Inspection on 12/07/06 for Camelot Rest Home

This inspection was carried out on 12th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 Rest Home 16/05/07

Camelot Rest Home 06/12/05

Camelot Rest Home 06/04/05

Camelot Rest Home 24/01/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Camelot Rest Home 152 Stourbridge Road Dudley West Midlands DY1 2ER Lead Inspector Mrs Jean Edwards Unannounced Inspection 12th July 2006 07:45 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 Rest Home DS0000061845.V303282.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 Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Camelot Rest Home Address 152 Stourbridge Road Dudley West Midlands DY1 2ER 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) 01384 214290 01384 256922 Rajan Odedra Care Home 25 Category(ies) of Past or present alcohol dependence over 65 registration, with number years of age (1), Dementia - over 65 years of of places age (5), Old age, not falling within any other category (13), Physical disability (1), Physical disability over 65 years of age (4) Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Camelot is a private Care Home registered to provide residential care for up to 25 frail older people, with some provision for older people with a physical disability, mental disorder and dementia. The home has been owned by the current Registered Proprietors since October 2004.The home is located on the main bus route, close to the Merry Hill shopping centre and Dudley town centre. There is limited parking at the front of the Home and there are large gardens to the rear. The Home comprises a number of large traditional properties, which have been extended and adapted to provide 21 single and 2 double bedrooms, located on the ground and first floors. There is a passenger lift, and a chair lift providing access to the first floor. Communal accommodation is available in two large rooms at the rear of the property that have been extended out to meet in a large conservatory. The home offers a number of aids and adaptations, including adapted bathing facilities, floor level showers, portable lift equipment, emergency call system in every room and some adjustable beds. The Home has developed links with organisations that are able to offer some culturally appropriate diets for Afro-Caribbean elders. The level of fees for this home is currently between £343 and £371 per week. This home does not charge top up fees. Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first unannounced key inspection visit for 2006 - 7, undertaken by an inspector from the Commission for Social Care Inspection (CSCI), starting at 7:45 am and finishing at 6:40pm. All Key National Minimum Standards have been assessed at this visit. The range of inspection methods to make judgements and obtain evidence includes: discussions with the acting manager, group manager, proprietor and staff on duty during the visit, examination of records and documents and discussions with residents, and relatives. Other information was gathered before this inspection visit from the submitted pre inspection questionnaire, reports of visits undertaken by the organisation’s care management consultant, notification of incidents, accidents and events, and an action plan submitted by the home following the unannounced inspection on 6 December 2005. Twenty service user surveys were sent to the home by the CSCI and an analysis of the nine survey forms returned is contained throughout this report. Comments have been generally positive, particularly about meals and staff. There are currently 23 people at the home, including two recent emergency admissions. During the visit the inspector has spoken to the majority of residents. Longer discussions have taken place with the residents whose care was looked at in depth. Relatives and other visitors have been asked for their views. Comments indicate that staff are friendly, helpful and welcoming. There has been a tour of the premises, including the grounds, communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and a sample of residents’ bedrooms, with their permission. What the service does well: The acting manager, in post for three months, has introduced considerable improvements across all areas of the home, with support from the care management consultants and proprietors. The home provides comprehensive information for prospective residents and their representatives and in answer to the questions on the CSCI service user survey forms all nine responses indicate that have received satisfactory information to help them make decisions and that they have a contract / terms and conditions of residency from the home. Residents are very complimentary about the care and support from the acting manager and staff. In response to the survey question: do you always receive the care and support you need? 8 people state - Always and 1 person states Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 6 Usually, with the comment: I have been to a lot of places and at last I have found a place I can call home the staff are very good. A new resident states, the staff here are brilliant, couldnt be better. I have been in three different homes for short stays recently and this is the best one. Cant ask for better. I like the food - the soups are especially good. When I came here they asked what I liked and disliked and I told them I didnt like rice pudding and I havent been offered it once. I have visitors every day, either my daughter or one of my two sons. You only have to pull the cord and someone comes very quickly, nothing is too much trouble. The acting manager, together with the care management consultants, has introduced quality and monitoring systems across a number of areas of the home, including how care is provided, records and the environment. This inspection was conducted with full co-operation of the Registered Proprietor, staff and residents. The atmosphere through out the inspection was relaxed and friendly. The Inspectors would like to thank staff, and residents for their hospitality during this inspection visit. What has improved since the last inspection? The majority of the previous 45 requirements are met or partly met and 3 of the 4 good practice recommendations have been met. The way the home plans each persons care has improved considerably with the introduction of new assessment processes, care plan and risk assessment formats. The written information is more detailed and specific and provides staff with clearer guidance. Health care assessments have improved, with detailed measures in place to minimise risks of falls and risks involved in moving and handling people. There are also improved records on each persons file, showing that there is good access to specialist medical, chiropody and dental care. Since the last inspection the registered proprietor has provided sit on scales on a regular basis for residents unable to stand and weight bear to ensure that all residents weights properly monitored. Each persons dietary needs are looked at and their weight is monitored, with advice requested from GPs and dieticians as needed. New menus have been devised and are now on display so that people can make realistic choices, including tea and supper choices. Each persons food choices are recorded. Improvements have been made to the way medication is stored, administered and recorded, with only very minor additional improvements needed as a result of this visit. Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 7 The acting manager has introduced a key worker system, which means that there is a closer relationship between staff and individual residents, whose preferences and needs receive more detailed attention. Staff are currently taking responsibility for organising more activities for residents, with outings advertised on a notice board in the reception area. The supply of communal newspapers, obviously valued by residents has been restored. The home has a copy of Dudley MBCs multi-agency policy and procedure for the protection of vulnerable adults, and is in the process of making sure that all staff have a good awareness of this document and the care management consultants have assisted the home to review and improve policies and procedures to provide care safely and protect vulnerable residents. The acting manager, as part of the improved monitoring systems in the home has put in place audits of the premises, bedding and towels. As a result improvements to the internal décor, fixtures and fittings and the exterior of the home continue to be made. There are patio containers with attractive summer flowering plants and the acting manager is hoping to develop an area of the rear gardens to grow produce, with assistance of residents who have expressed an interest. She is developing quality assurance monitoring processes, which actively involve residents, relatives and staff. The general cleanliness of the home has improved considerably and no malodours have been detected during this visit. Acting Manager has dealt with performance and absence issues as a matter of misconduct through the homes disciplinary processes acting on advice from employment law consultants. This has had the positive effect of decreasing the sickness levels and improving staff morale, which in turn benefits care for residents. Improvements have been made to a number of areas of record keeping, care, health, medication records and health and safety. The acting manager is undertaking a regular recorded analysis of accidents, which highlights any trends and improved measures are put in place to minimise risks. What they could do better: The registered person must make sure that all residents have an up-to-date contract/or terms and conditions of residence, containing full details including fees, which has been agreed and signed by them or their representative. Each person or their representative must receive written confirmation that the home is able to meet all of their needs and offers and decisions about introductory visits must be fully recorded on residents individual case files. This will demonstrate that people have good information and opportunities, to make decisions about where they will live. Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 8 The improvements relating to provision of more activities and outings must be built on and all residents must be asked about their preferred individual activities. The information collected must then be used to devise, advertise and offer a regular programme of a variety of group and individual activities, with each persons participation or refusal noted. To the question on the service user survey, are there activities arranged by the home that you can take part in? Answers are - always 8, never 1, with comments: prefer to stay in bedroom at watching films, videos, reading books and prefer own company. Whilst comments about food during the visit have been positive and the meals look appetising, the responses from the service user survey to the question: Do you like the meals at the home? Are as follows: Always - 4, Usually - 1, Sometimes - 3, with comment: prefer breakfast and tea. The home needs to explore these results with the residents. To the question on the service user survey, are the staff available when you need them, the responses are: always - 6 and usually - 3. At the visit it has been observed that following a shift change at 12 noon, there are only 3 carers available to assist with the meal, whilst a member of care staff helps out in the kitchen. The proprietors and manager must continue with the good recruitment of sufficient numbers of care staff, laundry staff and additional catering staff, and make minor adjustments to increase the numbers of care staff over the middle of the day, between 12 and 2.00 pm. Although the recruitment processes and staff personnel records show considerable improvements, there are a few additional areas, which need further improvement. 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. Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 9 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 Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, Standard 6 is not applicable The overall outcome for this group of standards is judged to be good. The home has an up-to-date statement of purpose and service user guide and is making some progress to update residents contracts / terms and conditions of occupancy. This has the effect that residents and their advocates now have improved information regarding their rights and entitlements, any agreed restrictions and how care will be provided. The home generally uses comprehensive assessment tools, which means that residents’ needs are thoroughly assessed to ensure that care needs will be met. The home actively encourages introductory visits and there is verbal evidence to demonstrate that people have been given the opportunity and time to make decisions, which are right for them. EVIDENCE: The home has a statement of purpose, which clearly sets out the objectives and philosophy of Camelot and this is supported with a service user guide, providing good clear information about the home. Discussions with residents Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 11 confirm that are given a copy of the service user guide. However there is currently no documentary evidence to demonstrate receipt of documents, which would be good practice. Recent CSCI inspection Reports and information about advocacy services are located in the reception area. The home has people from different cultural or ethnic backgrounds and ensures that staff understand the cultural expectations of those residents and there is training and guidance for staff to enable them to be responsive to the residents individual needs. For example arrangement have been put in place for members of the African-Caribbean day centre to visit a black AfricanCaribbean Elder who used to regularly attend the local centre until he became too frail to go. The members have also provided assistance to the home to make sure this residents final wishes are planned and recorded for when the time comes. This demonstrates very good practice. Each resident is provided with a contract or statement of terms and conditions. This needs to set out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the resident. The acting manager states that the document is in the process of being reviewed. Advice has been given about the very recent revisions and additions to the Care Homes Regulation 5, which needs to be incorporated into the next review. Evidence from examination of residents records and discussions confirm that the assessment is conducted professionally and sensitively and has involved the family or representative of the resident. The acting manager supported by the care management consultants has introduced comprehensive preadmission assessment documentation, including a personal profile, which is well completed. Individual preferences are recorded such as rising, retiring, preferred newspapers, likes and dislikes. These have been signed by the person or their nearest relative. In addition the profile indicates the persons physical condition, and medical history. However the home has recently admitted two residents at very short notice, on an emergency basis and has received only basic information from placement agencies. Discussions have been held about a recent variation request made to the CSCI and the inspector suggests simplifying the homes registration categories and adding conditions to maximise the homes flexibility for appropriate admissions of new residents. Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 The overall outcome for this group of standards is judged to be adequate. The improved care planning and monitoring provides staff with the information they need to adequately meet residents needs. There is good multi disciplinary working taking place on a regular basis, which results in the health needs of residents being generally well met. The home continues to make steady progress to improve the arrangements for administration of medication, which reduces potential risks to residents. EVIDENCE: Each resident has a care plan, in a new care plan format and there is improved evidence showing good practice of involving residents in the development and review of the plan. The plan in most cases includes essential basic information necessary to plan the individuals care and includes a risk assessment element. From examination of a sample of residents case files, some care plans have small omissions. Examples are missing areas from care plans where a resident has been admitted as an emergency with severe pain and MRSA and there is no documented guidance for the management regime of pain relief or for Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 13 infection control. There are also residents with occasional behaviours, which are described as outbursts of anger and aggression and there are no documented risk assessments or risk management strategies to guide staff as to how to deal with these situations. Similarly there is no risk assessment for a new resident who is a smoker. Evidence of updating information and changing actions appears on care plans. Some residents confirm their involvement in developing the plan and receive feedback on decisions made during reviews. All residents have good access to health care services to meet their assessed needs both within the home and in the local community. Some residents are able to choose their own GP within the limits of geographical borders and there is documentary evidence that all have access to dentists, opticians, chiropodists and other community services. There is evidence from records and discussions that each resident’s health is monitored and appropriate action taken. There is evidence in the care plans examined of health care assessments, screening treatment and intervention, and records of general health care information including weight monitoring, nutritional and tissue viability information. The home seeks professional advice on health care issues, acts upon it and generally is able to access the aids and equipment recommended. Since the last inspection the registered proprietor has provided sit on scales on a regular basis for residents unable to stand and weight bear. A new resident has refused to have a pressure relieving mattress, despite an assessment, which indicates a high risk of skin breaking down. Advice has been given to make a referral for a specialist occupational therapist to assess this persons needs, including appropriate bed and chair, with recommendations and decisions recorded. The home has a medication policy which is accessible to staff, medication records are generally up to date for each resident and medicines received, administered and disposed of are recorded. There are currently no residents who wish to administer their own medication. Where medication systems are in need of action the registered person is working towards improvement. For example any specialist instructions for the administration of medicines must be clearly documented as part of the medication regime in each persons care plan. From discussions it is evident that staff are aware of the need to treat residents with respect and to consider dignity when delivering personal care. The home arranges for residents to enjoy the privacy of their own rooms and provides screens in shared rooms, though these are in need of replacement. Discussions with residents indicate that are happy with the way that the staff deliver their care and respect their dignity. Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 14 The home has policies and procedures, which inform staff how they should handle dying and death. The wishes of residents about terminal care and arrangements after death are now recorded as part of their case file. Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 The overall outcome for this group of standards is judged to be good. There is evidence of progress to make planned and spontaneous activities available on a regular basis, which give residents improved opportunities to take advantage of and develop socially stimulating activities. The majority of residents are able to maintain good contact with family and friends. Dietary needs of residents are generally catered for with a balanced and varied selection of food that meets residents tastes and choices. EVIDENCE: Residents at Camelot have the confidence to discuss what makes them happy and comment where improvements can be made. The acting manager takes residents feedback seriously and makes changes where possible. Evidence from the service user survey forms indicate that staff listen to residents and make considerable effort to provide a flexible service, which enables them to enjoy a better quality of life. The acting manager and staff have growing confidence in its quality assurance system to confirm that practice reflects the policies, procedures and guidance. The acting manager has recently introduced a key worker system, which enables closer resident staff relationships where likes, dislikes and needs are shared. Key workers can use the information to plan activities, which residents Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 16 will enjoy. There is a good understanding for the need to increase the level of activities and access to socialisation. There has been a decision to review and reintroduce the supply of communal newspapers, and this is obviously valued by the number of residents living at the home. There is evidence that some people prefer to spend their time on their own in their own bedrooms, with individual interests. These decisions are well understood, respected and supported by staff at the home. The home needs to continue to develop a system for displaying information and bringing attention to community events and activities. There is evidence that family and friends of the residents feel welcome and know they can visit the home at any time. It has been indicated that staff always make time to talk to visitors and share information with the agreement of the resident. One resident has eight children and someone comes to Camelot every day to take her to visit her husband who is in a nursing home. Residents are able to have personal possessions in their room, but may be not always be able to bring items of furniture due to for example, space restrictions or health and safety considerations relating to the residents bedroom. There are inventories of residents personal possessions on the sample of files examined, however these are not always signed and dated by the resident or their representative. Residents enjoy the flexibility of meal arrangements and are able to eat in their own room if they wish. Regular drinks are available and staff are always willing make drinks at any time. It has been observed that there are plentiful supplies of cool drinks, with easy access for residents, around the communal areas of the home. The food in the home is of good quality, well presented and generally meets the dietary needs of residents. The cook / deputy manager is experienced, consults with residents and tries to meet the preferences and suggested dishes when preparing the menu. The home has introduced new menus, which include tea and suppertime choices as well as soup and other alternatives now displayed in large print and pictorial formats appropriate to residents understanding. Staff have training to help those residents who need help when eating and are sensitive in their approach. It has been recommended that consideration be given to the introduction on a trial basis of fresh fruit or vegetable juices and smoothies to encourage people to have their five portions of fruit or vegetables as part of a healthy diet. Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 17 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The overall outcome for this group of standards is judged to be adequate. Complaints are listened to and action is taken to look into them, and there are systems to record investigations and outcomes. Arrangements for protecting residents are not yet satisfactory. Policies, procedures, guidance and staff training have not been fully implemented in order to provide residents with safeguards from abuse. EVIDENCE: The home has complaints procedure displayed in the reception area and contained in the service user guide. Information supplied as part of the preinspection questionnaire indicates that the home has received four complaints, which have been investigated by the provider with satisfactory outcomes. From the results of the service users survey, there are some people indicating that they are unaware of how to raise concerns or use the homes complaints procedure. The results need to be discussed with residents and relatives to make sure they have sufficient awareness and knowledge of procedures. The home has not received any allegations relating to abuse of vulnerable residents. There is a copy of the multi-agency procedures for the protection of vulnerable adults, Safeguard and Protect at the home. The homes policies and procedures regarding protection of residents are generally satisfactory and with the support of the care management consultants they have been reviewed Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 18 and updated to be generally in line with regulations and other external guidance. There is documentary evidence that all staff have been made aware and have been given time to read and understand procedures for the protection of vulnerable adults. Progress is being made to provide all staff with appropriate adult protection training. Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 24, 26 The overall outcome for this group of standards is judged to be good. There continues to be significant and positive changes to the décor and furnishings. The incremental improvements contribute to creating a pleasing and pleasant environment for residents to live in. The grounds are maintained to provide a safe and pleasant outdoor environment for residents. EVIDENCE: Camelot has a bright and cheerful interior and there are improvements to the exterior of the premises, enhanced with containers of summer flowering plants. The tour of the building identified that a number of improvements have been made and the program of redecoration and refurbishment is continuing, with the majority of requirements for repairs and redecoration issued at the last inspection acted upon. The acting manager has undertaken a full audit of the home from which a prioritised programme of repairs, redecoration and replacement of equipment Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 20 has been devised and is in the process of implementation, incorporating the redecoration of residents bedrooms within an identified timescale. New bedding, pillows and towels have been purchased and residents have been asked for their preferences as to whether they have sheets and blankets and counterpane or a duvet. Not all residents bedrooms have been provided with lockable space and not all residents have two comfortable chairs in their bedrooms. Discussions and decisions need to be reviewed and documented. There are improvements to the overall cleanliness of the home and bathrooms are now monitored to ensure they remain free from clutter or items, which may be used communally. Cleaning schedules are in place for bedrooms, bathrooms, and kitchen and laundry areas. During discussion was residents indicate that they are comfortable, the home is clean, warm, well ventilated, and well lit. There are two spacious communal rooms and residents are able to generally sit where they wish, though some people are protective about their own personal space. There are a small number of additional improvements required at this visit, examples are: A defective window restrictor in bedroom 21, the home must ensure all other first floor window restrictors are in a satisfactory condition An unsecured wardrobe in bedroom 5, the home must ensure all other wardrobes are appropriately secured Compromised double glazing units (one large pane and one small opening window) in bedroom 5 It is noted that the laundry and kitchen areas are well organised, clean and tidy. Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The overall outcome for this group of standards is judged to be adequate. Staff morale and confidence has improved, with better attendance, diligence and less reliance on staff working in excess of contracted hours, and there is improvement to staff recruitment processes, which has reduced the potential for residents to receive an inconsistent and unsatisfactory service. The acting manager demonstrates a strong commitment to staff training, support and development. EVIDENCE: There are currently 23 residents accommodated, with a variety of dependency levels and diverse needs. Assessment of staffing rotas show an improvement in staffing levels, both in terms of numbers and stability. The acting manager with support from the care management consultants is able to regularly identify residents dependencies and occupancy levels and regularly review staffing levels, making appropriate adjustments. However during the visit it has been observed that from 12 noon, at the change of shifts one carer is allocated to provide catering support in the kitchen. This achieves the aim of the previous requirement to provide additional catering support to maintain satisfactory standards of food hygiene. However it leaves only three care assistants to support residents throughout the busy lunchtime period, from 12 noon to 2 p.m. The acting manager has agreed to review and improve the situation. Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 22 Assessment of the pre-inspection questionnaire submitted, staff files and staffing rotas during the visit show that three staff have left the homes employ, including the registered manager since the last inspection visit in December 2005 and a senior care assistant has been promoted to acting manager and four new care assistants have been appointed. There are considerable improvements to the documentation and management of staff personnel files, which is to the credit of the new acting manager. Generally robust recruitment processes are in place and there are only minor improvements needed as a result of this visit. The acting manager now signs and dates photocopies of qualifications held on file to evidence that originals have been seen. There is evidence that 11 of the 21 care staff have achieved an NVQ level 2 care award, with new candidates about to be registered. This means that the home is now able to demonstrate that it meets the ratio of 50 of care staff with an NVQ 2 (or equivalent) award. The acting manager demonstrate a strong commitment to staff training and development, together with support measures such as structured supervision, for example one person appointed in February 2006 has three recorded supervision sessions on the personnel file. The homes training plan and individual staff training profiles have not been seen at this visit and the acting manager has agreed to send documentary evidence to the CSCI office, Halesowen. During discussion the acting manager indicated that she had dealt with performance and attendance issues relating to one member of staff, with support from employment consultants, Peninsular. Following advice this had eventually had to be dealt with through the disciplinary route as a matter of misconduct. Advice was given to the acting manager that action must be taken to formally inform the CSCI office Halesowen of any disciplinary action taken to deal with staff misconduct as a Regulation 37 notification. During discussions it is evident that staff are knowledgeable about what residents needs are and how to meet them and there is a warm rapport with both residents and visitors. Staff spoken to generally feel that morale is improving and that they are aware of their responsibilities, what is expected of them. Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, 38 The overall outcome for this group of standards is judged to be adequate. The home does not currently have a registered manager however the acting manager is providing good leadership and direction, and there is reassurance about the future management arrangements, which should ensure continuity and consistency of effective leadership and support. The improvement in the standards of record keeping and health and safety compliance at this home has generally continued, improving protection for residents from risks of harm. EVIDENCE: Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 24 The registered manager resigned in April 2006 and has been replaced though the promotion of a long serving and experienced senior carer, Wendy Madeley as acting manager. She has submitted an application to be registered by the CSCI as registered manager for Camelot Residential Home. She has provisionally booked a place on the Registered Managers Award training course at Bourneville College and is exploring options to book a place more locally to the Black Country Training Consortium for September 2006. The acting manager is making progress to introduce an effective quality assurance system, which includes feedback from residents and relatives, stakeholders in the community, and in which staff feel they have ownership. The commissioning of Dudley MBC has recently monitored progress and the acting manager reports that they are satisfied with the homes efforts. Staff and residents meetings take place regularly, with minutes posted on notice boards. Progress has been made to produce an up to date annual development plan and the care management consultants (RNF) make the required visits to the home and reports of monthly unannounced visits relating to the conduct of the home, I made available to the home, registered proprietors and the CSCI office, Halesowen. It is recognised that it is particularly important for the home to receive monitoring, feedback and support for its continued improvement to achieve satisfactory compliance with required standards and for the CSCI to be kept informed between inspection visits. Residents have the opportunity to manage their own money if they wish, and some facilities are provided to help keep it safe. Where the home manages money on residents’ behalf a system is in place to record transactions and accounts for spending. A sample of balances and financial records examined are satisfactory. It is noted that one resident, whose finances are managed through appointeeship by the local authority, has a large amount of cash held by the home. The acting manager has agreed to explore options for this persons finances with the Local Authority Appointee. There are significant improvements to records keeping, which include comprehensive pre-admission proformas, personal profiles, care plans, risk assessments, tissue viability assessments, falls risk assessments, nutritional assessments, daily records and staff personnel files. A training course has been in September 2006 to provide the manager or senior staff with training to effectively promote the management of risks and health and safety. There are a small number of areas, which needed to be improved in relation to health and safety. The random assessment of a sample of health and safety and service maintenance records examined shows that they are generally satisfactory. Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 25 There have been 37 recorded accidents involving residents since December 2005. The acting manager has an effective system for auditing, analysing and evaluating accidents involving residents, with effective measures implemented. Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 26 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 2 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X 2 2 X 2 X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 2 2 Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? 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 OP2 Regulation 5(1) Requirement To review the contract / terms and conditions taking account of the revisions to the Care Homes Regulation 5 and the publication from the Office of Fair Trading relating to Contracts and terms & conditions in Care Homes To ensure that full assessment and care plan information is obtained prior to the admission of new residents or within 5 days of an emergency admission The written confirmation from the Registered Manager to the resident / representative must be expanded to include their identified assessed needs (Timescale of 31/05/06 Not Fully Met) To provide documentary evidence on each persons case file that trial visits have been offered prior to admission, recording outcomes. (Timescale of 31/05/06 Not Fully Met) To ensure that all areas of risk associated with individual service users are clearly documented, such as challenging behaviours, DS0000061845.V303282.R01.S.doc Timescale for action 01/11/06 2 OP3 14(1) 01/08/06 3 OP4 14(1d) 01/08/06 4 OP5 14(1) 01/08/06 5 OP7 15(1) 01/08/06 Camelot Rest Home Version 5.2 Page 28 smoking and personal safety within the Homes environment and on any activities where the Home has a duty of care. (Timescale of 31/05/06 Not Fully Met) 6 OP7 15(1) 13(4) To ensure all assessed care needs are identified on individual care plans, for example the management of pain relief, MRSA and any behaviours, which challenge the service To update PCs recorded daily routine, which has changed - no longer attending Caribbean day centre, already reflected in care plan dated 31 May 06 To ensure that a request is made for the GP to carry out investigations for EW for possible urinary tract infection To request a referral for an occupational therapist to assess AW for an appropriate pressure relieving mattress and chair 1) To ensure that staff record variable dosages of medication administered on MAR sheets, for example one tablet or two 2) To obtain a copy of the contract with the new pharmacy provider 3) To add the names of residents to the medication returns sheets 4) To forward copies of the staff certificates for accredited medication training following receipt at the home To investigate the recent 01/08/06 excessive maximum temperature of the medication fridge recorded as 14C and ensure the DS0000061845.V303282.R01.S.doc Version 5.2 Page 29 01/09/06 7 OP7 15(1) 01/09/06 8 OP8 13(1) 01/09/06 9 OP8 13(1)(4) 01/09/06 10 OP9 13(2) 01/08/06 11 OP9 13(2) Camelot Rest Home problem is resolved and the temperature is consistently maintained between 2C- 8C 12 OP9 13(2) 1) To ensure that Allendronic Acid and Risedronate Sodium 35mg are administered strictly in accordance with written instructions with immediate effect; that is to be taken half an hour before food, drink or other medication with a full glass of water and that the resident remains sitting upright / standing for half an hour following administration 2) To ensure any specialist instructions for the administration of medicines is clearly documented as part of the medication regime in each persons care plan 13 OP15 16(2i) To explore the comments made 01/09/06 by some residents on the service user survey forms, indicating not everyone is satisfied 1) All residents must be provided 01/09/06 with lockable facilities in their bedrooms, these must be adequate to store medication (self administration if preferred) (Timescale of 31/05/06 Not Fully Met) 2) To discuss the residents choices relating to the provision of bedside lights and comfortable chairs in their bedrooms, ensuring decisions are documented on individual plans (Timescale of 31/03/05 and 31/05/05 not fully met) 3) To ensure that all residents inventories are appropriately updated (Timescale of Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 30 01/08/06 14 OP24 16(2) 31/03/05 and 31/05/05 not fully met) 15 OP24 16(2) 23(2) Bedroom 11 (shared) must be provided with additional electric sockets and residents must be offered the option of individual bedside or over bed lights (Timescale of 31/03/05 and 31/07/05 not fully met) 01/10/06 16 OP24 16(2) 23(2) 1) To rectify the defective 01/09/06 window restrictor in bedroom 21, and ensure all other first floor window restrictors are in a satisfactory condition 2) To secure the wardrobe in bedroom 5 and ensure all other wardrobes are appropriately secured 3) To rectify the compromised double glazing units (one large pane and one small opening window) in bedroom 5 To provide suitable sluicing facilities (Timescale of 31/03/05 and 31/05/05 not met) To provide increased staffing levels to ensure that there are a minimum 4 carers, including a designated senior on the morning / early afternoon shift and a minimum of 3 carers, including a designated senior on the evening shift, with immediate effect (Timescale of 25/01/05 and 31/03/06 Not Fully Met) To ensure that the additional catering support to maintain satisfactory standards of food hygiene does not compromise dedicated care hours available, DS0000061845.V303282.R01.S.doc 17 OP26 23(2) 01/10/06 18 OP27 18(1)(a) 01/08/06 19 OP27 18(1)(a) 01/08/06 Camelot Rest Home Version 5.2 Page 31 for example between 12 noon and 2:00 pm when there must be 4 carers to provide dedicated care / assistance to residents. 20 OP29 17(2) Sch2&4 19(1) To obtain copies of the public liability insurance and CRB clearance from the hairdresser and any other independent practitioner who provides services to residents in the Home. (Timescale of 31/03/05 and 31/05/06 Not Fully Met) 1) To ensure application forms are fully completed with details of qualifications claimed and full employment history 2) To ensure any gaps in employment history are fully explored and reasons documented and checked wherever possible 3) To ensure the criminal declaration on application forms is completed 4) To check the authenticity of references, ensuring that there is a reference from the last care employer or documenting reason why not possible and request that referees print their name and use company paper or company stamp 5) To explore any gaps in information on reference forms 22 OP29 19(11) To expand the risk assessment used when staff are appointed on a PoVA first basis, including the named senior supervisor and signature of the manager DS0000061845.V303282.R01.S.doc 01/08/06 21 OP29 19(1) 17(2) Sch 2&4 01/09/06 01/08/06 Camelot Rest Home Version 5.2 Page 32 23 OP30 18(1c) 1) The registered person must ensure that there is a staff training and development programme, which meets National Training Organisation workforce training targets and ensures that staff fulfil the aims of the home and meet the changing needs of service users. (Timescale of 31/07/04 and 31/07/05 Not Fully Met) 2) All newly recruited staff must receive induction training to National Training Organisation (now Skills Council for Care) specification within six weeks of appointment to post, with foundation training within six months of appointment. (Timescale of 31/03/05 and 31/07/05 Not Fully Met) 01/09/06 24 OP31 17(1) 18(1c) 3) The in-house induction checklist must be completed with dates and signatures (Timescale of 31/07/05 Not Fully Met) 01/08/06 1) To provide appropriate, regular profession documented supervision sessions for the Manager - improved one since April 06 - must now be increased (Timescale of 31/03/05 and 31/05/05 not fully met) 2) To provide the Acting Manager with the new contract of employment /terms and conditions, which clearly reflect responsibilities including any oncall arrangements and extra duties 25 OP33 24 To forward the collated results of the annual residents, relatives and stakeholders questionnaires to the CSCI office, Halesowen DS0000061845.V303282.R01.S.doc 01/10/06 Camelot Rest Home Version 5.2 Page 33 26 OP37 37(2) 27 OP37 17(1) 28 OP38 13(4) 18(1c) To formally inform the CSCI office Halesowen of any disciplinary action taken to deal with staff misconduct as a Regulation 37 notification To ensure that all personal and sensitive information relating to residents is recorded on their individual file and not in the homes general communication book 1) To arrange accredited risk management training for all persons involved in undertaking risk assessments as soon as is practicable or engage the services of a competent person to provide documented risk assessments, with control measures and risk management strategies. (Timescale of 31/10/04 and 31/05/05 not fully met) Training booked for 21/09/06 2) To send details of training completed to the CSCI office, Halesowen 3) To provide documentary evidence that approved risk assessment awareness training has been arranged for all staff to be delivered within an identified timescale. (Timescale of 31/10/04 and 31/05/05 not met) 01/09/06 01/08/06 01/10/06 29 OP38 13(4) 17(2) To forward a copy of the homes asbestos risk assessment to the CSCI office, Halesowen 01/09/06 Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 34 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 OP1 Good Practice Recommendations It is recommended that residents or representatives signatures are obtained for receipt of their copies of the homes statement and purpose, service user guide and complaints procedure That for easier and monitoring and evaluation that a weekly activity planner is devised and implemented for each person. (Timescale of 31/03/05 not met) That the manager consults with the Local Authority appointee about excessively large balances held in temporary safekeeping on behalf of one resident in the homes safe That records are kept of the monthly calibration tests of the food probe That information be obtained from Environmental Services regarding new legislation (Jan 2006) relating to food safety 2 3 OP12 OP35 4 5 OP38 OP38 Camelot Rest Home DS0000061845.V303282.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: 0845 015 0120 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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