 were returned. Comments made by people in the surveys and to us during the inspection process have been included when drawing up the report. The homes file was reviewed and information obtained since the previous inspection considered. The providers have submitted an improvement plan, which they have regularly up-dated, since the last inspection. We have also met formally with the provider to hear how they planned to improve service provision. We performed a random inspection in September 2009 to review systems for management of medication. In December 2009, we performed further random inspection to review developments in service provision. We looked at the improvement plan, the providers action plans, the random inspections, the surveys and reviewed all the other information that we have received about the home since the last inspection. This helped us to decide what areas we should focus on when doing the inspection. The site visit was performed by three inspectors, one of whom was a pharmacist Care Homes for Older People Page 6 of 45 inspector. These people are referred to as we throughout the report, as the report is made on behalf of the Care Quality Commission (CQC). The site visit took place on Thursday 28th January 2010, between 9:25am and 4:45pm. The visit was unannounced. The new manager had commenced their role on Monday 25th January 2010 they were present during the inspection The new manager and provider were available for the feedback at the end of the inspection. During the site visit, we met with a range of residents and also observed their care. We met with several residents relatives to receive their opinion of service provision. We toured all of the home and observed care provided at different times of day and in different areas of the home. A mealtime was observed. We reviewed care provision and documentation in detail for three residents and looked at specific records relating to a further five residents. As well as meeting with residents, we met with the deputy manager, three registered nurses, seven carers, two domestics, the activities person, the volunteer, the maintenance person, the deputy cook and the administrator. We reviewed systems for storage of medicines and observed medicines administration rounds. A range of records were reviewed, including staff training records, staff employment records, complaints records and maintenance records. Care Homes for Older People Page 7 of 45 What the care home does well: What has improved since the last inspection? The home have managed to develop service provision and have addressed a range of requirements which have been un-met since the previous key inspection. Assessments of need, including nursing needs are now accurately carried out and generally reviewed when a persons condition changes. Records relating to clinical care are now in place. Individualised care plans have been developed. Care plans relating to recreational activities for individuals have been drawn up. Where a person is not able to change their position or give themselves food or drink independently, monitoring charts are now in place. Fluid charts are totalled every 24 hours. Where a person is prescribed a medicine on an as required basis, individual protocols have been put in place. Records for such medication reflects the prescribers intentions and their actual use. The home has put much effort into ensuring that residents privacy and dignity are upheld. This includes ensuring that staff are meeting the personal needs of residents with restless and complex behaviours. Personal care, such as attention to clean fingernails, clothing and bed linen has improved. The home has begun to ensure that residents, including people with dementia care needs and limited communication, are able to exercise choice. Staff ensure that they use residents own names when addressing or referring to them. Meals times have much improved. They are now more organised. Residents who wish to eat in the dining room are served table by table. Residents who prefer to eat their meals in their own rooms are served hot meals and desserts are served separately from their main course, so that they remain hot or cold, as applicable. Liquidised meals are no longer mixed up together. The home is now complying with its own complaints procedures, with full evidence of investigation of complaints. Care plans relating to personal safety include an assessment of how a person can be enabled to summon assistance. Staff have been trained in their responsibilities for safeguarding vulnerable people. Care Homes for Older People Page 8 of 45 The home have facilitated assessments of people who are not safe in the chairs provided and as advice as been received about appropriate seating, have acted upon this advice. More lifting belts to aid manual handling have been provided. Unpleasant odours have been reduced in the home. Equipment, chemicals and disposables needed to prevent risk of spread of infection have been provided in all parts of the home where personal care is provided and clinical waste is now being correctly managed. Staff were using correct disposable equipment to up-hold the principals of infection control. Information given to residents has improved and the service users guide now includes the homes fee range. The providers monthly visits are completed in detail and deficits in service provision are identified and acted upon. The providers have ensured that a full audit trail is in place when moneys and valuables are handed in for safekeeping. Accidents to people, including unexplained bruising, are fully documented. Call bells are fully available to residents. Oxygen cylinders are now securely stored. What they could do better: The home continues to need to address certain areas, many of which were identified are the previous key and random inspections. Improvements continue to be needed in the provision of health and personal care. Where a person is assessed as having a need or a risk, a care plan must always be put in place to direct staff on how the need is to be met or risk reduced. Care plans must be reviewed and up-dated when a persons condition changes. As at previous inspections, they need to ensure that staff are fully aware of residents individual needs and to follow peoples plans of care. Where frail people are not able to move their positions or give themselves meals or drinks, monitoring records relating to this must always be accurate and provide evidence that care plans are being followed. Where residents need regular checks to ensure their safety, there must be evidence that this is taking place. Improvements continue to be needed in the management of medicines. Controlled drugs must always be stored in a cupboard which complies with legislation. This matter was identified at the random inspection of September 2009 and should have been addressed in full by this inspection. Blood testing devices must be suitable for use. Residents would benefit from developments in their daily lives. Residents need to be more supported in social activities by all staff in the home. Staff must support frail residents at mealtimes by always sitting with residents when supporting them to eat. Where a resident prefers a particular drink this should be documented, so that all staff are made aware. Some improvements are needed to the home environment. All parts of the home must be warm enough for residents to use. All laundry, including potentially infected laundry, must be correctly managed. All staining to carpets across the home should be removed. Many improvements are needed in staffing and several matters remain un-met from Care Homes for Older People Page 9 of 45 previous inspections. The home must ensure that there are enough staff on duty to meet residents nursing and care needs. They must follow acceptable standards on the recruitment of staff. All newly employed staff must be fully inducted into their role. There must be evidence that all staff have been trained in all relevant areas relating to meeting the range of different residents needs. Full systems for staff supervision need to be developed. Management systems need attention. The home needs to ensure that it develops systems for clinical audit. All records relating to nursing and care must be accurate and all records required by us must be available for inspection, in the home. Improvements are also needed in health and safely practice. The home needs to continue to address requirements from the fire safety officer. They also need to develop environmental risk assessments. All staff must perform safe manual handling at all times. Where bed rails are used, they must be used in a correct manner, to ensure the safety of residents. All staff who use bed rails need to be fully trained in their use and aware of their individual responsibilities for protecting residents. Emergency alarms in lifts need to be fully audible. We appreciate that the home have put much effort into the development of services to ensure the health, safety and welfare of residents. However there remain concerns that so many outcome areas, particularly relating to Health and Personal Care, Staffing and Health and Safety continue to show issues that need to be addressed. Considering improvements made, we have assessed outcomes to residents as adequate, but if improvements are not built upon, risk to residents remains. It is therefore our intention to perform another key inspection of the service by the end of June 2010, to ensure service provision continues to improve. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 45 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 45 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made in information provided to people planning to be admitted to the home and improvements are planned to ensure that the home can demonstrate it can meet the assessed needs of residents, prior to admission. Evidence: At the previous key inspection, we observed that the provider had not supplied its fee range in its service users guide and we set a requirement so that people could be properly informed of such matters. We reviewed the information again at this inspection and observed that the homes fee range had now been included. The service users guide is set out in an approachable style, including a section on frequently asked questions, which gave a clear picture of the providers aims for provision of care to residents on a daily basis. All of the people who responded to us in surveys reported that they had been given enough information about services provided by the home, prior to admission. One Care Homes for Older People Page 12 of 45 Evidence: relative commented XXs room was prepared well for XX small adjustment e.g. TV aerial position had been moved to where we had agreed. However one person did report a small induction pack for patients relatives would be helpful, we did get a brochure with aims etc but it needs more basic A-Z - baths available, must be booked, visitors - anytime, but preferably not at mealtimes, etc.. This comment indicates that the provider may like to re-consider looking at information given to residents prior to admission or if all residents and their supporters have been given the full service users guide for the home. As the home was judged as providing poor outcomes for residents at inspection of 13th July 2009, social services and other statutory agencies have not been placing residents in the home. This means that residents are generally not being admitted. We reviewed assessments before admission at the random inspection of 21st December 2009 and found that systems had improved since the previous inspection, including a review of pre-admission documentation to allow for a more in-depth assessment of the residents needs. We observed that a new residents pre-admission assessment was dated and signed and generally documented the persons 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 the persons preferences for time of going to bed. We concluded at that inspection that more work was needed to ensure that all areas relating to a residents needs were 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 their assessment stated none documented. The person was fully able to converse, so the persons own perception of their religious needs should have been documented. The 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, 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. The new manager reported that they were planning to continue to develop practice in assessment of need prior to admission, to ensure that the home were in a position to meet every prospective admissions needs. Care Homes for Older People Page 13 of 45 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will now have some of their personal and health care needs met by the homes revised systems. They continue to need to meet all of our requirements, to ensure that residents are supported as they need, and risks to them reduced. Evidence: At the previous key inspection, this outcome area was judged to be poor. After the inspection, we performed a random inspection on 15th September 2009. It was performed by a pharmacist inspector to review progress towards meeting requirements relating to medicines management. Following this, we met with the provider and they submitted a detailed improvement plan, followed by action plan updates. We performed a random inspection on 21st December 2009 to review progress. At the random inspection, we found that fifteen requirements relating to health and personal care remained un-met. Additionally, three recommendations from the inspection of 13th July 2009 also remained un-met. A further five recommendations relating to health and personal care were identified. People responded to us in surveys about this outcome area. Two people felt they Care Homes for Older People Page 14 of 45 Evidence: always received the care and support that they needed and three that they usually did. Four people felt they always got the medical care that they needed and two that they usually did. Of the staff who responded to surveys, one felt they always, two usually, two sometimes and three never were given up-to-date information about the people they cared for. One person felt they always, three usually, two sometimes and one never given enough support and knowledge to meet the individual needs of people in the home. Comments from different people included they care for XX in all aspects of care and another the Drs are called out promptly if required and routine care like chiropody is organised well. However one person commented that the home needed proper personal care i.e. hair washing, nail cutting, keeping skin nice/apply moisturiser etc., another its not a home atmosphere, more like a hospital, Im pleased to do all the extras for XX but they really should be done as routine by the staff and another some of the nurses are not very approachable. We observed improvements in assessment and care planning. All of the assessments for risk of pressure ulceration were correctly completed and considered all factors which would affect the person. One of the people we considered had had their assessments reviewed and altered when their condition changed. However another person had an assessment for bed-rails, where it had had a tick placed in the box for alternatives considered, but there was no documentation to state what alternatives had been considered for the person. At this inspection, we observed some improvements in care planning and care provision. During the inspection, we met with a frail resident who was in bed. They had an air mattress provided. Their records stated that they could re-position themselves if they wished to; there was also a turn chart in their room. Their records documented that they usually got up during the morning, but we observed that they were still in bed. We discussed this residents needs with with a carer. They reported that the person generally did get up every morning but on the morning of the inspection, they had not felt like doing this. The carer reported that they had been popping back to the resident to see when they wanted to be assisted. The carer also reported that the person was able to change their position in bed, but that sometimes they did not remember to or at other times did not feel like doing it themselves, so staff would support the person and document what they had done on their turn chart. Such observations were not reflected across all areas. When we visited another resident, we observed that one of their eyes were closed. We asked different people about this, including the persons relative, a carer, the activities person and a registered nurse, and received different information from them all. There was no care plan about this persons eye and no records had been made about the persons eye in the individuals daily record. Care Homes for Older People Page 15 of 45 Evidence: We met with a resident who needed assistance to give themselves food and fluids and as also met with a carer who was assisting the person to eat and drink their lunch. The carer was giving the person their lunch-time meal with a teaspoon, as stated in the persons care plan, because the person was not able to open their mouth wide and had difficulties in swallowing. The carer we spoke with knew how much thickening agent the person needed in their drinks in order to swallow safely. However such practice was not observed everywhere else. One resident whose records stated that they needed their fluids thickening to a syrup consistency, was observed to have no thickening agent in their juice at all during the morning and when we returned after lunch, their drink had been thickened to a jelly consistency. There continues to be evidence that staff are not following care plans. One resident had an assessment and care plan which stated that they were not at risk of falling out of bed and so did not need bed rails to be used. When we visited them after lunch, we observed that their bed rails had been raised. We asked a carer and a registered nurse why this was and they were not able to inform us of the reason. The deputy manager was very clear that bed rails were not to be used for this person and why. There is a body of evidence that bed rails have the potential to present risk to residents and should only be used if indicated, so it is of concern if staff are not following assessments and care plans relating to their use. We discussed how senior staff communicated with more junior staff to direct them on how to meet residents needs. Junior staff reported that they now had a hand-over report. One carer reported that handovers tells you all you need to know. A registered nurse who worked in both wings of the home reported that they always received a handover report about the residents when they took over a different wing. However we continued to observe some occasions where communication clearly needed improvement. One residents records stated that they were to be offered milky drinks to support them in weight gain. We reviewed their fluid charts and none of their charts provided evidence that they had been given milky drinks. We discussed this with a care assistant who reported that it was the catering assistants role to give out such drinks. We discussed the matter with a registered nurse, who did not know why the resident was not being given milky drinks. We discussed the matter with a second registered nurse who was aware of the requirement in the persons care plan but did not know why it was not being followed. When we looked at the persons fluid chart at the end of the inspection, there continued to be no records that they had been given milky drinks and the only warm drink given to them was documented as tea. We observed improvements in records relating to changes of residents positions and Care Homes for Older People Page 16 of 45 Evidence: the giving of food and fluids. More records than at previous inspections were up-todate and showed that the home were meeting residents needs to prevent risk of pressure ulceration and dehydration. It appeared that monitoring charts were more often kept in residents rooms to ensure accuracy and ease of completion for staff. However we still did observe one resident whose monitoring chart was not in their room at 9:40am, but on our return at 10:00am had been placed in their room, apparently completed. This persons turn chart stated that they were to be turned every three hours, however their chart showed that they had not had their position changed between 3:00am and 7:00am. Another person was documented as being on their right side when we visited them at 10:00am, which was how they were lying. When we visited the person at 12:30pm, they continued to be on their right side, however their turn chart documented that they had been moved onto their back at 11:00am. A third persons chart stated that they had been placed on their back at 8:00am however when we visited them at 10:45am, they were on their right side, with pillows in place to position them on this side, but no documentation had been completed in relation to this. The home also needs to improve other areas of monitoring of residents. Fluid charts were now totalled every 24 hours. However it continued to appear that the information gained from fluid balance charts was not reviewed when planning and evaluating care. Two of the people we considered in details charts indicated a low fluid intake, but their care plans had not been evaluated to assess the person for risks of dehydration or plans developed to support the person in taking in more fluids on a daily basis, to prevent risk. Improvements have been made in nursing care to residents. A resident who had a supra-pubic catheter had full records relating to this, including the clinical indicator for the catheter. A person who had sustained a skin tear had records relating to this and while one registered nurse did not know about the current condition of the wound, another registered nurse and the deputy manager were both able to report on the wounds current condition. A person was unwell at the time of the inspection and a carer was able to inform us of why the home were concerned about the resident and that their GP had been asked to attend. All care was provided behind closed doors. Residents who were restless were supported in remaining clothed. Frail people who were now supported in having clean fingernails, hair, mouths and eyes. We observed much improvement in staff when addressing residents and unlike previous inspections, staff consistently called residents by their own preferred name, not generic terms of endearment. When staff referred to residents amongst themselves or to us, they were observed to always refer Care Homes for Older People Page 17 of 45 Evidence: to them by their own preferred name, not by their room number. Our Pharmacist Inspector looked at all the areas of medicine handling in the home. We looked at the storage and records in the home, observed two medication rounds and talked to members of staff. The medicines were generally stored appropriately, however one controlled drug cupboard was not fixed to a solid wall as the legislation dictates and some nutritional supplements were stored in open view in a corridor. The former matter is an un-met requirement from the random inspection of September 2009, and should have been addressed in full by now. We saw medicines being given in a considerate and safe manner with persuasion for people reluctant to take them and any complete refusals recorded. A new homely list was in each folder of medication administration records along with examples of the nurses signatures and photographs of the residents. Some medication administration records had medicines still printed on them that were no longer in use, these medicines were not being given, but the records should be made clearer. Some people need blood tests for diabetes that the nurses carry out. The equipment they currently use is not that which is recommended for nurses or carers to use on other people and must be changed. The home continues to improve its safe medicine procedures as seen by the use of medicine care plans for everyone in the home. The manager had also produced separate sheets to record the use of cream and lotions which they planned to introduce immediately which should improve the recording of these products about which we had some concerns. Care Homes for Older People Page 18 of 45 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be supported by improvements in their daily lives and at mealtimes, however staffing for activities needs to be enhanced and certain aspects relating to provision of care at mealtimes continues to need development. Evidence: At the last key inspection, this outcome area was judged to be poor. Since the last inspection, we have met with the provider and they have provided us with improvement plans, which they have updated. At the random inspection of 21st December 2010, we noted improvements in care planning in relation to activities and social care. The home had also introduced documentation to support choice for residents. However at that inspection, we continued to be concerned about mealtimes, particularly the supervision of frail residents and those with complex behaviours. People commented about this outcome area in surveys. Three residents reported that the home always and one sometimes arranged activities which they could take part in. One person commented that the home did activities well, another over Xmas my XX enjoyed the activities organised, another XX has lots of visitors and these are always welcomed in and another that activities seems to be ok. However another person commented that the staff never have time to just sit and chat to residents and Care Homes for Older People Page 19 of 45 Evidence: another could my XX listen to music each morning as the social worker arranged. Three people reported that they always and two usually liked the meals. One person described the good home cooking & choice, another person reported some carers could be a little more patient when giving meals and not try to rush. A carer said there was reliance on the activities coordinator to provide stimulation for people, which meant many people only got activities opportunities once per week. They said care assistants were under too much pressure of routine tasks to be able to engage meaningfully with people, although their National Vocational Qualification training had stressed the importance of whole person care. A resident also described activities provision as a once a week opportunity. They attended exercise sessions and valued these. Otherwise they read a lot, and felt that without that interest they would be bored. A volunteer as recently been employed to support the activities coordinator. They told us their primary role was to support activities work, but they were happy to help in any way. We observed that the activities person and volunteer were very much in evidence during the inspection. The activities person was able to inform us about needs of people who did not come down to sitting rooms, as well as people who engaged in group activities. The employment of a volunteer will benefit activities provision, however emphasis still needs to be placed on giving care staff more opportunity to support residents in this area. We observed major improvements at mealtimes. Meal-times were much more organised, with care staff being available in dining rooms to support residents and once people in dining rooms had been supported, to assist people who ate in their rooms. Residents were served table by table and meals taken to residents in their own rooms were observed to be hot. A resident report to us that they always enjoyed their meals. We saw that after their meal, the person experienced good engagement with staff and an inclusive atmosphere was encouraged over a cup of tea with people in the sitting room. The resident said that although some staff did not have good command of English, they were good at communicating in other ways and the resident always felt they were understood. On Countess Wing, staff split their duties so one undertook service in the dining room, one delivered meals to rooms and one gave one-to-one assistance to people that needed this, one after the other. The volunteer was also available at lunch-time and gave a lot of assistance to service of lunches in the dining room. We observed that staff showed much more consideration to residents at the mealtime. We observed a carer take a meal to a frail person in their room, gently waking them up and making sure that they were fully awake and ready before they gave them their meal. Pureed meals were observed to no longer be mixed together when Care Homes for Older People Page 20 of 45 Evidence: assisting resident to eat their meals. However, we observed one carer leaning over a persons bed rail to give them their lunch, not taking down the rail and sitting to support the person in eating, to ensure that the meal was a social occasion for the person, as much as possible. A relative informed us that a resident had a lemon-type juice provided for them and that they knew that their relative did not like lemon flavour. They reported that they had told staff about this on several occasions and had provided the resident with alternative flavoured juices but that staff did not use these. We reviewed the residents records but there was no documentation about the persons preference for fluids. We met with the deputy cook. Copies of nutritional risk assessments and care plans were now being kept in kitchen and the cook showed a good understanding of individuals requirements for diet. For example one persons need for a low cholesterol diet. Lunch time information included which cutlery and other aids carers need to supply or use for individual residents. No residents needed special diets for religious or ethnic reasons but the deputy cook was aware that this may happen and showed where this would be recorded. Care Homes for Older People Page 21 of 45 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will be more supported in raising issues of concern to them and be better safeguarded, this needs to be continued and further developed by the homes managers, to ensure that residents are fully protected. Evidence: At the last inspection, this outcome area was judged to be poor. Following this inspection, the provider has met with us and submitted an improvement plan, which they have up-dated regularly. We have also performed a random inspection. We are aware that a range of safeguarding alerts have been raised about the home and these have been investigated in accordance with local multi-agency procedures. The provider has fully co-cooperated with all of the investigations. People commented to us about complaints in their surveys. All of the people who responded reported that they knew how to raise issues informally and four people reported they knew how to make a formal complaint, while two reported that they did not. All of the staff who responded to surveys reported that they knew what to do if someone had concerns about the home. Some people used surveys as opportunities to raise issues of concern to them. One person reported 3 new face cloths recently bought (2 weeks ago) and marked with name have completely disappeared within a week! and another laundry and returning clothes that continually go missing. While there is a wardrobe clothes are usually rolled up and put in drawers. Comments from staff included some staff are not approachable another that half the time you can Care Homes for Older People Page 22 of 45 Evidence: only go on courses if it is free and another that managers needed to treat the staff decently. Sixteen complaints had been recorded as received between 1st September 2009 and the present. These included operational matters raised by staff, and concerns raised by residents or their visitors. There was a standard tracking form that showed the details of a complaint and how it was received, what investigation took place, the findings of the investigation and any actions decided on as a result. Correspondence to inform complainants of the outcomes of investigations suggested complaints were taken seriously and looked at in depth. Learning points were translated into actions to prevent recurrence. For example, a recent concern by a visitor about lax security of the entrance had led to a review of arrangements, and we saw the measures that had subsequently been adopted to bring about improvement. The quality of complaint handling should be included in routine provider audits. This should be evidenced by each complaint record being signed to show that when it has been seen at that level. Comments received above indicates some work continues to be needed to ensure that all areas of concern are noted and addressed. At the previous inspection, we had set a requirement relating to the safety of people who were not able to access their call bell. By this inspection, people who were not able to summon assistance independently had care plans in place to state how their safety was to be maintained. Care plans mainly related to directions such as that the person much be checked up on for periods such as hourly or two hourly. While some of these people had records relating to when they were turned, there were no written records to show that the persons condition was being monitored at the frequency indicated in their care plan, so it was not possible to see if the plans were being followed for the individual. This is of concern as some residents had variable medical conditions and/or dementia care needs and so could put themselves at risk. At the random inspection, we were concerned that some residents did not have call bells or had call bells which had been left under or behind furniture. This had been addressed by this inspection and all rooms that we visited had call bells visible in them. Records showed that staff have been trained in safeguarding and staff spoken with reported that they appreciated the training. Care Homes for Older People Page 23 of 45 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will largely be supported by an environment which meets their needs and where improvements are being made. Evidence: At the last inspection, this outcome area was judged to be poor, with main concerns relating to compliance with the principals of infection control and provision of equipment to residents. We met with the provider after the inspection and they provided us with an improvement plan, which they up-dated, as their action plan progressed. We also performed a random inspection on 21st December 2010. People commented to us about the home environment in surveys. Three people commented that the home was always, two usually and one sometimes fresh and clean. People made comments in surveys, one person commented that they needed more proper equipment, another more investment, another the refurbishment side of the home has dropped considerably since the new owners have taken over and another old carpets are being left in rooms which should be replaced. Camelot comprises two wings with a garden in between. Comilla Wing was purpose built as a care home. Comilla Wing is an older building which has been extended, parts of which are listed. Rooms all vary in shape and type. The home is steadily reducing its number of double rooms and increasing its numbers of en-suites in bedrooms. Care Homes for Older People Page 24 of 45 Evidence: There are passenger lifts in-between each floor of the different parts of the building. The garden area has raised flower-beds for wheelchair users to enjoy. We observed improvements at this inspection. The home has been seeking the advice of occupational therapists about equipment for disability and are implementing their advice. For example one person who used to spend all their time in bed had been assessed by an occupational therapist as needing to be provided with a profiling bed and to be gradually supported in sitting up, before being assessed for a suitable chair. This was observed to be taking place. This person informed us that they were comfortable. Their bed had been placed opposite their window so that they could both see out and watch their television. We observed in sitting rooms that lifting belts were fully visible and available for staff to use to support residents. The provider reports that they are gradually investing in more profiling beds to meet residents needs. At the random inspection, two areas of the home were identified to be cold and requirements were set. These were not due to be addressed by this inspection. The sitting area of Countess Wing was curtained off during the inspection while the maintenance person redecorated the area. They reported that once they had completed this, they would be going on to further concentrate on bedrooms. We observed that many carpets in bedrooms continued to show signs of stating and this needs to be addressed, to enhance a homely atmosphere in the home. Before the previous inspection, we had been informed by different people that odours had been noted in different parts of the home. When we performed that inspection, we found this to be a correct observation. By this inspection, odours were very much reduced and were only noticeable in one small area of the home during the inspection. Domestic staff were very much in evidence in the home. They reported that they had all the equipment and chemicals that they needed to perform their role. One person reported on improved levels of support and supervision to domestic staff. We visited the laundry. The laundress was on annual leave and a senior member of the domestic staff was performing the role. The laundry was clean and tidy. The person performing the laundry reported that staff complied with the homes infection control policies when they placed soiled or potentially infected linen in red alginate bags. However we observed that the home continued to place all other used linen in the same bag and not to separate at source, as is currently advised, to reduce risks of cross-infection. Systems have been put in place to ensure that underclothes and socks are marked and returned to individual residents. We observed in Comilla Wing that laundry in red alginate bags continued to be placed in an over-full linen skip, so that it spilled out over onto the floor; this was under a notice stating that all linen bags must Care Homes for Older People Page 25 of 45 Evidence: only be half full. If alginate bags for infected or potentially infected linen are not correctly managed, there is a risk to cross-infection. Care Homes for Older People Page 26 of 45 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents continue not to be supported by numbers of staff that they need who have been inducted and trained in their role. Evidence: At the previous inspection, this outcome area was judged to be adequate. Following this inspection, we met with the providers on a formal basis and they submitted an improvement plan and then informed us of how their action plan was progressing. We also performed a random inspection on 21st December 2010, to review progress towards meeting requirements. People commented to us about staffing in surveys. Five people felt that there were usually and one sometimes staff available when they needed them. Two members of staff felt that there were usually, four sometimes and two never enough staff on duty to meet the needs of residents. Comments included if XX presses their bell, it is never long before it is answered, another that the home have staff who work well under pressure and another every member of staff cares to the best of their ability. However one person reported that the home needed more staff, another more training to staff and another not enough time/staff to do the job properly and staff need support. Several people were concerned about the English language skills of staff. One person reported some of the staffs English is very limited making it hard for other staff to understand or explain things, another that the home needed to Care Homes for Older People Page 27 of 45 Evidence: have staff that speak English and another we currently have new staff members where English is not their first language therefore communication may be a problem. Evidence in Health and Personal care and Daily life and Social Activities above continue to provide evidence that the home needs to continue to ensure that there are enough staff on duty, who have been fully inducted, trained and are supervised to support residents. A care assistant we met with considered the home understaffed, work was constant task to task, there was no time to sit with residents and on shift, there were some they had not spoken to all morning. This was echoed by several other staff we spoke to. Another care assistant disagreed; they considered the staffing levels about right, providing they were upheld. Afternoons were quieter and gave an opportunity for engagement, for example, the previous day they had undertaken nail cutting with several residents and used that as conversation time. A source of frustration for staff was that they were moved too often between the units. This degree of movement had been brought in by the previous manager, but there was no continuity for staff or residents. This meant that they lost sight of the longer-term picture for individual residents. Staff reported that they could look at care plans but did not regard them as accessible. Such frequent moves will also affect any key worker and named nurse systems; such systems ensures continuity of care for residents. The home cares for some residents who have additional dementia care needs, for such residents continuity of care is of much benefit. We looked at the personnel records for five recently recruited staff. These were three care assistants, a senior care assistant and a cleaner. In each case there was an application form and record of interview. None of these staff had been given a start date for employment before receipt of confirmation that they were not on a list that barred them from working with vulnerable people. There was evidence that peoples identities were checked, and Criminal Records Bureau disclosures were applied for at the earliest opportunity, so usually they were received shortly after people commenced their induction. Two references were obtained for each person. Personnel files were all ordered in the same way, and contained a checklist that showed when the various documentation was requested and received, including work permits and confirmation of nurses registration with the Nursing and Midwifery Council, where applicable. We noted in one instance that there was a break of over two years in a persons record of employment. It is necessary to show that such breaks have been recognised and explored. A similar matter was identified at the previous inspection and a requirement set, so it should have been addressed by this inspection when employing new staff. Similarly, if a person has a criminal conviction or caution in their past, there should be a record of how this has been addressed with them, leading to a Care Homes for Older People Page 28 of 45 Evidence: decision that their appointment has been assessed as safe. The home does not document their assessment of prospective member of staffs verbal or written English language skills. A member of staff reported they dont train new staff properly and another that if could be difficult to talk to the new members of staff due to language difficulties and that getting the message through can be hard. An induction record for each staff member showed how they had been introduced to various aspects of working safely in the home. These varied in how many elements had been signed off by mentoring staff. The induction record showed that a number of training DVDs were expected to be seen, but the records for recently appointed staff did not confirm this had happened. We were told that management had recognised there had been some shortfalls in operation of the induction process, which it was intended would now receive higher priority. It remains the intention to align induction with recognised Common Induction Standards. Training matrices showed training accomplished by, and identified for, nursing, care and auxiliary staff. From this had been drawn up a list, under each area of training, of the staff that needed initial or refresher training. A month-by-month action plan for staff training in 2010 made use of this information so training could be targeted at priorities identified. This did not include all areas identified, but the new manager said it was a working document that would be added to during the year. They were planning to access a range of training resources from their previous place of work. We saw that training packs for food hygiene and dementia awareness were distributed to the staff identified respectively in the training plan, with return dates for assessment. The next training course being run in the home was a four hour session on moving and handling. The staff detailed for this corresponded to the list of names in the training plan. A care assistant reported that they thought they had good access to training. A different care assistant reported to us that they had been trained in manual handling, food hygiene, abuse awareness, infection control and dignity awareness. The home had been included in an offer of external training by a speech and language therapist. The new manager said staff would be detailed to attend if there should be insufficient volunteers to do so. Care Homes for Older People Page 29 of 45 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will have improved supports by new management systems in the home, however there continue to be matters which have the potential to put residents at risk in their health, safety and welfare. Evidence: At the last inspection, this outcome area was judged to be poor. Since the last inspection, we have held a formal meeting with the provider, who has submitted an improvement plan to us. As their action plan progressed, they submitted up-dates to us. The homes previous manager left at the end of 2009. We performed a random inspection a few weeks after they had left. At that time the homes deputy manager was responsible for the management of clinical care, as they had done previously. As well as this role, they were also revising all the nursing and care documentation and at times acting as one of the registered nurses on duty. The provider has been successful in recruiting a new manager. This person had only come into post a few days before this inspection. They reported that they had been approved by us to be the manager of another home and had had experience of making improvements in a home which Care Homes for Older People Page 30 of 45 Evidence: had been poorly rated previously. The new manager reported that until they had their Criminal Records Bureau clearance returned, they were concentrating on conducting audits of service provision in the home. The provider performs regular visits to the home and completes clear and detailed records of these visits on a monthly basis. We recommended that they should include the quality of complaint recording in each monthly audit. The deputy manager had a good personal knowledge of clinical outcomes for residents. Full records of accidents to residents, including unexplained bruising, are now maintained. The new manager reported that they will be including systems for the audit of clinical outcomes as part of their reviews of service provision. We reviewed systems for management of residents moneys and observed that they had been fully modernised since the last inspection, to include a cash-less system. The administrator reported that a full audit of valuables held on behalf of residents has taken place and that residents supporters had been contacted to remove any such items held by the home. As noted in Health and Personal Care above, the home still needs to ensure that all records relating to residents are in place, are accurate and completed contemporaneously. As all invoices for fees are dealt with centrally by the providers, copies of invoices are not retained in the home. In order for us to ensure compliance with Regulations, the home needs to be able to provide us with evidence of correspondence relating to payment of fees, including additional charges and that the registered nursing contribution is credited to each self-funding individual. Staff commented to us about supervision in surveys. One person reported that their manager regularly, three sometimes and one never gave them enough support and met with them to tell them how they were progressing. One person reported in their survey that it seems as though a lot of work is put into the few instead of it being shared out, and another we all deserve a bit of respect for the job we do. One care assistant reported to us that the home was getting better with lots of support from management. Several people we spoke with were in agreement that supervision of work was important, and was insufficient. They said poor standards of work by some were not picked up by nursing staff or management, and this resulted in extra work for others. During the inspection, we observed on Comilla Wing that two more experienced carers and two less experienced carers were working together, rather than each experienced carer working with a junior carer. Both the junior carers first language was not English and we observed them more than once conversing with each other in their own language. This would not have happened if they had each been allocated to a more senior carer. As noted in Health and Personal Care above, we also found that not all staff were aware of matters affecting residents, or followed care plans. This indicates that more supervision of staff at all levels is needed. Care Homes for Older People Page 31 of 45 Evidence: One person commented in their survey that the home needed more training on the safety side i.e. fire mainly. We are aware that the home has been visited by the fire safety officer and that they have directed the home on improvements that they need to make. The providers has developed an action plan to address what has been required by the fire safety officer. We also advised that the home should develop individual fire evacuation plans to identify resources and additional training to ensure that each resident can be safely evacuated to a place of safety in the event of a fire. We observed three different residents being assisted to move by care staff using equipment. Two of the manual handling procedures were correctly performed, using equipment in a correct manner, with staff supporting the resident throughout and explaining what they were going to do, as well as keeping in touch with each other throughout the procedure to ensure that the resident was safe. However the third observation of use of equipment was not correctly performed.The brakes were not applied to the equipment, which could have provided risk to the resident and staff. The safety belt was not placed correctly on the resident, so it did not hold them in position and the staff used the persons belt to transfer the person due to this. This is unsafe practice and could have put the resident and staff at risk. The two members of staff observed to do this were new and their first language was not English. Their performance may relate more to lack of correct supervision for them in their role and incomplete training. We continued to observe that some bed rails were not used in a safe manner, this included safety rails showing a large gap between the rail and head of the bed where a person could get their head or a limb entrapped and rails which were loose in their fixings. We discussed this with the maintenance person who was able to show us their monthly checks on bed rails. They reported that they considered the issue related to staff lack of understanding of the risks presented by the use of bed rails. They reported that they had ensured that bed rails were correctly put on beds but that staff moved them when performing care, they also performed care over the bed rails, rather than lowering them to perform care. As noted in Daily Life and Social Activities above, we observed a member of staff doing this when assisting a resident to eat. The home needs to take urgent action to improve performance in this area. At the matter has been un-met for an extended period of time, this matter has been reported to the Health and Safety Executive. The maintenance man reported that they were beginning to work on environmental risk assessments but that they had not been completed yet. They showed us their maintenance book, which showed that staff reported defects to them and of the Care Homes for Older People Page 32 of 45 Evidence: actions they had taken. Our pharmacist inspector used one of the three lifts with a registered nurse, the lift stopped unexpectedly between floors. The registered nurse rang the bell. This was hardly audible and the registered nurse informed the Pharmacist Inspector that this was not the first time the lift had done this. We are aware from correspondence with the provider that one of the lifts has not functioned properly in the past and that it has been repaired but is the subject of an on-going review process. In order to ensure the safety of residents and staff, the home needs to ensure that the lifts alarm bell is fully audible, so that staff can take action to ensure peoples safety, if the lift does stop. Care Homes for Older People Page 33 of 45 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 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 resident. 2 7 15 Where a person is assessed 31/03/2010 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. Care plans must be reviewed and updated 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 Care Homes for Older People Page 34 of 45 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action changed needs. 3 7 12(1) Where a resident is not able 31/03/2010 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. 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 19 23 Management must ensure that all parts of the home used by residents are warm enough for them to use. Requirement not due to be met by this inspection. This is to prevent risk of discomfort or hypothermia for residents. 26/02/2010 15/12/2009 Care Homes for Older People Page 35 of 45 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 6 26 13(3) The home must ensure that all potentially infected laundry and general laundry is correctly managed. Requirement met in progress. This is to prevent risk of infection. 31/03/2010 7 27 18(1) The home must ensure that 31/03/2010 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 in progress. Enough staff need to be on duty to meet resident nursing and care needs and to ensure their safety. 8 29 19(1) The home must ensure that 31/03/2010 it follows standards and regulations on the employment of staff in full at all times, including the employment of registered nurses. Requirement in progress, it has not been addressed in full. By following standards and regulations, the home will be able to ensure that it will not recruit people who are Care Homes for Older People Page 36 of 45 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action unsafe to work with the client-group. 9 30 18(1) The home must ensure that 31/03/2010 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 30 18(1) The home must ensure that 31/03/2010 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. 11 31 8(1) The provider must ensure 30/04/2010 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. 12 33 24(1) As Camelot is a care home 31/03/2010 Page 37 of 45 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action with nursing, systems for audit of quality of clinical 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. 13 37 17 Records relating to the 27/01/2010 provision of nursing and care 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. Requirement addressed in part. Records of brusing and other injuries to residents are made but other records are not always accurate or completed at the time care is given. This is to ensure that staff at all levels have accurate information and that correct actions can be performed to meet residents needs. 14 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 31/03/2010 Care Homes for Older People Page 38 of 45 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action person completing the record. Requirement addressed in part. Records were signed and dated. Not all records required by us were available in the home. 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. 15 38 23(4) The home must be able to 31/12/2009 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. 16 38 13(4) The home must develop full 31/03/2010 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 environment have been reduced to a minimum. Requirement in progress. Care Homes for Older People Page 39 of 45 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 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 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 addressed in part, assessments are now in place but rails are not safe and assessments were not always followed. 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. 18 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. 30/09/2009 30/09/2009 Care Homes for Older People Page 40 of 45 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, Care Homes 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 9 13 Blood testing devices used in 31/03/2010 the home must be suitable for use by a nurse or another person as stated in the Medicines and Health care Products Regulatory Agency information. Blood testing devices used in the home must be suitable for use by a nurse on another person as stated in the Medicines and Health care Products Regulatory Agency information. This will ensure that staff and people in the home are protected from harm. 2 12 18 The provider needs to 30/04/2010 ensure that carers are enabled to support individual people in social activities Activities are a key area of social lives for residents, particularly people who are Care Homes for Older People Page 41 of 45 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 frail or have dementia care needs. 3 18 13 Where residents are assessed as being at risk if their condition is not regularly checked upon, there must be written monitoring systems to show that people are being observed at the frequency directed. People who have complex medical conditions and or dementia care needs who are not able to summon assistance independently need to have their condition monitored ion accordance with their care plan. 4 36 18 Full systems for staff supervision must be put in place. If staff are not properly supervised, residents may be put at risk. 5 38 13 Lift alarms must be fully audible or appropriate warning systems must be in place if the lift becomes stuck. This is to ensure the safety of people using the lift. 31/03/2010 30/04/2010 31/03/2010 Care Homes for Older People Page 42 of 45 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 1 3 Admissions assessments should detail how a disability will affect a persons ability to perform activities of daily living. This recommendation was made at the random inspection of 21st December 2009. It was not reviewed at this inspection. 2 3 The home should follow relevant NICE guidelines when making assessments of clinical need when a person is admitted. This recommendation was made at the random inspection of 21st December 2009. It was not reviewed at this inspection. 3 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. This was identified at the random inspection of 21st December 2009. It has not been addressed. 4 5 9 12 Consideration should be given to the appropriate storage of nutritional food supplements. Admission assessments should detail the persons own perception of their religious needs. This recommendation was made at the random inspection of 21st December 2009. It was not reviewed at this inspection. 6 15 Carers should always sit down with the resident when supporting them to eat their meal. This recommendation has not been addressed for the previous two inspections. 7 15 Where a resident does not like the flavour of a particular drink, this should always be documented and staff should ensure that the persons likes and dislikes are respected. All staining should be removed from carpets in residents rooms and communal areas. This recommendation has not been addressed for the past two inspections. 8 19 Care Homes for Older People Page 43 of 45 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 9 19 Thermometers should be provided in colder areas of the home and regular written observations of the temperature be documented. The practice of staff working accross all parts of the home, at all times, should be reviewed to ensure continuity of care to residents and forster a key worker and named nurse apporach to nursing and care provision. The interview assessment should document potential employees written and verbal English language skills. The quality of complaint recording should be included in each monthly audit by the provider. Each resident should have an individual fire evacuation plan drawn up. All people who use, fit and check safety rails should be fully trained in their use. This recommendation was identified at the previous key inspection. It has not been addressed. 10 27 11 12 13 14 29 33 38 38 Care Homes for Older People Page 44 of 45 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. 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