Inspection on 16/05/07 for Camelot Rest Home

This inspection was carried out on 16th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Camelot Rest Home 12/07/06

Camelot Rest Home 06/12/05

Camelot Rest Home 06/04/05

Camelot Rest Home 24/01/05

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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 Key Unannounced Inspection 15th May 2007 08:40 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.V335673.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.V335673.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 Usha Odedra Wendy Madeley Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users in the category DE(E) up to a maximum of 5 can be accommodated at any one time for as long as the home can demonstrate it can meet the service users assessed needs. Service users in the category MD(E) up to a maximum of 2 can be accommodated at any one time for as long as the home can demonstrate it can meet the service users assessed needs. To include 2 existing named service users with physical disabilities over the age of 65 years PD(E) and 1 existing named service user with past or present alcohol dependence A(E) for as long as the home can demonstrate it can meet the service users assessed needs. 12th July 2006 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.V335673.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the key inspection visit for 2007 - 8, undertaken by an inspector from the Commission for Social Care Inspection (CSCI), for eight hours over two weekdays. All Key National Minimum Standards have been assessed at this visit. The range of inspection methods to obtain evidence and make judgements includes: discussions with registered manager and staff on duty during the visits, discussions with residents and examination of a number of records. Other information was gathered before this inspection visit from the pre inspection questionnaire, notification of incidents, accidents and events submitted from the home. Twenty service user surveys, ten relatives surveys and five GP / professional surveys were sent to the home by the CSCI. An analysis of the fifteen survey service users, ten relatives and five GP responses is contained throughout this report. Results are very positive. There are currently 20 residents living at the home. During the visit the inspector spoke to the majority of residents. Longer discussions have taken place with the residents whose care was looked at in depth. The inspection has included a tour of the premises, including the grounds, communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and residents’ bedrooms, with permission. What the service does well: The manager has successfully completed the CSCI registration process and has continued with the 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, assisting people to make decisions, which are right for them. The residents are very complimentary about the care and support they receive with comment such as: it is the best place I have ever been and I have been all over. It is a great home, and I mean home. The staff are great , and a comment from a relative, I am always informed of any issues that affect my mother. The home has 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. A resident states, I cannot walk far and the staff do my shopping for me, I cannot praise them enough. Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 6 Members of staff take responsibility for organising an increasing amount of activities for residents, with outings advertised on a notice board in the reception area. The home has a supply of communal newspapers, which are valued by residents and used by staff to discuss local and world events with residents. A comment from the relatives survey states, I see staff encouraging residents to do various things during the day, playing dominos, gardening, and exercises etc. join in activities and generally make life more enjoyable for them. Staff are aware of each persons dietary needs, food intake is recorded as required and residents weight is monitored, with advice requested from GPs and dieticians as needed. Pictorial menus are on display so that people can make realistic choices, including tea and supper choices. Comments about food during the visit have been positive and the meals look appetising. One resident states, the meals are lovely and another person states, I can have as much as I want and have a good breakfast, little lunch and good tea-time meal. The home has a copy of Dudley MBCs multi-agency policy and procedure for the protection of vulnerable adults, and has made sure that all staff have a good awareness of this document. The home has used the skills of the care management consultants to assisted with the review and improvement of policies and procedures to provide care safely and protect vulnerable residents. The registered manager is continuing with the development of an area of the rear gardens to grow produce, with assistance of residents who have expressed an interest. There are patio containers with flowering plants and a selection of vegetables, such as carrots and spring onions. There are also tomato and lettuce plans growing in a greenhouse. The manager has taken advantage of a Government grant to apply for funds to develop an area of the rear garden with raised beds. There are a number of residents who enjoy gardening and will have great pleasure from the hands on experience. The cleanliness of the interior of the home is good and the exterior is well maintained. The staff are caring, knowledgeable about the residents needs and they are welcoming and friendly. Comments from the relatives survey include, I have observed the staff over the past several years, and I have seen a great improvement in how they deal with residents, especially dementia residents, and staff seem to treat everyone with respect and genuine caring. I think this arises out of the fact that the care staff have worked at the home for many years and build good relationships with residents, and I feel the home fulfils its job well, the residents are looked after and cared for with respect for residents and genuine caring. The registered manager, together with the care management consultants, has put in place quality and monitoring systems, which actively involve residents, relatives and staff across a number of areas of the home, including how care is provided, records and the environment. Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 7 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 registered manager has updated the information about the home and has taken action to improve and update contracts /or terms and conditions of residence, which contain full details including fees, agreed and signed by the resident or their representative. Each person or their representative now receives written confirmation that the home is able to meet all of their needs. Everyone is offered the opportunity to make introductory visits, with outcomes and decisions about visits fully recorded on residents individual case files. This demonstrates that people have good information and opportunities, to make decisions about where they will live. The way the home plans each persons care has continued to improve with very detailed and specific written information providing staff with clear guidance about each persons needs and preferences. Health care assessments are good, with detailed measures in place to minimise risks of falls and risks involved in moving and handling people. There are also records on each persons file, showing that there is good access to specialist medical, chiropody and dental care. The results from all five GP surveys are very positive about the way this home meets residents healthcare needs, which indicates the good relationships between the staff and health care professionals. A relative comments, I am always informed by phone if my mother has any health issues, or has to go to hospital so that I can meet her there. Wendy informs me how they propose to solve any health needs and always carries the plan through. The homes system for the management and administration of residents medication has been improved in a number of areas, though there are still some further improvements needed, so that residents are safeguarded as far as possible. The registered manager has taken commendable action to explore the comments made by some residents on previous service user survey forms, indicating not everyone was satisfied with the meals provided. There are twice yearly food questionnaires, with arrangements put in place to respond to requests. For example one person wants chicken drumsticks and a local delicacy, pigs feet occasionally. She has also asked for residents and relatives Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 8 opinions about the change of location of the dining room. Comments are very favourable. The registered manager creates an environment, where comments and concerns are welcomed as an opportunity for the home to improve and a comment from the relatives survey states, Wendy and her staff are always helpful and answer any concerns I have regarding my mother. The registered manager, as part of the monitoring systems in the home has put in place audits of all areas the premises. As a result improvements to the internal décor, fixtures and fittings and the exterior of the home continue to be made. For example new blinds have been fitted to the dinning room and new furniture for this area has been delivered, make an attractive environment for residents to eat their meals. The manager also prioritises the decoration and refurbishment of residents bedrooms. The signage for bathrooms and toilets had been improved, with pictures of old style WCs, which appear to have more meaning for older people with dementia. They have been particularly successful helping one new resident with severe dementia to find and use the toilet. The laundry area has been reorganised and has improved infection control measures in place. The recruitment processes and staff personnel records show considerable improvements, and there are only a few additional areas, which need further improvement. A considerable number of areas of record keeping, including care plans, health, medication records and health and safety have been further improved. The manager is continuing to undertake 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: As already indicated a small number of improvements are needed to make the home system of medication administration as safe as possible. The improvements relating to more activities and outings must be built on and an individual activities planner put in place for all residents, who are asked about their preferred individual activities. The record must show refusals and any alternatives offered. There is a redecoration and maintenance plan in place and the registered persons must continue the improvements already identified, in a timely manner. Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 9 The registered manager must also make additional improvements to the recruitment processes and staff personnel records. For example making sure each persons application form is fully and accurately completed so that any gaps in employment history are identified and can be accounted for, so that good safeguards are in place to protect vulnerable residents. 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 Rest Home DS0000061845.V335673.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 Rest Home DS0000061845.V335673.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, 4, 5, Standard 6 is not applicable Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an up-to-date statement of purpose and service user guide and has updated residents contracts / terms and conditions of occupancy. This has the effect that residents and their advocates have good information regarding their rights and entitlements, any agreed restrictions and how care will be provided. The home 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 evidence to demonstrate that people have been given the opportunity and time to make decisions, which are right for them. Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 12 EVIDENCE: The registered manager has obtained copies of the Office of Fair Trading publication and has taken account of the revised Care homes Regulations and has incorporated changes into the homes contracts and terms and conditions of residency. There is evidence from the service user surveys and sample of residents case files that all residents have a comprehensive, clear contract, with fees and rights and responsibilities documented. From discussions and observations there is evidence that all prospective residents and families have an invitation to visit before coming to live at the home. There is evidence that a new resident due to be admitted on 19 May 07 has been offered the opportunity to visit the home. She does not feel able to make the visit but her daughter has visited the home on three occasions. The sample of residents case files demonstrates that the registered manager writes to each resident and their family to confirm that the home can meet their assessed and identified needs. There are currently 20 residents accommodated at the home, and discussions with the registered manager and assessment of the pre inspection information supplied by the home indicates that there is an awareness that if and when residents deteriorate they may need care, which the home is not able and not registered to provide. The staff show that they are aware of residents needs, and there are improved records of each residents preferences such as rising, retiring, likes and dislikes, preferred gender of staff to give assistance with personal care, which reduces risks of reliance on verbal communication between staff. Camelot Rest Home DS0000061845.V335673.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 improved care planning and monitoring provides staff with the information they need to satisfactorily meet residents needs. There is good multi disciplinary working taking place on a regular basis, which results in the health needs of residents being well met. The home is making good progress to improve the arrangements for administration of medication, which safeguards residents health and well being. EVIDENCE: Each resident has a comprehensive care plan, with evidence of the involvement of residents and their families where appropriate, in the development and review of the plan, which demonstrates good practice. Residents confirm their involvement in developing the plan and receive feedback on decisions made during reviews. The sample of three care plans examined during the inspection include all essential information necessary to plan the individuals care and there are a range of risk assessments in place. All care plans include beliefs, contact with relatives, physical abilities, health & Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 14 hygiene, mental health including all areas which are being put in place, e.g. signage, prompts, and activities. There is satisfactory evidence that information and changing actions appear on care plans. One resident has been referred for dental care and it has been established that he needs all remaining teeth removed. There is a plan for this to be achieved with sensitivity. An example from a new residents plan are: that he forgets to eat and staff are aware he will eat with verbal prompts to use knife and fork. It is recorded that this resident needs assistance of one carer to have a shave and bathe. The risk assessments include his tendency to wander and he is at medium risk of falling. There is guidance for staff offer sensitive supervision and assistance as needed. Each residents file has good written evidence of a range of risk assessments, dependency levels, for falls, for moving and handling, Waterlow tissue viability and where this is high showing which equipment is in place. 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 residents have appropriate access to dentists, opticians, chiropodists and other community services. A relative states, the home are always striving to find anything that helps my mother to be comfortable. . There is good evidence in the sample of 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 manager and staff are proactive in seeking professional advice on health care issues, always acting upon it and generally able to access the aids and equipment recommended. The comments from the GP surveys and from visiting district nurses are very positive about relationships with staff at this home. The manager also utilises the services and skills of the nurses and other healthcare workers to deliver some in house training relating to conditions such as diabetes and mental ill health. The home has a comprehensive medication policy, accessible for staff guidance. Staff involved in medication administration have received accredited medication training and demonstrate a good awareness of the use and effects of medications in the home. 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 improvement action, there is confidence that the registered person is working to achieve the improvements. For example any specialist instructions for the administration of medicines, such as Allendronic Acid 70mg and Risedronate Sodium 35mg is now clearly documented as part of the medication regime in each persons care plan and are administered strictly in accordance with written instructions. Small improvements are required as a result of this inspection, for example not Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 15 all variable dosages of medication administered are recorded on MAR sheets, whether one tablet or two has been given. It has been noted that not all short life medication is labelled with date of opening and use by date; especially eye drops and one undated eye drops were discarded during the visit. The staff must record carried forward balances of medication on MAR sheets to enable accurate audits of stocks to take place. From observations and discussions there is evidence that staff are aware of the need to treat residents with respect and they consider personal dignity when delivering personal care. The home arranges for residents to enjoy the privacy of their own rooms and there are plans to replace the screens in shared rooms with improved versions. The residents say that are happy with the way that the staff deliver their care and show them respect. There are policies and procedures, which inform staff how they should deal with dying and death. The wishes of residents about terminal care and arrangements after death are all recorded as part of their case file. One new resident who has little family contact has indicated he wishes to be buried with his father. Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 16 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. There is 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. Residents cultural and spiritual needs are well met. The majority of residents are able to maintain good contact with family and friends. Dietary needs of residents are well catered for with a balanced and varied selection of food that meets residents tastes and choices. EVIDENCE: There is evidence that the residents and relatives are able to discuss what makes them happy and make comments where they feel improvements can be made. The registered manager is very responsive and takes residents feedback seriously, making changes wherever possible. Evidence from the service user and relatives survey forms indicate that staff listen and make genuine efforts to enable residents to enjoy a good quality of life. The home has a key worker system, which enables closer relationships between residents and staff, where likes, dislikes and needs are understood. Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 17 There is improved evidence that Key workers use information to plan activities, which residents will enjoy. There is an increased level of activities, especially relating to residents with dementia or sensory difficulties. The home provides a supply of communal newspapers, and this is obviously valued by the number of residents living at the home and members of staff use the news items as opportunities for discussion. The home needs to build on the progress and offer increased opportunities for socialisation in the local community. The home needs to expand the system for displaying information and bringing residents attention to community events and activities. During discussions some people say that they prefer to spend their time on their own in their own bedrooms, with individual interests. The staff are well aware of individual residents decisions, which are respected and supported. There is evidence that family and friends of the residents feel welcome and know they can visit the home at any time. Visitors say that staff always make time to talk to them and share information. This is done with the agreement of the resident. During the tour of the premises it is evident that residents are able to have personal possessions in their room, though there may be some restrictions, for example larger items of furniture, which may be due to space restrictions or health and safety considerations relating to the residents bedroom. The home has menus, which include tea and suppertime choices as well as soup and other alternatives and these are displayed in large print and pictorial formats to help residents with limited understanding to make meaningful meal choices. The registered manager has responded proactively to explore the comments made by some residents on the previous service user survey forms, indicating not everyone is satisfied with meals provided. She has introduced twice yearly food questionnaires and arranges responses to the results. For example one resident now has pigs feet and also likes chicken drumsticks. The manager has also sought feedback regarding the changes to the location of the dining room, which has been entirely positive. Residents are able to enjoy the flexibility of meal arrangements and can eat in their own room, or at a small table in one of the sitting rooms, if they wish. There are plentiful supplies of cool drinks, with easy access for residents, around the communal areas of the home and it is evident that staff willingly make drinks for residents at any time. The food is good quality, well presented and generally meets the dietary needs of residents. The deputy manager /cook is very experienced, and speaks to the residents on a daily basis and tries to meet the preferences and requested dishes. All staff have recently undertaken NCFE health & nutrition training and are sensitive in their approach to help those residents who need help when eating. Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 18 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. Complaints are listened to and action is taken to look into them, and there are effective systems to record investigations and outcomes. Arrangements for protecting residents are satisfactory. Policies, procedures, guidance and staff training have been well implemented in order to provide residents with good safeguards from abuse. EVIDENCE: The home has complaints procedure displayed in the reception area and contained in the updated service user guide. Information supplied as part of the pre-inspection questionnaire indicates that the home has received seven complaints, which have been investigated by the provider with satisfactory outcomes. It is positive that the registered manager creates the environment where people are able to raise small issues and have a satisfactory resolution, which then improves the care of the residents. The results of the service users survey indicate that the majority of residents and all relatives are aware of how to raise concerns or use the homes complaints procedure. 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 Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 19 vulnerable adults, Safeguard and Protect at the home. The homes policies and procedures regarding protection of residents are satisfactory and with the support of the care management consultants they have been reviewed 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. All staff have been provided with appropriate adult protection training and those spoken to are able to discuss their awareness and knowledge of any action, which may be needed. Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 20 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, 21, 22, 24, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The significant and positive changes to the décor and furnishings are continuing. The incremental improvements contribute to creating a pleasing and pleasant environment for residents to live in. The grounds are maintained to provide a safe, pleasant and stimulating outdoor environment for residents. EVIDENCE: Camelot has a bright and cheerful interior, creating a warm and homely environment. The improvements to the exterior of the premises are continuing and include renovation to the flat roofs. The majority of requirements for repairs and redecoration issued at the last inspection have been acted upon. The defective window restrictor in bedroom 21 has been rectified and action has been taken to ensure all other first floor window restrictors are in a satisfactory condition. The compromised double glazing units in bedroom 5 have been replaced and all wardrobes are now appropriately secured. Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 21 The tour of the building identified that a number of improvements have been made and the program of redecoration and refurbishment is continuing, with prioritised redecoration and refurbishment of residents bedrooms. One resident has had her room redecorated and has all her own old style furniture. Her family are all in America, contact is maintained with phone calls and she has many family photos displayed in her bedroom. Another bedroom has a table and chair in the large bay window, where the resident enjoys breakfast, whilst watching people on the way to work. Another resident, who is fiercely private and independent agreed to unlock his bedroom and proudly showed his collections from charity shops, used to personalise his room. The registered manager has responded to a previous requirement to provide lockable facilities, comfortable chairs and bedside or over-bed lamps in residents bedrooms. Following consultation with residents and families the decisions as to whether people want the facilities or not have been recorded on their individual files. One resident, who proudly showed his bedroom states he does not want an armchair and has his room arranged exactly to his liking and no-one enters or touches his possessions without he is there and gives his consent. The registered manager has introduced a major change, with consultation, to create two separate sitting rooms by relocating the dinning area, which has been hailed a success. There are new blinds in the dinning room and new dinning furniture has been delivered. There are plans to replace curtains and covers throughout the home, as soon as a seamstress can be found. The two spacious sitting rooms create discrete areas for residents who may have different needs and may have needs for their own personal space. There is continued progress with the gardening projects and the rear garden now has a greenhouse, growing tomatoes, lettuce and spring onions. On the patio there are a number of containers of flowering plants, as well as containers growing carrots and other root vegetables. The manager has taken advantage of the offer of a Government grant to apply for funds to develop an area of the rear garden with raised beds. She has already identified and started to clear the area, which will provide great pleasure for a number of residents who enjoy gardening and will have fun from the hands on experience. 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. There is only one bedroom with a malodour, where the resident has a continence problem and the manager is exploring remedies. The floor covering in this bedroom needs to be replaced. Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 22 The kitchen and laundry areas are well organised, clean and tidy. There are a number of improvements to the laundry, with additional locked cupboards for secure storage. The COSHH information, laundry procedures and risk assessments, with the 10 golden rules are displayed on the walls. There is a new more efficient and environmentally friendly tumble dryer, which is included on the cleaning schedule to remove the lint after use, to improve fire safety. During discussion residents indicate that they are comfortable, the home is clean, and well lit. However parts of the home are excessively warm, which must be remedied to ensure the temperature is comfortable throughout, with good ventilation. There are a small number of additional improvements required at this visit, especially improvements to the sluice room, for better infection control. Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 23 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 adequate. This judgement has been made using available evidence including a visit to this service. Staff morale and confidence is good. Improved staffing levels mean that there are generally sufficient care staff during the day, ensuring that residents have care, support and needs for stimulation met. The staff recruitment processes are generally satisfactory, which provide residents with safeguards. The registered manager demonstrates a strong commitment to staff training, support and development. EVIDENCE: There are currently 20 residents accommodated, with a variety of dependency levels and diverse needs. Assessment of staffing rotas the improvement in staffing levels, both in terms of numbers and stability is being maintained. The registered manager regularly monitors residents dependencies and occupancy levels and reviews staffing levels, making appropriate adjustments. The home is staffed with 5 carers on the early shift, 4 carers on the late shift and 2 wakeful night carers. There is a designated carer on all shifts and the registered manager is supernumerary to the care hours. Assessment of the pre-inspection questionnaire submitted, staff files and staffing rotas during the visit show that 4 staff have left the homes employ, since the last inspection visit in July 2006 and seven new care assistants have been appointed. Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 24 There is evidence that 17 of the 21 care staff have achieved an NVQ level 2 care award, with remaining 4 candidates about to be registered. This means that the home is now able to demonstrate that it meets the ratio of 75 of care staff with an NVQ 2 (or equivalent) award, which enhances the care and support for the residents. The considerable improvement to the documentation and management of staff personnel files has been maintained, to the credit of the registered manager. Generally robust recruitment processes are in place and there are only a small number of improvements needed as a result of this visit. The registered manager signs and dates photocopies of qualifications held on file to evidence that originals have been seen, which is good practice. The registered manager has obtained a copy of the private chiropodists public liability insurance, however this copy has expired in January 2006 and an up to date copy is needed. The hairdresser has not yet provided evidence of a satisfactory CRB clearance. Also where criminal convictions or cautions are disclosed on CRB records a full explanation of the offence must be sought and documentary evidence of the assessment of any risk must be put in place. The registered manager continues to demonstrate a strong commitment to staff training and development, together with support measures such as structured supervision. From the sample of 4 staff files examined there is documented evidence that they have participated in recorded supervision sessions. During discussions staff say that they find the sessions useful and helpful. The home has an annual training plan and individual staff training profiles. The home has a new training provider following the inappropriate behaviour demonstrated by the previous training provider, for which the home has received an apology. The registered manager has written with the concerns to alert the West Midland Care Association and Skills for Care Council. It is very positive that 15 staff have undertaken an ASET accredited dementia training course delivered by Wolverhampton College. Some staff have commenced a distance learning package to achieve a Certificate in Health & Safety. There is written evidence from the district nurse relating to in house staff training relating to diabetes, blood glucose monitoring and MRSA. Staff spoken to demonstrate that they are knowledgeable about residents needs and how to meet them. There is a warm and genuine rapport with both residents and visitors. Staff say they feel that morale is good and that they feel supported, valued and are aware of their responsibilities, what is expected of them. Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 25 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, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an effective registered manager providing good leadership and direction, which ensures continuity and consistency. There are systems for resident consultation at Camelot, and there is evidence that efforts are made to ensure that residents’ views are formally sought and acted upon. The improvement in the standards of record keeping and health and safety compliance at this home has continued, providing protection for residents from risks of harm. Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 26 EVIDENCE: Wendy Madeley has successfully completed the CSCI registration process to be the registered manager at Camelot. She achieved the role through promotion as a long serving and experienced senior carer, and acting manager. She demonstrates a strong commitment to her own personal development and training. She has commenced training to achieve the Registered Managers Award (RMA) with JS Consultants. Wendy and 8 staff completed Managing Risk Assessment training on 26 September 2006 and have cascaded their improved knowledge and skills to the whole staff team, lessening the risks for residents. The registered manager has introduced 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 monitored progress and the manager reports that they are satisfied with the homes efforts. The collated results of the annual residents, relatives and stakeholders questionnaires and twice yearly food questionnaires are used to make improvements to the services provided. The manager and deputy manager carry out regular documented quality audits, which include the quality standards, environment, equipment, laundry, infection control. Staff and residents meetings take place regularly, with minutes posted on notice boards. The home has an up to date annual development plan and the care management consultants (RNF) make the required Regulation 26 visits to the home and reports of monthly unannounced visits relating to the conduct of the home are made available to the home, registered proprietors and the CSCI office, Halesowen. The Registered manager has proactively obtained a copy of the AQAA required annually on request by the CSCI. She recognises 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 to be able to provide evidence to the CSCI. 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. 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. The registered manager has consulted the Local Authority appointee about large balances previously held in temporary safekeeping on behalf of one resident in the homes safe and this issued has now been satisfactorily resolved and has resulted in a very positive rapport between the home and the Court of Protection and finance officers at Dudley MBC. Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 27 The consultancy company Peninsular retained by the home has conducted a health & safety audit with a written report supplied, which is very positive. The deputy manager / cook has obtained and implemented information from Environmental Services regarding new legislation (Jan 2006) relating to food safety. She now ensures that records are kept of the monthly calibration tests of the food probe. Food safety is maintained to high standards at this home. The random assessment of a sample of health and safety and service maintenance records examined shows that they are generally satisfactory. Mandatory training is provided for all staff commensurate with their roles in a rolling training programme. There have been 51 recorded accidents involving residents and 1 recorded accident involving a member of staff since July 2006. The registered manager has an effective system for auditing, analysing and evaluating accidents involving residents, with effective measures implemented. Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 28 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 3 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 X X 2 2 2 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement To ensure that staff record variable dosages of medication administered on MAR sheets, for example one tablet or two (Timescale of 01/08/06) 1) To ensure that all short life medication is labelled with date of opening and use by date, especially eye drops 2) To record carried forward balances of medication on MAR sheets 3 OP24 16(2) 23(2) Bedroom 11 (shared) must be provided with additional individual bedside or over bed lights (Timescale of 31/07/05 and 01/10/06 Not Fully Met) To ensure that when shared bedrooms 10 and 11 are redecorated and new privacy rails are installed each residents should be provided with separate hand wash basins and separate independently operated over-bed lights Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 30 Timescale for action 01/07/07 2 OP9 13(2) 01/07/07 01/09/07 4 OP26 23(2) To provide suitable sluicing facilities (Timescale of 31/05/05 and 01/10/06 Not Met) 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 31/05/06 and 01/08/06 Not Fully Met) 1) To ensure application forms are fully completed a full employment history including details of dates employment commenced and ceased (Timescale of 01/08/06 Not Fully Met) 2) 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 (Timescale of 01/08/06 Not Fully Met) 01/09/07 5 OP29 17(2) Sch2&4 19(1) 01/08/07 6 OP29 19(1) 17(2) Schedules 2 and 4 01/08/07 7 OP31 17(1) 18(1)(c) To provide the Registered Manager with an expanded contract of employment /terms and conditions and job description, which clearly reflect responsibilities including any oncall arrangements and extra duties 01/08/07 Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 31 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 - Not Met 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 additional signage be used in bedrooms, for example, pictures of clothing, to assist residents who lack understanding maintain independence 2 OP12 3 OP22 Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 32 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: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Camelot Rest Home DS0000061845.V335673.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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