Inspection on 21/07/08 for Camelot House, Wellington

This inspection was carried out on 21st July 2008.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Camelot House, Wellington 15/12/08

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Camelot House, Wellington Chelston Wellington Somerset TA21 9HY Lead Inspector Kathy McCluskey Unannounced Inspection 21st July 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Camelot House, Wellington Address Chelston Wellington Somerset TA21 9HY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01823 666766 01823 667568 info@camelothousenursing.co.uk Camelot Care (Somerset) Ltd Mr Tyrone Redverse Dulken Taylor Care Home 66 Category(ies) of Dementia (66), Mental disorder, excluding registration, with number learning disability or dementia (66) of places Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 care needs on admission to the home are within the following categories: Dementia (Code DE) Mental disorder, not including learning disability or dementia (Code MD) The maximum number of service users who can be accommodated is 66. Rooms 1, 2, 3 and 5 can only be used by people who are fully mobile. 2. 3. Date of last inspection N/A New service Brief Description of the Service: Camelot House is registered with the Commission for Social Care Inspection to provide nursing care for up to 66 older people who have a dementia or mental disorder. The home is not registered to provide care to people who have a primary diagnoses of a learning disability or to those who require general nursing care. The home is owned by Camelot Care (Somerset) Ltd. The responsible individual is Mr J.Teasdale. The registered manager is Mr Ty Taylor. Camelot Care (Somerset) Ltd was first registered by the Commission in February 2008 and although the directors, Mr and Mrs Teasdale have owned the home since 2003, the change in provider makes this a new service. The home has a Social Services Quality Rating. This year the home have been awarded a 4 star excellent rating from Environmental Health. It has also achieved the Investor in People Award for its commitment to staff training. Camelot House is a detached property situated on the main road between Taunton and Wellington and is on the bus route to both towns. Local amenities, which are close by, include a garage with a small convenience store and two Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 5 garden centres. The home has recently benefited from major building and refurbishment works which have included a new extension which has been designed to meet environmental recommendations for people with dementia. This unit was registered by the Commission in June 2008. Several improvements have also been made to the existing environment and garden areas. Full details can be found in this report. The home has a large car park. We were advised that current fee levels are between £390 & £750 per week. Additional costs met by people using the service include; Hairdressing, personal items/toiletries and chiropody. Some activities incur some costs such as entrance fees, outside entertainers etc. Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service for each outcome group under four general headings. These are; - excellent, good, adequate and poor. This was the home’s first inspection since registering as a new provider. This unannounced key inspection was conducted over one day (7.75hrs) by CSCI regulation inspector Kathy McCluskey. The Commission’s regional lead pharmacist Brian Brown spent part of the morning of this inspection examining the home’s procedures for the management and administration of medication. The registered manager, Mr Ty Taylor and both company directors Mr and Mrs Teasdale were available throughout this inspection. At the time of this inspection 37 people were living at the home. During the day we were able to observe interactions between staff and the people living there. We were able to speak with a number of people, staff, one relative and one healthcare professional. We were given unrestricted access to all parts of the home and all records requested for this inspection, were made available to us. As part of this key inspection we sent comment cards to a number of people using the service, relatives, staff and healthcare professionals. We received completed comment cards from six relatives and three people living at the home (2 had been completed with help from relatives). Comments have been included in this report as appropriate. We were also able to use information from the home’s completed Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Details have been included throughout this report as appropriate. We would like to thank all involved for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 7 What the service does well: The home has been awarded a Quality Rating with the Local Authority. It has also recently been awarded a 4 star excellent rating from the Environmental Health Department. Camelot House provides people with a comfortable and homely environment. The directors have demonstrated their commitment to improving the standard of the environment and have taken steps to ensure that it is appropriate to the needs of older people with dementia. The new wing has been designed and built in line with environmental recommendations for people with dementia. Major improvements have also been made to existing parts of the home and there are plans to improve all areas of the home. People have access to two pleasant and secure garden areas. These have been well designed and are accessible to people in wheelchairs. The home has procedures in place to ensure that nobody moves to the home unless they have been appropriately assessed. The home liaises closely with appropriate healthcare professionals and obtains assessments where available. People who are thinking about moving to the home are given the opportunity to ‘test drive’ the home and are provided with detailed information about the home and services offered. The home’s care planning and review processes are good which help to ensure that people’s assessed needs are identified and met by staff in a consistent manner. The home ensure that people living at the home are cared for by appropriate numbers of well trained staff. Registered nurses are on duty 24hrs a day. Staff told us that training opportunities were good and that they felt well supported. Training records showed us that staff had received up to date mandatory training. NVQ training is promoted and currently 63 of care staff have achieved a minimum of an NVQ level 2 in Care. More staff are working towards this award. The home have achieved the Investor in People award for their commitment to staff training. Appropriate procedures are in place and followed which reduce the risk of harm or abuse to the people living there. Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 8 The home employs activity staff and opportunities are available for people to engage in activities both within the home and during trips out. Links with the local community are encouraged. The home has a wheelchair accessible mini bus. People benefit from effective management systems where an open and inclusive style of management is promoted. The home has procedures in place to ensure the health and safety of persons at the home. We received six comment cards from relatives and they made the following comments about ‘what the home does well’; ‘Friendly atmosphere and we are always welcomed’ ‘Whenever we visit, everywhere seems bright, cheerful and calm and people seem contented and well cared for’ ‘The home provides entertainments and trips and we have meetings for relatives and friends to discuss outings etc’ ‘The care of the residents, allowing them to be individual but safe’ ‘They give excellent care and staff are friendly’ ‘Communication with family is extremely good’ What has improved since the last inspection? What they could do better: The home’s procedures for the management and administration of peoples’ medication needs improving to ensure that medicines are administered in line with the prescriber’s instructions. We received the following comments from relatives; ‘We are satisfied with the running of the home and the major renovations planned will help residents and staff’. ‘More one to one attention’ ‘More attention to detail such as nail care and trimming their hair’ Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 5. Standard 6 is not applicable as the home is not registered to provide intermediate care. Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. The home ensures that people who are thinking about using the service, and/or their representatives, have the information they need to enable them to make an informed decision about moving to the home. The home has procedures in place to ensure that it only offers a service to people whose needs and aspirations can be met by the home. People are given the opportunity to test drive the home. EVIDENCE: Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 12 The home has produced a Statement of Purpose, Service User Guide and brochure, which contain photographs. These documents provide information about the home and services offered. The home’s completed AQAA confirms that they provide; ‘Comprehensive and attractive Service User Guide containing photos about the home’ and that ‘Invitation to visit by relatives and full information given about our service with additional brochures given out about care related services’. We were informed that the home is in the process of developing its’ own website which will provide people with additional information about the home and services offered. Two people using the service who completed a comment card for the Commission confirmed that they had received enough information about the home before they moved in which enabled them to make an informed decision to move there. We examined four care plans at this inspection and all contained evidence that people thinking about using the service had been appropriately assessed by the home before a placement was offered. We were also able to see that the home had obtained additional assessments from appropriate healthcare professionals where available. The AQAA completed by the home confirmed that they; ‘Request SAP assessments about prospective clients and any other multi-disciplinary medical opinions to help judge the needs to the person and followed by preassessment by the home (majority of times done by 2 trained staff)’ The AQAA also stated; ‘Following admission we request a biography from relatives to enable staff to more fully understand the resident’. The home’s completed AQAA told us that people who are thinking about using the service and/or their representatives are encouraged to visit the home before making a decision to move there. The home also offers a four-week trial period on admission. We were able to meet with one relative during this inspection and they were able to confirm that the admission process was managed in a ‘very sensitive manner’ and that they had been given the opportunity to visit the home before making a decision. ‘Simple, clear contracts are sent out as soon as all information is received’ We received three completed comment card from people using the service and they confirmed that they had received a contract. Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. The assessed needs and preferences of individuals’ are clearly set out in their plan of care. The home ensure that people have access to a range of appropriate healthcare professionals. The home’s procedures for the management and administration of peoples’ medication require some improvements. People are treated with respect and the home has procedures in place to ensure that their preferences during their final days and following death are respected. EVIDENCE: Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 14 During this inspection we examined four care plans in detail and ‘tracked’ the care of these people through examination of other records such as accidents, medication and contacts with healthcare professionals. We also met with these people and viewed their bedrooms. We found care plans to contain information which reflected the individuals’ assessed needs. Care plans had been devised from completed assessments which included moving and handling needs, nutritional assessments, risk of pressure sore assessments and dependency assessments. Completed risk assessments were also in place. There was evidence that the individual and/or their representative had been involved in the care planning and review process. It was positive to note that the home had completed assessments in line with the Mental Capacity Act, which identified the persons ability to make informed decisions about their care. Care plans also contained information as to the individuals’ preferences with regard to preferred times for waking, retiring to bed, dietary preferences and bathing. The home’s completed AQAA told us that a life history is requested from the individual’s relative. This provides the home with important information about the individual’s life and social interests. Information for staff on how assessed needs should be met contained sufficient information to ensure that care was delivered in a consistent manner but this could be further improved especially with regard to the management of challenging behaviour. We found that one care plan needed a more person centred approach so that staff could be very clear on the processes to follow when this person exhibited challenging behaviour. We discussed our findings with the registered manager and registered providers at the time of this inspection and it was agreed that action would be taken to address this. Care plans contained evidence that people have access to appropriate healthcare professionals. Each person is registered with local GP’s. The home maintains detailed records relating to the persons contact with healthcare professionals. There was evidence that people have access to appropriate mental health professionals as appropriate. We had feedback from three healthcare professionals and no concerns were raised regarding the care provided. The home maintains good contact with healthcare professionals. Peoples’ weights are monitored by the home on a monthly basis. Records viewed clearly identified any concerns and we were able to see that care plans had been raised where required. Three people using the service completed a comment card for the Commission and in response to the question; ‘Do you receive the care and support and medical support you need?’ they responded ‘Always’. They also confirmed that staff listened and acted on what they said. Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 15 We received a completed comment card from six relatives, four responded ‘Always’ to the questions; Do you feel that the care home meets the needs of your relative?’ and ‘Does the care home give the support or care to your relative that you expected or agreed’. Two responded ‘Usually’. ‘I never thought my relative would walk again, but since being at Camelot House they have managed to get her mobile again’. ‘The points in the care plan appear to be practised’ The home’s completed AQAA told us; ‘Each resident has their own GP and access via referral, physiotherapists, occupational therapists, dieticians and speech therapists’. ‘Residents have access to dentists, visiting opticians and chiropodists (monthly visits). ‘Hospital appointments are always kept, staff accompany residents and a copy of the appointment is sent to the relative’ The Commission’s regional lead pharmacist examined the home’s procedures for the management and administration of peoples’ medication and his findings were as follows; We found that the home are using a monitored dosage system for managing the administration of medicines and that the medication administration record (MAR) charts are mostly produced by the pharmacist supplying the medicines. However we found that when hand written entries are made on the charts that the entry made does not always specify the dates that it refers to and also that the dose to be administered is not the same as that on the dispensing label and also that abbreviations are used. During the inspection it was observed that a medicine was given at half the dose prescribed and this may have been due to the use of abbreviations on the chart. We also observed that when people are prescribed a variable dose that the dose actually administered was not always either recorded or clearly recorded, so meaning that it is not possible to monitor how a person is responding to their prescribed treatment. We also saw that a pre-code was used on the MAR chart when medicines were not administered, however this pre-code was used on the same chart to mean different things and on talking to the manager he also came up with a further definition for the pre-code that was not recorded. This means the reason for non-administration is not clear. We also found that within people’s plans of care that there were no directions to staff on how to make the decision on what dose to administer or how to monitor the response to the dose. We found similar concerns for medicines prescribed to be administered “when required” that there was no guidance available to members of staff about when a medicine was to be administered, or how the person was to be monitored after the administration and when a subsequent administration was to be made. We found that records were made appropriately to reflect the application of prescribed creams and also that people were having prescribed nutritional supplements in accordance with their assessed needs. All medicines were stored securely in accordance with current regulations and manufacturers guidance. Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 16 Following feedback at the end of the inspection a serious concerns letter was sent regarding the administration of variable doses and “when required” medicines. The manager and provider stated during the feedback that they would address the issues and confirm this in writing to us. The home’s completed AQAA told us that people are treated with respect and that their right to privacy is respected. ‘Resident’s privacy and dignity are observed at all times when delivering health and personal care which is in keeping with the home’s philosophy’. Throughout the day we were able to observe staff interactions with the people living at the home. These were noted to be kind and respectful. People looked clean and well attired. All bedrooms are for single occupancy. The home has procedures available for staff relating to end of life care and following death. Care plans contained information about the individual’s preferences following death and of their religious beliefs. The AQAA told us that; ‘Dying and terminal care are discussed with relatives on admission and staff have been trained in this area’. The home have started to produce a book for people titled ‘In loving memory’. This contains photos of people who have passed away at the home. Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. The home ensure that people are given the opportunity for social stimulation and community contact. People are offered a wholesome and varied diet and the home could improve the arrangements for offering choices and promoting independence during meal times. EVIDENCE: The home employs an activities co-ordinator who works week day afternoons. Additional staffing is available for activities two afternoons a week. Care plans contained information about individuals’ life history and social interests. A separate activity file is maintained which contains an activity assessment sheet for each person. This clearly identifies the person’s physical and cognitive abilities and also identifies their interests. The activity co-ordinator also records details of the activity offered and of the outcome for the individual. Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 18 We sampled a number of records and these confirmed that people are regularly offered a range of activities. There was evidence of one to one sessions with people as well as group activities. There was also evidence that people are offered trips outside of the home. Outside entertainers regularly visit the home and arrangements are made for religious services at the home. One relative made the following comment in a completed comment card; ‘We often receive letters from the home inviting us to forthcoming activities’. A hairdresser visits the home twice a week. During the afternoon of this inspection we were able to observe the activity coordinator initiating small group activities as well as spending time chatting to people on an individual bases. A notice board in the reception area of the home contains photographs of recent trips and events at the home. The most recent being the home’s annual fete. We were told that the home’s pet rabbit ‘Pudding’ is a favourite at the home. The home’s completed AQAA told us that in the last 12 months they have; ‘Purchased a mini bus with tail lift so that residents can easily be taken on trips’ and that ‘The activities co-ordinator has attended a number of relevant courses and that the majority of staff have attended course activities for dementia care’. We spoke with one relative during this inspection and they confirmed that they could visit at any time and they were always made to feel welcome and were offered refreshments. During this inspection we were able to observe the lunch-time experience for people at the home. As previously mentioned, the home record information about peoples’ dietary preferences in their plan of care. The majority of people were observed utilising both dining areas. All meals are freshly prepared and cooked at the home by the home’s catering staff. Meals arrived in the dining areas in hot trolleys. The meals looked wholesome and plentiful and soft diets had been attractively presented. We noted that meals were already plated. The cook informed us that people are asked about their choices for the lunch-time meal during the morning. We spoke to three people just before lunch and nobody was able to remember what they had ordered. The home could further enhance the lunch-time experience for people if they considered the use of serving dishes and explored more appropriate methods for offering choice to people with memory difficulties. We discussed this with the registered manager and registered providers at the time of the inspection. In January 2008 the home were awarded a 4 star excellent rating by environmental health. Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. The home has effective procedures in place, which allow people to raise concerns. Appropriate procedures are in place, which reduce the risk of harm or abuse to people living at the home. EVIDENCE: The home displays an appropriate complaints procedure which also includes the contact details appropriate external agencies. Four people using the service completed a comment card for the Commission and they confirmed that they knew who to make a complaint. This was also confirmed by five of the six relatives who completed a comment card. Three people spoken with during the inspection told us that they would feel comfortable in raising concerns if they had any. No concerns were raised with us during this inspection. The home’s completed AQAA states; ‘The home endeavours to have good relationships with its’ clients and is open to suggestions’ ‘Following complaints a thorough investigation is undertaken and a response is made promptly within Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 20 28 days’ ‘In the Service User Guide, the home promotes the services of advocates’. The home have been proactive and have worked closely with appropriate agencies, including the Commission, to address a concern received in June of this year. The home has a range of policies and procedures available to staff to ensure that people are protected from the risk of harm or abuse. The home has a copy of Somerset’s revised Safeguarding Adults procedure and training records indicated that all staff have received appropriate training. Policies are also in place relating to the acceptance of gifts, missing persons and the management of aggression. Staff spoken with also confirmed that they were aware of the ‘whistle blowing’ policy and that they knew how to raise concerns. The home’s staff recruitment procedures reduce the risk of harm or abuse to the people living there. Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. The home has benefited from major building and refurbishment work and there are plans for further improvements to existing parts of the home. The home is fitted with a range of appropriate aids and adaptations to assist the people living there. People can choose from a number of communal areas and each person has their own bedroom which they can personalise. People have access to pleasant and secure garden areas. The home has appropriate procedures in place to reduce the risk of the spread of infection. The standard of cleanliness is good. Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 22 EVIDENCE: In June of this year, the Commission approved an application from the home to increase their registered numbers from 42 to 66. The purpose built extension to the existing home has been designed in line with environmental recommendations for older people with dementia. This new wing, named the Daffodil Wing consists of 24 bedrooms located over two floors. Each bedroom exceeds the National Minimum Standards for size and all are fitted with ensuite toilet facilities, adjustable beds and comfortable furnishings. Lighting in each bedroom is sensor controlled. Under floor heating is installed on the ground floor with individual thermostats in each bedroom. Bedrooms on the first floor are fitted with cool touch radiators and thermostats. The décor is colour coded to aid recognition of certain facilities such as toilets and bathrooms. On the Daffodil Wing there are two bathrooms fitted with Arjo assisted baths and one bathroom with a bath which can be accessed by a hoist. The registered provider has further plans to improve bedrooms in the existing part of the home. Major work has been carried out already to improve and increase communal areas. The home benefits from a large entrance area which leads in to a very spacious reception area. A very spacious conservatory provides additional seating and dining facilities. This has been fitted with blinds to ensure that it remains at a comfortable temperature. A very large lounge has been created and seating has been arranged to enable people to sit in smaller groups and in different areas. All furniture and fittings are new and are of a very good standard and a large wall mounted plasma television with DVD has been installed in one part of this lounge. People have access to a sensory room. Corridors leading to bedrooms in the existing parts of the home have been repainted to assist people to better orientate themselves. Additional gardens to the front and rear of the property have been created and have been landscaped with the needs of older people with dementia in mind. The gardens provide safe and pleasant areas which people can easily access. During this inspection we observed people utilising both gardens, some with staff support and some independently. Full details about the home’s environment can be found in the home’s Service User Guide/brochure. The home has a range of suitable aids and adaptations to assist the people living there. All bedrooms have adjustable beds, there is a good supply of Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 23 pressure relieving equipment and moving and handling equipment. A nurse call system is fitted throughout the home and grab rails and assisted toilets are appropriately sited. Passenger lifts give access to the first floor. To ensure the safety of people living at the home, apart from doors leading to the gardens, external doors are fitted with a key pad devise which is linked into the home’s fire alarm systems. The home employs domestic staff and on the day of this inspection, all communal areas and number of bedrooms viewed were found to be clean and fresh smelling. The home has procedures in place to reduce the risk of the spread of infection. Training records indicated that the majority of staff have now completed training in infection control. We were able to see that staff had access to a good supply of protective clothing and gloves and aprons were being worn as appropriate. Liquid soap and paper hand towels are appropriately sited throughout the home. As previously mentioned, all areas viewed during this inspection were clean and free from malodours. One relative said; ‘Whenever we visit we find the home clean, fresh and welcoming’ Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. Peoples’ needs are met by adequate numbers of staff who have been appropriately trained. The home ensures that staff have the skills needed to meet the needs of the people living there. The home follows robust staff recruitment procedures which reduce the risk of harm or abuse to the people living there. EVIDENCE: At the time of this inspection we were told that 37 people were living at the home and we were informed that staffing levels were currently as follows; Morning – 2 registered nurses and 6 care staff Afternoon – 2 registered nurses and 4 care staff Evening – 2 registered nurses and 5 care staff Night – 1 registered nurse and 3 carers, this reduces to 2 carers after 2200hrs. We were informed that current staffing levels were sufficient to meet the numbers and needs of the people at the home. This was also confirmed by the three staff members spoken with. Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 25 During the inspection, the registered providers and the registered manager confirmed that staffing levels would be increased as required to meet peoples’ needs and/or an increase in the numbers of people living at the home. The home appears to have a stable staff team and they have not had to use agency staff. In addition to the care hours identified above, the registered manager is on duty during the week. Domestic, laundry, kitchen, maintenance, administrative and activity staff are also employed. The home’s AQAA told us that of the 19 permanent care staff employed, 12 have achieved a minimum of an NVQ Level 2 in care. This equates to 63 which exceeds the 50 recommended in the National Minimum Standards. We were also told that 5 staff are currently working towards this award. Two care staff spoken with were positive about the NVQ training. One confirmed that they had just completed the NVQ 2 award and that they were hoping to undertake the NVQ level 3. We examined the home’s procedures for the recruitment of staff. Three staff recruitment files were examined and these were found to contain all required information. We were able to see evidence that staff did not commence employment until the home was in receipt of an enhanced criminal record check (CRB) and protection of vulnerable adults check (POVA). Staff files also contained signed contracts, job description and confirmation that the employee had received a copy of the General Social Care Council code of conduct. We were also able to see evidence that staff undertaken an appropriate induction programme on commencement of employment which included all mandatory training and training in the Mental Capacity Act and Protection of Vulnerable Adults. Newly appointed staff then follow a 12 week induction programme which follows the Skills for Care Common Induction Standards. We were able to speak to a member of staff who had recently commenced employment. They confirmed that they had received a ‘very good’ induction and had received the training they needed to care for people at the home. Another member of staff told us that, ‘The training is really good here’ and ‘I’ve done all the mandatory training plus more’. The home have achieved the Investor in People Award for their commitment to staff training. In response to the question; ‘Do the care staff have the right skills and experience to look after people properly?’ five of the six relatives who completed a comment card for the Commission responded, ‘Always’. ‘The staff seem to be experienced, caring and kindly’. Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 26 Three people responded, ‘Always’ to the question; ‘Do you receive the care and support you need?’ Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. People benefit from effective management systems where an open and inclusive style of management is promoted. The home has systems in place to ensure that staff are appropriately supervised and that the views of other stakeholders are sought. The home follows correct procedures to ensure the health and safety of persons at the home EVIDENCE: Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 28 The registered manager is Mr Ty Taylor. Mr Taylor is a registered mental health nurse who has many years experience in caring for older people with dementia. Staff spoken with were very positive about the registered manager and all confirmed that they received very good support. The home’s completed AQAA told us that; ‘The registered manager is well qualified and experienced for the task and is approachable and respected by relatives and staff’, ‘He has a vision to develop the home as a beacon for successful dementia care’. Through observation and discussion, it was very apparent that the registered manager has a very good knowledge and understanding of the needs of the people living at the home and is very much ‘hands on’. A relative stated in a completed comment card that; ‘The home always keep me informed about my relative and let me know immediately if there are any concerns’ ‘I phone regularly and they are very helpful’ The registered manager and providers promote an open and inclusive style of management. There is a relatives’ forum and regular meetings are held with minutes maintained. We were able to see that relatives’ suggestions are encouraged and responded to. Relatives have been fully involved in arranging events at the home such as the summer fete recently held. Regular meetings are held for all staff. Minutes of the most recent meetings held in April and June of this year were examined. As part of the home’s quality assurance procedures, questionnaires are sent to relatives on an annual basis. We were able to see an analysis of questionnaires which had been returned in March 2008. Responses to questions were either ‘good’ or ‘excellent’. The providers confirmed that following the major building works, they were currently at the home on a daily basis to ensure the smooth running of the home. One relative spoken with informed us that they found them ‘very approachable’ and ‘very knowledgeable about the needs of people’. We were informed that the home assists people to manage small amounts of money. The providers and the registered manager confirmed that they did not act as financial appointee for any person living at the home. We sampled some financial records and found these to be well maintained. Two signatures are obtained for all transactions and receipts are in place to confirm purchases made on behalf of people. Balances were not checked during this inspection. Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 29 We were able to see evidence that staff are appropriately supervised. Staff receive formal one to one supervision sessions at least six times a year. Records relating to three staff were examined. These were detailed and clearly identified any training needs or requests. Staff spoken with were positive about the support they received. In addition to regular supervision sessions, staff receive an annual appraisal. At the time of this inspection, the home was able to demonstrate that it follows appropriate procedures to ensure the health and safety of persons at the home. This was ascertained through a tour of the premises and on examination of the following records; FIRE SAFETY – Training records confirmed that staff have received up to date training in fire safety. Under current fire safety regulations, the home were required to complete a fire risk assessment. This document was not examined at this inspection. The home is fitted with fire detection & alarm systems, emergency lighting and fire fighting equipment and records seen indicated that servicing was up to date. EQUIPMENT SERVICING – We were able to see up to date servicing records for the home’s mobile and bath hoists and passenger lift. Six monthly servicing was last carried out on 13/05/08. Training records indicated that staff have received up to date training in moving and handling. GAS SAFETY – The home has an up to date landlords annual gas safety certificate dated 13/11/07. ELECTRICAL SAFETY – The home ensures that all portable electrical appliances are tested in accordance with Health & Safety legislation. Records of tests are maintained. To ensure the safety of people living at the home, all first floor windows have restricted openings. Free-standing wardrobes are secured and radiators are either covered or are a low heat surface type. In the new unit, under floor heating is fitted throughout the ground floor. Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 4 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 x 3 Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement Arrangements must be in place to ensure that guidelines are available to staff to determine how and when “when required” medicines are to be given and the expected outcomes from the intervention. Arrangements must also be made to inform staff how decisions are to be made regarding the dose to be administered. A serious concerns letter was sent on 22nd July 2008. Timescale for action 21/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP15 Good Practice Recommendations The registered person should consider the use of serving dishes at meal times and should explore alternative methods for enabling people to make choices about the meals offered DS0000071382.V368836.R01.S.doc Version 5.2 Page 32 Camelot House, Wellington Camelot House, Wellington DS0000071382.V368836.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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