Inspection on 06/12/05 for Camelot Rest Home

This inspection was carried out on 6th December 2005.

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 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 16/05/07

Camelot Rest Home 12/07/06

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 6th December 2005 07:50 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.V272047.R01.S.doc Version 5.0 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.V272047.R01.S.doc Version 5.0 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 Ms Susan Laws Care Home 25 Category(ies) of Past or present alcohol dependence over 65 registration, with number years of age (1), Mental Disorder, excluding of places learning disability or dementia - over 65 years of 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.V272047.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 06/04/05 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 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. Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit was undertaken by two inspectors from the Commission for Social Care Inspection. The visit started at 7:50 am and lasted until 4.30pm. The purpose of the visit is to assess progress towards meeting a large number of requirements to make improvements to meet the National Minimum Standards. A range of inspection methods has been used to make judgements and obtain evidence, which include: discussions with the registered proprietor, the deputy manager and staff on duty during the visit. A number of records and documents have been examined. Other information was gathered before this inspection visit from notification of incidents, accidents and events, and an action plan submitted by the home following the last inspection. During the visit the inspectors spoke to the majority of the 20 residents who were at home, one person is in hospital. Longer discussions took place with residents whose care was looked at in depth. A brief tour of the building has taken place, looking in particular at the communal rooms, laundry, bathing facilities and sample of residents’ bedrooms, with their permission. What the service does well: The proprietors and manager have responded to the previous unannounced inspection visit with a completed action plan, giving dates for the required improvements to be put into place. Camelot continues to have a small group of staff who have worked at the home for a long time and know the residents well. They are caring, committed and flexible, often willing to work extra shifts. There is a warm relationship between most staff and residents. A resident commented that staff are friendly and helpful. Another person commented that the staff are fantastic. Members of care staff continue to carry out a wide range of duties in addition to caring, such as laundry, cooking and cleaning tasks. The meals are well prepared and appetising, members of staff ask residents what they prefer for each meal, and taking time to offer people help if they need it. The majority of residents say that they are happy with the meals provided. One person commented that the meals are nice, another person states the food is great, the best. Camelot is comfortable and homely. 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. Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 6 The Inspectors would like to thank staff, and residents for their hospitality during this inspection visit. What has improved since the last inspection? The manager has expanded written information about the home, which gives prospective and existing residents and families up to date information about the home, the staff and the way care is provided. There is also information available about how to see the homes recent inspection reports. Each person or their representative now receives written confirmation that the home is able to meet all of their needs and offers and decisions about introductory visits are now fully recorded on residents individual case files. This demonstrates that people have good information and opportunities, to use to make decisions about where they will live. The way the home plans each persons care is now improving. The written information is more detailed and specific and provides staff with clearer guidance. Health care assessments have improved, with more detailed records of the measures in place to minimise risks of falls and risks involved in moving and handling people. 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, however the menus need to include tea and supper choices. Each persons food choices are recorded. There are also improved records on each persons file, showing that there is good access to specialist medical, chiropody and dental care. Improvements have been made to the way medication is stored, administered and recorded, with only very minor improvements needed as a result of this visit. Staff are currently taking responsibility for organising more activities for residents, with outings advertised on a notice board in the reception area. Arrangements have been made for all residents and staff to have Christmas party at a local venue. The home now 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 homes own policies and procedures. Improvements to the internal décor, fixtures and fittings and the exterior of the home are being continued. The exterior has been painted in an attractive and stylish shade of cream. Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 7 The general cleanliness of the home has improved and no malodours have been detected during this visit. Some improvements have been made to some areas of record keeping, care, health, medication records and some areas of health and safety. The manager has resumed regular recorded analysis of accidents, which highlights any trends with improved measures 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. Although improvements have been made with each persons plan for their care, further improvements are still required to make sure information is detailed and specific and care needs are properly met. The registered person must continue improvements to the system of medication in the home. An immediate and serious concern has been identified relating to the practice of untrained staff undertaking blood monitoring procedures for people with diabetes. And immediate requirement has been issued for the registered person to take action to rectify this situation. Following on from the improvements made by providing organised trips, all residents must be asked about their preferred individual activities. The information must then be used to devise, advertise and offer a regular programme of a wide variety of activities, with each persons participation or refusal noted. The proprietors and manager must have a record of the planned programme of general redecoration, including residents bedrooms and the ongoing replacement of furnishings and equipment. The proprietors and manager must continue with the recruitment of sufficient numbers of care staff, laundry staff and additional catering staff. The home has continued to experience difficulties in retaining and recruiting sufficient numbers of appropriate staff. Since the last inspection the entire night staff team last left the homes employ. This is a matter of serious concern and the registered person has been required to maintain adequate staffing levels with sufficient numbers of trained, experienced, competent staff, with immediate effect. There are additional serious concerns about recruitment practices at the home. For the second time since February 2005 staff have been allowed to commence employment at the home without satisfactory checks and clearances and Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 8 appropriate documentation. The registered person has been required to put additional safeguards in place with immediate effect and give assurances to the CSCI that the situation will not be allowed to occur again. The home must fully develop quality assurance monitoring processes, which actively involve residents, relatives and staff. There are a small number of areas relating to health and safety, which need to be improved, for example the staff must stop using wooden door wedges to prop open residents bedroom doors and the registered person must make sure approved dor guards are fitted so that residents can leave bedroom doors open and also be safe in the event of fire. 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.V272047.R01.S.doc Version 5.0 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.V272047.R01.S.doc Version 5.0 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): 1,2,5 The organisation has produced an updated and expanded 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 actively encourages introductory visits and there is now documentary evidence to demonstrate that people have been given the opportunity and time to make decisions, which are right for them. EVIDENCE: The manager has revised and expanded the home statement of purpose and service user guide and copies of these documents have been made available to the CSCI office, Halesowen and to residents and their families at the home. The contracts examined on a sample of residents case files have not been revised in accordance with the Office of Fair Trading publication (Unfair Terms in Care Homes Contracts) and may contain terms and conditions, which are considered unfair. One person admitted to the home on 22 April 2005 does not Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 11 have completed contract, no fees are specified and there is no signature or date. From discussions and assessment of a sample of residents case files there is evidence that the home now ensures that there is detailed care management assessment information from referral agencies. In addition the home carries out its own comprehensive pre admission assessment. There is evidence that a proactive reassessments and reviews of residents needs are now being conducted. The residents files assessed have provided documentary evidence that written confirmation is given to each person and/or their relative or representative that the home can meet their assessed needs. The home is also recording offers and outcomes of introductory visits. One person did not have an introductory visit to the home because he was in hospital, another person took the opportunity to visit the home before being admitted and this is recorded in her case file. Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 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 Progress is continuing to implement more comprehensive care planning, ensuring that all healthcare needs are properly recorded. The improvements reduce the potential to place residents at risk. EVIDENCE: There are improvements to the care planning processes, though further developments are needed. The deputy manager acknowledges that further work needs to be done and is continuing the processes. Some areas of the care plans are more detailed and specific and provide staff with clear guidance. Examples of care planning needing fuller detail are care for people with dementia, Parkinsons disease, multiple sclerosis and short-term care needs, such as infections, medication regimes, and evaluation of goals. There are now generally improved risk assessments and health care screening assessment tools in place for each person. However there is inadequate and inaccurate reassessment and review of the risk assessment and care plan relating to agitation and the use of Promazine medication for PB. The review for December 2005 states no changes, when there is clearly documented evidence of increased agitation and increased use of Promazine. Furthermore there is no evidence of a documented and up to date tissue viability Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 13 assessment or details of any pressure relieving equipment recorded on the sample of residents case files examined. There is recorded evidence that each persons weight is regularly monitored, though the home is awaiting delivery of sit on the scales for people unable to weight bear. There are good records in place relating to the health care checks provided for older, which demonstrate that all regular checks have been offered, whether or not they had attended or what the outcome has been. A sample of case files assessed show records of dental appointments, checks carried out by opticians, including diabetic eyesight screening, appointments with the chiropodist and the district nurses. The home has copies of comprehensive medication policies and procedures available and observation of the administration of medication indicates that good practice guidance is being followed. A small number of previous requirements are not yet fully met, examples are expansion of the medication policy to include guidance on the use of PRN medication and the use of homely remedies. A specimen procedure and template produced by the CSCI pharmacists relating to the homely remedies has been given to the home for their guidance during this visit. Random audits of medication stocks identified one discrepancy, though tracking is more difficult where the receipt of medication has not been accurately recorded and signed for. Additional areas identified as needing improvement at this visit relate to the lack of carried forward medication stocks on MAR sheets and the lack of recording of variable dosages, one tablet or two, on MAR sheets. Examination of LMs care records and discussions have identified that a number of care staff are undertaking BM procedures, without appropriate training. This usually occurs on an ad hoc basis, sometimes at night, in response to challenging behaviour to measure the persons blood sugar level to determine whether a glucose drink is required. Discussions have established that only two senior carers have received training from the district nurses; and this was some time ago. The registered persons are required to take immediate action to rectify the situation; an immediate requirement has been issued to this effect. At this visit there is generally a satisfactory standard of care at a practical level during the daytime shifts and a number of residents made positive comments about the kindness and care given by staff. During the visit some staff are using pet terms of address, as terms of affection towards the residents. This practice must be avoided unless specified in the residents care plan, to maintain each persons dignity. Residents records do not always show the person s preferred name / term of address. Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 14 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): 12,14 There has been some progress to make planned and spontaneous activities available on a regular basis. Residents are better able to take advantage of and develop socially stimulating opportunities. The residents are offered opportunities to exercise choice and control over their personal environment and lifestyle. EVIDENCE: Some residents feel that there are now more opportunities to be involved in planning and other activities such as Dominos, board games or sing-a-longs, which take place as and when individual members of staff have the time and take the initiative. There is also improved evidence that staff are able to spend talking to two residents and to provide more regular activities or outings. There is a planned activities program displayed, together with photographs of residents and staff taken on outings. A notice is displayed in reception advertising the Christmas party and entertainers who are coming to the home for events for the residents enjoyment. However currently there is limited evidence of each residents participation or refusals. One person continues to attend a day centres, the Claughton Centre for two days each week and Henry Court for one day each week; these are centres Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 15 specifically for African Caribbean Elders. In addition he attends Queens Cross Centre, operated by Dudley Social Services. Currently the home does not have information about advocacy services proactively displayed. However discussions with residents indicate that they are encouraged and supported to make their own decisions and they are able to have furniture and personal possessions in their own bedrooms. There is currently insufficient evidence of up-to-date personal inventories on each persons file. Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 16 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 Complaints are listened to and action is taken to look into them, however there continues to a lack of clear recording of investigations, outcomes and lessons learned or of communication to complainants about improvements made. Progress has been made to review the procedures for the protection of vulnerable adults and progress is being made to provide staff training. EVIDENCE: The home has a complaints procedure, which is clearly displayed in the reception area and contained in the service user guide. The homes complaints log has been examined; there are no recorded complaints since the unannounced inspection in April 2005. There is insufficient detail relating to a complaint received by the proprietors in March 2005. The home has a copy of the multi-agency procedures for the protection of vulnerable adults, Safeguard and Protect. The manager needs to continue to review the homes policies and procedures to ensure there is linkage with the multi-agency procedures. Currently there is no 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. Limited progress is being made to provide all staff with appropriate adult protection training. Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 17 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, 24, 25 Improvements to the internal decor the communal areas of the home and residents bedroom is being continued. The home is a pleasant and comfortable environment for residents. EVIDENCE: These standards were assessed at the inspection visit on 6 April 2005. Previous requirements have been reviewed and where they are not fully met reprioritised timescales have been agreed. The exterior of the home has been repainted and attractive and stylish shade of cream, considerably enhancing the look of the premises. A brief tour of the building identified that a number of improvements have been made and the program of redecoration and refurbishment is continuing. However there is still no documented program for the ongoing maintenance, redecoration and refurbishment of the building, fixtures, fittings and equipment. The proprietor states that there are plans to redecorate all bedrooms. During the tour of the home, the door to bedroom 14 has been wedged open using a Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 18 wooden door wedge, because the resident chooses to spend her time in her own room and likes the door open. However the use of wooden door wedges has the potential to warp the doorframe, rendering the smoke seal in effective. Additionally the radiator in bedroom 14 is not working and a portable heater has been put in place, which is excessively hot to the touch and is unguarded. The resident states that the heating in her bedroom has been defective for some time, possibly weeks. There is no documentary evidence that this has been reported for maintenance and remedial action. The portable heater has not been risk assessed and does not have an up-to-date PAT test certificate. The resident states she would like her bedroom redecorated and is willing to replace the carpet, which is her own. She would like a pink bedroom carpet. The registered person is advised that the provision of floor coverings is the responsibility of the home, unless the resident chooses to have a particularly expensive carpet. The resident in bedroom 14 currently chooses to watch her own TV in her own room and she spends the majority of the day in her wheelchair. For comfort she positions her wheelchair against the wardrobe and props a pillow against the wardrobe door. The registered person must make a referral for an up-todate assessment by an occupational therapist to ascertain whether or comfortable and appropriate seating can be provided for MN in bedroom 14. There is an improvement to the general cleanliness of the home and bathrooms are now monitored to ensure they remain free from clutter or items, which may be used communally. There are some additional improvements required at this visit, examples are the provision of a wastepaper bin in the ground floor bathroom / WC and the investigation and resolution to the extractor fan in the en suite, which is currently not working. Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 19 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 recruitment processes for new staff have deteriorated, there are a lack of acceptable safeguards for the protection of vulnerable people. Although the staffing levels have improved there are not adequate numbers of staff with satisfactory employment clearances, experience and training for this home to provide a satisfactory level of care, especially during the night for the number of residents with complex care needs. EVIDENCE: There are 20 service users accommodated, with a variety of dependency levels and diverse needs. Assessment of staffing rotas identified shortfalls in appropriately recruited, trained, experienced and competent staff, particularly on the night staff rota. Senior staff state that the entire night staff team have left the homes employ over a period of a few weeks since September 2005. The reason given is that they have taken up employment at a newly opened home nearby. Assessment of staff files and staffing rotas during the visit identified that four new care assistants have been appointed since 18 July 2005 and have commenced employment at the home without a satisfactory POVA /CRB clearances and two staff with only one written reference, at their start date. Despite the immediate requirement and letter identifying similar serious concerns on 24 January 2005, staff have been appointed without POVA clearances, without a written risk assessment, without named supervisors on Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 20 the rota, without discussion with the CSCI office, Halesowen and with no evidence that they are supervised at all times and not allowed to undertake personal care for residents. Furthermore it is a matter of very serious concern that staff with little or no care experience, with all mandatory training and without CRB clearances are rotad to work together on wakeful night duty, without supervision and effectively left in charge of the home. A further immediate requirement notice has been issued at this visit; the registered persons must take immediate and remedial action to ensure the safety and well being of all residents and staff at this home. Assessment of staff training records identified that there is insufficient detail to provide evidence that all staff have up-to-date mandatory training, in areas such as moving and handling, use of hoists, fire safety, food hygiene, first aid, health and safety, and infection control. The training matrix uses the code x to show that staff have received training, however this does not demonstrate that staff are up to date with the required training. An example is the deputy manager, who also undertakes significant amounts of catering duties and on further examination of records it is identified that her food hygiene training took place on 26 November 2002. There is planned food hygiene and fire safety training due to take place in January 2006. There was no documentary evidence that this visit of the number of staff who have achieved an NVQ care award. Therefore the home is not able to demonstrate that it meets the ratio of 50 of care staff with an NVQ 2 (or equivalent) award. Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 21 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): 35,37,38 There is a lack of progress to provide formal professional managerial support and supervision. There has been limited action to ensure continuity of care, resulting in practices, which do not safeguard the health, safety and well being of people using the service. EVIDENCE: The registered manager, Ms S. Laws, who has worked the home for many years and has considerable managerial experience is on leave at the time of this visit. However the registered proprietor, present for part of this visit, has not been able to demonstrate that the previous requirement to provide the manager with professional supervision and support has been met. Therefore this requirement remains outstanding. The registered provider states that the home is receiving support from a Care Management Consultancy. However there is no documentary evidence available of Regulation 26 Reports of findings and guidance from the Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 22 Proprietors / Responsible Individuals one nominated representatives visits to the Home. Although there is evidence of good practice and improvements relating to some areas of record keeping such as care plans and health care documentation, there are serious failures to maintain records relating to recruitment. The home has failed to notify the CSCI office, Halesowen in accordance with Regulation 37 relating to the compromised night staffing arrangements. This is considered to be an event, which adversely affects the well being of residents. The manager has resumed the regular analysis of accidents involving residents, which is used to identify any trends or areas of particular risk and action is taken to improve control measures. Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 23 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 X X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X 2 1 X STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X 1 2 Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 24 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 OP2 Regulation 5(1) Requirement To review the contract / terms and conditions using the publication from the Office of Fair Trading: Guidance on Unfair Terms in Contracts in Care Homes (Timescale of 24/1/05 and 31/05/05 Not Fully Met) To ensure all residents have a fully completed, signed and dated contract / terms & conditions on file Service user plans must contain details of changing needs, short term needs with clear guidance for staff to ensure that action is taken to meet and monitor each persons health and wellbeing, for example weight loss and falls (Timescale of 31/05/05 Not Fully Met) 1) The Registered Person must ensure that all residents have a recorded falls risk assessment in place, which is reviewed and evaluated on a regular basis (Timescale of 31/05/05 Not Fully Met) 2) Access must be provided to Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 25 Timescale for action 01/02/06 2 OP2 5(1) 01/02/06 3 OP7 15(1) 01/02/06 4 OP8 13(4) 01/02/06 sit on scales on a regular basis for residents unable to stand and weight bear (Timescale of 31/05/05 Not Fully Met) 5 OP8 13(4) 1) To ensure that there is a documented and up to date tissue viability assessment in place for each resident 2) To ensure full details of any pressure relieving equipment is recorded as part of individual care plans 6 OP9 13(2) To devise procedural guidelines 01/02/06 for the administration of PRN medication to be documented and implemented as appropriate as part of individual plans (Timescale of 31/03/05 and 31/05/05 Not Fully Met) 01/02/06 1) The homes medication procedures must be expanded to include: guidance for staff when residents repeatedly refuse medication (Timescale of 31/05/05 Not Fully Met) 2) The homely remedies policy / procedure must be revised to include documented ratification by GPs (Timescale of 31/05/05 Not Met) The excessive temperature of the medication fridge must be investigated and resolved to ensure the temperature is consistently maintained between 2C- 8C (Timescale of 31/05/05 Not Fully Met) 1) The registered person must ensure that the practice of untrained staff undertaking invasive body procedures, blood glucose monitoring procedures, ceases with immediate effect. DS0000061845.V272047.R01.S.doc 01/01/06 7 OP9 13(2) 8 OP9 13(2) 01/02/06 9 OP9 13(2) 06/12/05 Camelot Rest Home Version 5.0 Page 26 10 OP9 13(2) 11 OP9 13(2) 2) The registered person must 16/12/05 implement a written protocol for all residents with diabetes, agreed with district / diabetic nurses, as a matter of urgency. Documentary evidence must be forwarded to the CSCI office, Halesowen by 1700 hours on Friday 16 December 2005. 1) To record carried forward 01/01/06 medication stocks on MAR sheets 2) To ensure variable dosages, one tablet or two, are recorded on MAR sheets 1) To ensure that preferred name / term of address is recorded on every residents plan 2) To ensure staff avoid the use of pet terms of address unless specified in the residents care plan The decisions of residents and / or relatives relating to final wishes must be recorded in sufficient detail in their service user plan to enable preferences to be followed (Timescale of 31/05/05 Not Fully Met) To undertake regular audits of participation in activities provided to record and identify refusals with alternative options offered / or reasons recorded 1) To ensure that the new menus are displayed in formats appropriate to residents understanding (Timescale of 31/05/05 Not Fully Met) 2) To record tea and supper options on the menus Details of complaints received by the home must be documented in the homes complaints log, be DS0000061845.V272047.R01.S.doc 12 OP10 12(1) 01/01/06 13 OP11 15(1) 01/02/06 14 OP12 16(2)(n) 01/02/06 15 OP15 16(2)(i) 01/01/06 16 OP16 22 01/01/06 Camelot Rest Home Version 5.0 Page 27 17 OP18 13(6) 18(1) (c) fully investigated, with the outcome formally notified to the complainant (Timescale of 31/05/05 Not Fully Met) 1) To devise and implement policies and procedures to safeguard the management of service users finances, which need to be cross-referenced to the staff employment handbook (Timescale of 31/03/05 and 31/05/05 not met) 2) To provide staff training relating to responding to suspicions of abuse; and dealing with challenging behaviour (Timescale of 31/07/04, 30/11/04 and 31/05/05 not fully met) The Registered Persons must conduct a documented audit of the premises, from which a prioritised programme of repairs, redecoration and replacement of equipment is devised and implemented, incorporating the redecoration of residents bedrooms within an identified timescale(Timescale of 31/05/05 Not Fully Met) To ensure that there are bins for used paper hand towels in all bathrooms and WCs To arrange a reassessment by an appropriately qualified occupational therapist of MNs needs for adapted equipment, such as a comfortable chair for her bedroom The registered person is required to provide evidence of actions to rectify the defective radiator in bedroom 14, and implement a documented risk assessment for the portable heater as an interim measure, with immediate effect. Documentary evidence must be DS0000061845.V272047.R01.S.doc 01/02/06 18 OP19 23(2)(b) 01/02/06 19 20 OP21 OP22 23(2)(j) 16(2)(c) 23(2)(n) 12/12/05 16/12/05 22 OP24 13(4) 23(2) 09/12/05 Camelot Rest Home Version 5.0 Page 28 forwarded to the CSCI office, Halesowen by 1700 hours on Friday 9 December 2005. 23 OP24 16(2) 1) To undertake an audit of each bedroom documenting where all elements of this standard are met and recording reasons where it is not met. (Timescale of 31/07/04, 31/03/05 and 31/05/05 not fully met) 2) To discuss the service users 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 the furniture belonging to the resident in room 11 is documented on an inventory on her individual file and that all other inventories are appropriately updated (Timescale of 31/05/05 not fully met) 1) To redecorate bedroom 14 10/03/06 according to MNs preferences 2) To provide a replacement for the residents own (worn, stained) carpet according to preferred option 1) Bedroom 11 (shared) must be redecorated, including the renovation of skirting boards and window sills (Timescale of 31/07/05 Not Fully Met) 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 31/07/05 Not Fully Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 29 01/02/06 24 OP24 16(2)(c) 25 OP24 16(2) 23(2) 01/03/05 Met) 3) Documentary evidence that both people have agreed to share a bedroom must be obtained and details of privacy arrangements recorded on each persons plan (Timescale of 31/07/05 Not Fully Met) 26 OP25 23(2)(p) To repair the defective fan in the 01/01/06 ground floor shower room near to the treatment room- repaired - but still not working 1) To provide suitable sluicing 01/01/06 facilities (Timescale of 31/07/04, 31/03/05 and 31/05/05 not met) 2) As an interim measure the carpet must be removed from the sluice and an appropriate flooring provided (Timescale of 31/05/05 Not Fully Met) 3) To devise and implement a cleaning schedule for the laundry area, to ensure that floors are mopped daily (Timescale of 31/03/05 and 31/05/05 not fully met) 4) The kitchen cleaning schedule must be expanded with all products and dilution consistently recorded (Timescale of 31/05/05 Not Fully Met) 1) To provide additional catering support to maintain satisfactory standards of food hygiene. (Timescale of 31/03/05 Not Met) 2) To allocate sufficient time to the deputy Manager, who is undertaking the majority of catering duties, to undertake Managerial tasks such as staff supervision, NVQ assessments etc. (Timescale of 31/03/05 and Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 30 27 OP26 23(2) 28 OP27 18(1)(a) 01/01/06 31/05/05 Not Met) 3) 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 - not met on occasions Dec 05 (Timescale of 25/01/05 and 6/04/05 Not Fully Met) 4) To provide additional ancillary hours to undertake cleaning, laundry and catering duties to ensure the firm is maintained to an acceptable level of cleanliness and infection control, especially whilst redecoration work is in progress (Timescale of 25/01/05 and 31/03/05 Not Fully Met) 5) To ensure that a Regulation 37 notification is completed and forwarded to the CSCI Satellite office - Halesowen for ANY time that the care staffing level falls below 4 care staff during the morning shift or 3 for the remainder of the waking day, identifying contingency measures in place (Timescale of 25/01/05, 31/05/05 Not Met) The registered person must submit documentary evidence of revised staffing levels implemented, including the next 4 weeks staffing rotas, with clearly designated hours and duties, including named supervisors and designated senior carers on night duty, to the CSCI office, Halesowen by 1700 hrs on Friday 9 December 2005. DS0000061845.V272047.R01.S.doc 29 OP27 17(2Sch 2&4 8(1a,c) 09/12/05 Camelot Rest Home Version 5.0 Page 31 30 OP27 17(2Sch 2&4 8(1)a)c) 31 OP28 18(1)(c) 32 OP29 17(2) Sch 2&4 19(1) The registered person must submit a written proposal to rectify the deficits of adequately trained, experienced and competent night staff, with satisfactory employment clearances to the CSCI office, Halesowen by 1700 hours on Friday 9 December 2005. To forward documentary evidence of NVQ achievements (matrix and copies of certificates) to the CSCI office, Halesowen 1) Ensure that a written reference is obtained from applicants last employer (as one of the two written references obtained) (Timescale of 31/03/05 and 31/05/05 not fully met) 2) To record all interviews with prospective staff and develop a suitable person specification for specific posts. (Timescale of 31/03/05 and 31/05/05 not fully met) 3) To complete the process of obtaining all information required for staff files to meet the documentation identified in Regulation 17(1) Schedule 2 and 4. (Timescale of 31/03/05 and 31/05/05 Not Met) 4) 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 31/05/05 Not Fully Met) 5 Staff files must contain copies of up-to-date and accurate job 09/12/05 01/02/06 01/01/06 Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 32 descriptions and copies of contracts of employment (Timescale of 31/05/05 Not Fully Met) 6) Records of staff training on files need to be reconciled to the staff training matrix (Timescale of 31/03/05 and 31/05/05 Not Fully Met) 7) To review and update the disciplinary and grievance procedures and staff contracts in view of the introduction of the protection of vulnerable adult abuse (POVA) register. (Timescale of 31/03/05 and 31/05/05 not met) The registered person is required 06/12/05 to cease to employ any further persons until All satisfactory clearances have been received in compliance with the Care Homes Regulations 2001, Schedules 2 and 4, including documented and satisfactory explanations of any gaps in employment, satisfactory POVA /CRB clearances and 2 satisfactory written references, one of which should be from the current or previous employer, with immediate effect. The registered person is required 06/12/05 to seek agreement with the CSCI satellite office, Halesowen in any exceptional circumstances to allow the employment of persons on a POVA first basis, providing evidence of rigorous preemployment checks, a documented risk assessment and copies of rotas with evidence of a named supervisor to ensure supervision at all times, and written assurance that no personal care will be undertaken until a satisfactory CRB DS0000061845.V272047.R01.S.doc Version 5.0 Page 33 33 OP29 17(2) Sch 2&4 19(1) 34 OP29 17(2) Sch 2&4 19(1) Camelot Rest Home 35 OP29 17(2) Schs 2&4 19(1) 36 OP30 18(1)(c) clearance is received. The registered person is required to provide written confirmation from the CRB that police / criminal records clearances obtained from Poland for Polish Nationals are satisfactory, without the need for further POVA/CRB clearances in the UK, to be forwarded to the CSCI office by Friday 16 December 2005. 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, 31/03/05 and 31/07/05 not fully met) 2) All newly recruited staff must receive induction training to National Training Organisation specification within six weeks of appointment to post, with foundation training within six months of appointment. (Timescale of 31/03/05 partly met) 16/12/05 01/02/06 37 OP31 17(1) 18(1)(c) 3) The in-house induction checklist must be completed with dates and signatures (Timescale of 31/07/05 Not fully Met) 1) To provide appropriate, 01/02/06 regular profession documented supervision sessions for the Registered Manager (Timescale of 31/03/05 and 31/05/05 Not Met) To implement an annual development plan for the home DS0000061845.V272047.R01.S.doc 38 OP33 24 01/03/06 Camelot Rest Home Version 5.0 Page 34 39 OP33 24 40 OP33 24 41 OP33 24(1)(2) 26(2) 42 OP36 18(1)(c) based on a systematic cycle of planning – action – review, reflecting aims and outcomes for service users. (Timescale of 31/07/04, 31/03/05 and 31/07/05 Not Fully Met) To review and expand the discharge procedure to include reference to Notification of Termination of accommodation, as required by Regulation 40(Timescale of 31/03/05 and 31/07/05 not met) To review all policies and procedures to ensure that they are individualised to relate to this home (Timescale of 31/03/05 and 31/07/05 Not Fully Met) To ensure that documented Regulation 26 visit from the organisation’s nominated representative are conducted consistently as prescribed on a monthly basis, with reports to the Home and the CSCI Satellite Office – Halesowen. (Timescale of 31/03/05, 31/05/05 not met) 1) To progress the formal documented supervisions sessions for all care staff (Timescale of 31/03/05 and 31/05/05 Not Fully Met) 2) To devise and implement a documented annual schedule of supervision sessions, to be displayed to encourage staff participation in the process (Timescale of 31/03/05 and 31/05/05 Not Fully Met) 3) To ensure staff supervision notes include a demonstration of action (Timescale of 31/03/05 and 31/05/05 Not Fully Met) The registered person must ensure that Regulation 37 DS0000061845.V272047.R01.S.doc 01/03/06 01/03/06 01/03/06 01/02/06 43 OP37 37 16/12/06 Page 35 Camelot Rest Home Version 5.0 notifications are submitted to the CSCI office, Halesowen for any event affecting the well being of service users, including any time staffing levels are compromised 44 OP38 13(4) 18(1)(c) 1) 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 Fully Met) 2) To devise and expanded laundry procedure and guidelines, to be displayed in the laundry area and ensure that personal protective equipment for staff, such as disposable gloves and aprons, are available at all times in the laundry and sluice (Timescale of 31/03/05 and 31/05/05 Not Fully Met) To ensure all staff attend fire 01/02/06 drills and fire training twice yearly as the minimum (Timescale of 31/03/05 and 31/05/05 Not Fully Met) 16/12/05 1) To resume the regular hot water tests, lapsed since October 2005 2) To record remedial action in response to temperature records showing excessively high or low water temperatures 3) To cease to use the wooden door wedge for bedroom 14 or elsewhere in the home; providing dor guards or other self closing mechanisms approved by the West Midland Fire Service 01/02/06 45 OP38 23(4)(d) (e) 46 OP38 13(4) Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 36 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 2 3 4 5 6 7 Refer to Standard OP4 OP9 OP12 OP18 OP27 OP29 OP30 Good Practice Recommendations That consideration is given to requesting a variation to the homes registration to increase flexibility of admissions That refresher training relating to blood glucose monitoring procedures is provided by an approved trainer / nurse, for senior staff trained some time ago 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 staff signatures are obtained to provide evidence that all staff have read and have an awareness of policies to protect vulnerable adults That rotas identify service user dependencies and occupancy levels, and that a regular documented review of staffing levels, using the staffing tool, is conducted That the Manager signs and dates photocopies of qualifications held on file to evidence that originals have been seen. That the staff training matrix is expanded to include all training, and that the date of completed training is entered, rather than entering X Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 37 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. Extracts may not be used or reproduced without the express permission of CSCI Camelot Rest Home DS0000061845.V272047.R01.S.doc Version 5.0 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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