Inspection on 24/04/08 for Cameo Rest Home

This inspection was carried out on 24th April 2008.

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

Cameo Rest Home 21/10/08

Cameo Rest Home 05/06/06

Cameo Rest Home 19/12/05

Cameo Rest Home 06/07/05

Cameo Rest Home 12/01/05

Cameo Rest Home 23/06/04

Cameo Rest Home 05/02/04

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Cameo Rest Home 14 Hopleys Close Glascote Tamworth Staffordshire B77 3JU Lead Inspector Wendy Grainger/ Amanda Hennessy Key Unannounced Inspection 07:30 24th April 2008 and 29th May 2008 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 Cameo Rest Home DS0000004926.V363069.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. Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cameo Rest Home Address 14 Hopleys Close Glascote Tamworth Staffordshire B77 3JU 01827 53906 01827 64458 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) Mrs Yvonne Patricia Aikens Mrs Yvonne Patricia Aikens Care Home 10 Category(ies) of Dementia (4), Dementia - over 65 years of age registration, with number (4), Old age, not falling within any other of places category (10) Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 4 Dementia (DE) - Minimum age 57 years on admission Date of last inspection 5th June 2006 Brief Description of the Service: Cameo is located on the edge of the town of Tamworth positioned at the end of a cul-de-sac. The home was registered some years ago to provide care for ten older people. The service users presently at the home would not easily access the small selection of shops in the area. Standing in its own grounds Cameo is a two-storey home; car parking was located at the front of the home. There is a garden at the rear of the home. Within the home is a small office, two lounges one used as a combined dining room. Cameo has one shared bedroom; there are no en-suite facilities provided. As the fee information has not been included in this report we advise the reader to contact the service for this information and of any other costs that may charged for, in addition to the fees. Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall rating for this service is 0 star. This means that the people who use the service experience poor quality outcomes. Two Inspectors carried out this key unannounced inspection separately over two days. Mrs Wendy Grainger visited the home on the 24th April 2008 between 07.20 and 17.45 and Mrs Amanda Hennessy visited on the 29th May 2008 between 08.15 and 13.15. The service did not know we were coming on either occasion. The manager/ Proprietor was present during the majority of our inspection on both days. Information for the report was gathered from a number of sources: a questionnaire- Annual Quality Assurance Assessment (AQAA) was completed before the inspection by the homes manager/ proprietor which was sent to us; We looked at the environment including looking at the communal areas and a sample of the bedroom accommodation, discussion with the manager and care staff and people who live at the home and visitors to the home. We looked at how the service responded to any concerns and how the service was protecting people from abuse including looking at how the service recruited and trained staff. We also looked at the number of staff available to care for people at the home. Four people who live in the home were ‘case tracked’ this involves establishing people’s experiences of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes of the care that they receive. Tracking people’s care helps us understand the experience of people who use the service, how they spend their time and whether the service was promotes people’s privacy and dignity. We looked also looked at the arrangements for administering medication. . There was one requirement made at the previous inspection which we found was not met. Eight requirements and sixteen good practice recommendations were made as a result of this inspection. We would like to thank people living at the home, the Manager and staff for their assistance and hospitality during the inspection. Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The provider has failed to address our previous requirement regarding recruitment processes. Appropriate recruitment procedures minimise the risk of unsuitable people working with vulnerable people and protects them from potential harm. It is positive that staff have a good knowledge of peoples needs but further improvement could be made if care records are improved. Staff need to more Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 7 fully record and monitor changes to people health and ensure that required risk assessments are completed. Risk assessments are needed for the use of bedrails and safe and appropriate moving and handling which if adequately completed and available can minimise the risk of accident or even serious injury to people. There is a need to improve recordkeeping and safe administration of medicines. There should be records of the receipt and administration of all medicines. Appropriate records minimise the risk of medicine errors and also gives assurance that people receive their medicines as prescribed. Adequate heating must be provided at all times to promote the health and well-being of the people who use the service. The manager must ensure that crucial repair work is undertaken in a more timely fashion. The Proprietor has confirmed that they will be addressing the problems with the heating shortly. Water temperatures in bedrooms and other areas should be regulated to prescribed temperatures to prevent risk to people who use the service. The provider needs to ensure that she and her staff are fully aware that any incident, accidents and other notifiable issues are reported to us which will give increased confidence that issues are appropriately addressed. The provider needs to ensure that all hazardous liquids are locked away and that “disinfectant” is not decanted and left in the bathroom as this practice is unsafe and places people at risk. During our inspection we discussed with the provider our concerns, the shortfalls we had identified and improvements that must be made to ensure that people who use the service are safe and their well-being promoted. 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. Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 8 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 Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 9 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): 1,3,4,5 and 6. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Peoples’ needs are assessed but information gained about their needs and information about the home are insufficient to give assurance that the home is suitable for all individuals needs. EVIDENCE: The Statement of Purpose remained unchanged and was not fully inspected during this key inspection. The Statement of Purpose was not readily available to the people who use and or visit the service. It was contained in the office and would have to be requested. We asked to see the service user guide but were told that it is not available. A service user guide tells people about the home and what it provides. A service user guide should be readily available for all people living and wishing to live at the home. Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 10 Peoples’ records seen showed us that people wishing to live at the home have their needs assessed. A confirmation letter about this assessment is then forwarded to them and a copy left on their file. We found that the pre admission assessment document used contained only limited information and that peoples’ needs were not fully explored. More pertinent detailed information would assist staff to know about peoples needs and give them instructions how their needs can be met. People confirmed that they visited the home before their relatives were admitted. An opportunity to “try before you stay” is essential as it enables people to experience the home and help them to decide if it will be suitable for them. One person made the following comment; ‘I viewed other homes and this was the first choice’. This service does not provide intermediate care. Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Healthcare needs are met although improved care planning records would give increased confidence that people will consistently receive the care that they need and risks to their health will be minimised. Medication practices at the home need to be improved as there is no assurance that people have their prescribed medication which may adversely affect their health and place them at risk. People are treated with respect and kindness. EVIDENCE: Care plans are available for most people, although one person to be admitted (a week earlier on the first of our two inspection days) had no plan of care Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 12 based on her daily needs, no risk assessments had been implemented, or there was no recognition of her social choices. We also found that care plans lacked sufficient detail to provide staff with instructions on how peoples’ needs should be met. Records are inconsistently completed about individuals ‘days‘. Staff told us that if there was nothing to report then a summary for the week was completed. Records were not adequate to evaluate changes to people’s condition and as a result problems with health needs were not adequately followed through. One person was recorded on the 11/5/08 as having “a rash on right foot” but there was no further mention of this in their records. Staff also recorded for the same person on the 28/2/08: “X has a greeny coloured gunk oozing out of her left eye”. But there was no further reference to her eye identifying improvement or otherwise, until a record of a Doctors visit taking place on the 5/3/08 (six days later) when this person was prescribed eye drops. We found that care plans and required risk assessments were incomplete or were not available. Two care plans that we looked at had no risk assessments available for the use of bedrails, another care plan did have a bedrail risk assessment but it did not sufficiently detail all risks and how they would be addressed. The provider confirmed to us, that ‘no risk assessment had been completed prior to bed guards being fitted’. We have had a complaint made to CSCI stating that staff are putting a chair beside peoples’ beds to keep them in. We asked the night worker about whether a chair was placed beside beds at night and she showed us which room this was (the previous complaint related to another person), we were told it was because that “she threw her legs out of bed and was at risk of falling out of bed”. The Manager later told us that it was the persons own request for the armchair to be placed at the side of the bed- but there was no record of this in her care records. The use of an armchair to keep someone in bed is poor practice and put people at severe risk of injury. We found that risk assessments to provide information about safe moving and handling provided insufficient information about how people should be lifted or moved safely. No risk assessments were available to manage and promote people’s continence. The Manager told us that they had been done by District Nurses for their entitlement to incontinence pads. We were concerned to be informed that as one person needed two people to get her up she had to stay in bed. We asked staff how they were able to assist her to the toilet, as there was only one member of staff on duty at night and were told: “she wears pads”. This person’s care plans stated that she was able to use the toilet during the day or commode at night, this suggests that her dignity was not being upheld. We were concerned that when entering the home on both occasions the home was cool. On our first inspection day we found people who had been up for two Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 13 hours minimum and sitting with blankets around them, had not been served a hot drink. The night staff before leaving prepared a hot drink. Arrangements were in place for the continued health care from other professional agencies for example; one person had been referred for physiotherapy. The physiotherapist was so impressed with this persons and staff efforts, she no longer has to see this person. It was also positive that there were visits from District Nurses a Doctor and a Physiotherapist on day two of the inspection. We spoke with people who live at the home, they told us that they were; “ happy and satisfied with the care they received” that “the girls are very nice” one said “I am happy here.” A relative told us; “My x has settled in well, she is receiving good care”. Another relative told us; “ x , getting better she is more sparkling”. One relative told us; “ They keep me in touch with the needs of my x”. Staff we observed during the day were receptive to the needs of the individuals. Medication is kept in a locked trolley at the end of the dining room. The staff have received training in the safe handling of medication and have recently started additional ‘safe handling of medication’ training. We found that improvements are needed to the ordering of medication, records of receipt and administration of medicines. Staff do not check the prescription before it is sent to the pharmacy and also do not record the receipt of medicines into the home. Discrepancies that we highlighted included: one person with a bottle of 28 diazepam tablets, one was recorded as given but when we checked the contents of the bottle there were 29 remaining in bottle, we were unable to ascertain the reason for this. The medication record for the diazepam had been handwritten and stated that one tablet should be given when required, yet the instructions on the bottle stated that one tablet should be given daily, this means that this person was not receiving their medicine as it had been prescribed for them. We saw no instructions detailing when the diazepam “was required”. There was a record for another person that all paracetamol tablets had been given but there were two left in the cassette for the previous three evenings. We also saw gaps in the medication record particularly for medicines to be given “ as required” but there was no care plan to detail when these medicines were required and should be given. Gaps in the medication record do not provide evidence whether or not the medicine has been given and if not given why it was not given. Required improvements will protect people from medication error and provide confidence that people have the medicines that they are prescribed. The home does not have any controlled drugs at the present time. There is a need to ensure that they have appropriate arrangements in place should people required controlled medicines such as a hard bound book with Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 14 numbered pages. We also advised the Manager of new guidance for the storage of controlled medicines. The staff on duty including the night person was seen to spend time with the people who use the service. Our observations showed that each of the people who use the service were treated with respect, kindness and understanding”. Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 – 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Activity provision needs to be further developed to ensure that it meets the recreational and social needs of each person. Visiting times are open and flexible, with visitors being made to feel welcome at any time. Menus could be improved upon by offering a wider variety and choice. EVIDENCE: When we arrived at the service at on the first day of our inspection at seventhirty am, two people were already up in the lounge. Staff on duty told us about one of these people, “she had been up since five-thirty am, that she had woken at five am and wanted to come down”. One person told us; “ I always used to get up early with my husband”. Whilst this shows us that preferred Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 16 rising times of people who use the service are taken into consideration which is positive practice, we did have concerns in that staff had allowed these people to get up early and sit in an inadequately heated lounge which could place them at risk. We found only limited evidence of activities taking place at the home. Since our last key inspection one entertainer had been arranged to come to sing and play a keyboard. Information provided expressed that each Thursday activities take place, there was no written evidence to confirm this at the time of our inspection. Staff did tell us that they have singalongs which people enjoy. A person commented that, ‘her relative had been out only once’ indicating that she would like to go out more often. From information provided, we understand that regular visits from a minister take place. A minister however would come to the home when requested apart from seasonal celebrations. The home needs to seek and record information on behalf of the lady with an alternative faith, ensuring her spiritual needs are met. The Annual Quality Assurance Assessment (AQAA) completed by the provider told us; ‘ No restriction on visiting to the home, families and friends are always encouraged to visit the home. This information we found to be correct; during the inspection three relatives visited to the home. One relative told us; “ I feel that I am made welcome at any time”. Another told us; “ I visit my x daily for a short time”. “ I am made welcome”. The menus are recorded daily on a small white board; this is then left in the entrance. The cook was seen/heard to go into the lounges and ask people their choice for lunch. While the menus were somewhat repetitive, we were told that they were based on the likes of the people. Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 – 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There are appropriate systems in place to listen to and respond to peoples’ concerns but the management of the home need to learn from these concerns to give confidence that concerns will be addressed. People are protected from abuse by a staff group who are aware of what is abuse and know of the appropriate actions to be taken to safeguard people at the home. EVIDENCE: We saw that a complaints procedure is displayed in the hall. The complaints policy has been updated since our visit in April to include correct contact details of the Commission for Social Care Inspection. People and their relatives we spoke to confirmed that they would know how to make a complaint if they had the need. One relative made the following comment; ‘ X will make her feelings known if she is unhappy. Yes I know how to make a complaint’. Another comment from a relative about complaints told us; ‘ I have never had the need to speak to anyone. I am aware how to make Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 18 a complaint”. A person who uses the service told us that ‘ she knew who to speak to if she had a problem’. Staff on the day confirmed that they were aware of the process to activate the complaints process. We have received two complaints since our last key inspection about the service relating to a number of issues including, the lift, water temperatures, and central heating. We looked into the latest complaint during our inspection and found evidence to uphold some aspects of the complaint examples being; hot water temperatures that are higher than recommended for safety and problems with the heating. Our previous key inspection carried out in June 2006, identified that the staff have not accessed the Vulnerable Adults Policy for Staffordshire. During this inspection we found that the staff still had not accessed this document. We were pleased to see that induction materials make staff aware of the need to protect people against any form of abuse. Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,26. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Appropriate heating, hot water and safe and appropriate use of equipment will make this home a safer and more comfortable place for people to live in. EVIDENCE: The lounge and dining room are homely and well maintained and have pleasant views over the garden. It was positive to see that peoples’ bedrooms each held a number of their own possessions making these rooms feel personalised. We were told that some improvements have been made since our last key inspection including a new dining room table and chairs, new cooking stove and new armchairs in some bedrooms. Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 20 We were disappointed to find a number of concerns about the premises during both visits to the home, which we discussed with the provider as follows; The home was cold when we arrived for both visits, three people who use the service had blankets around their shoulders. They told us they were cold and radiators we touched were cold. The lack of adequate heating could place people at risk. Staff did take measures to address the heating inadequacy when we highlighted our concern to them during the morning of our first inspection day. The Manager told us that there have been problems with the heating and was having the work to address the problems when the weather gets warmer as they would be without heating for two to three days. The carpet in bedroom four on the first floor requires attention as it is uneven and a potential tripping hazard. Each of the bedroom water temperatures we tested were over the required temperature and put people at risk from scalding. The Manager agreed that there were problems with the hot water getting too hot and confirmed that this would also be addressed with the repairs to the central heating system. There was water dripping through the ceiling into a large bucket in the single toilet on the ground floor. The remaining section of the floor was wet and a possible hazard to the people in the home. There was no notice on the door to inform people that it was “out of order” in an attempt to prevent accident or injury. This had been addressed when we visited on the 29/5/08. The main washing machine has been out of order for almost a week waiting we are told for a part; due on the 29/04/08. The staffs are using the only bath to sluice out soiled linen. The provider was using her personal machine to do all the washing. It is unacceptable to use the bath in view of the possibility of cross contamination. The home has an alternative bathroom on the first floor, used as a storeroom. It would be more practicable to use this facility. The problem with the washing machine had been addressed when we visited on the 29/5/08. We found the upstairs bathroom on day two of the visit to being used as a store room with bed mattresses, a trolley, wheelchairs, bedrails being stored there and a bedside cabinet, lamp, lampshade and incontinence pads stored in the bath. The Deputy Manager told us that they do not use the upstairs bath as people prefer the downstairs bath with the hoist. An additional assisted bath should be provided upstairs so that people had access within a short distance from their room to an appropriate bath. Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27.28.29.30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Night staff may be insufficient to meet all peoples’ needs. Improved training opportunities will give greater assurance that staff have sufficient knowledge and understanding of peoples needs to meet them. Poor recruitment practices put people at risk from people who are unsuitable to work with vulnerable people EVIDENCE: People living at the home and staff told us that they thought that staffing numbers were appropriate. We were told that there are two staff during the day and the cook. At night there is one waking night staff. We were told by the night worker that she is unable to get one person up as she needs two staff. This was also confirmed in this persons care records. We asked how she managing during the night to toilet this person, we were told: “She uses (incontinence) pads”. Her records said that she should be assisted to the toilet and to use the commode before she goes to bed. This would suggest that this person has no option other than use her incontinence pad as there are insufficient staff to assist her to use either a commode or the toilet. Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 22 The Manager who lives next door to the home later told us that she is always on call should night staff required assistance. We feel that all night staff must be made fully aware that they may contact her at any time and or that there is a need to review the sufficiency of staff at night to ensure that people care needs can be appropriately met. The previous inspection highlighted shortfalls in staff recruitment and a lack of required checks. This inspection also found shortfalls in recruitment, although references and other pre employment checks are now undertaken. We did find that additional information is required to give confidence that the risk of unsuitable people working at the home is minimised. There was inadequate information about staff’s previous employment. We found that staff are employed with confirmation that they are not on the Protection of Vulnerable Adults list and before their criminal records. If staff are employed without the return of their criminal records check appropriate risk assessment should be completed that confirm that recruitment processes are robust and have been authenticated and staff should also be supervised until the check has been returned but this was not the situation. The information to ensure that people who use the service are protected from any form of abuse was insufficient. We evidenced the records for training for the awareness of caring for people with Dementia; a total of three staff has had some training in 2006. The home is registered to offer accommodation to four people with a mental disorder. A number of the staff have achieved either Level 2 or 3 for the National Vocational Qualification (NVQ) in Care and are working towards 50 of its staff with NVQ level 2. Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36,38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management health and safety arrangements do not provide confidence that people health and welfare are consistently and adequately protected at the home. . EVIDENCE: The registered manager has been in the caring profession for a number of years, she has been the registered provider for Cameo for 18 years. The staff on duty demonstrated their awareness of individuals needs. They assisted and guided people in their life style. Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 24 We spoke with the staff who were pleasant, they were aware that while they have received some training more has been planned. The home did return their Annual Quality Assurance Assessment (AQAA) when required. The AQAA included very little information and did not give us confidence that systems were being checked and developed. For example we asked about Equality and Diversity at the home, Cameo responded: “there is a written policy on this subject”- all other entries were blank in this section and yet in another section the home failed to confirm that they have an Equal Opportunities, diversity and anti-oppressive practice policy. The provider has failed to seek feed back from the stakeholders to the service. We have discussed this with the provider a number of times. The Deputy manager told me that she does do staff supervision but not as regularly as necessary. She described staff supervision taking place with more than one member of staff as “ chats in office about practice such as confidentiality” but no records are maintained of this. The home does keep small amounts of money for people living in the home within the homes safe. There are records of all transactions although no receipts were available which would be good practice. The provider needs to ensure that people were free from hazards by securing all the hazardous liquids identified to her. Chemicals should not be decanted into other containers. The secondary door on the porch remains without a handle since the last key inspection 2006. We were told that estimates have been requested, the door will have to be replaced; in the event of a fire this could pose a problem. Records seen showed that obligatory training is inadequate; while some staff have received Moving & Handling training others have not. A number of the staff has First Aid this was evidenced from the certificates. Further training has been arranged for the Safe Handling of Medicines and were told that staff will be expected to attend. There was very limited evidence for other obligatory training including: Infection Control, Health & Safety, Control Of Substances Hazardous to Health (COSHH). The records for the prevention and procedure in the event of a fire were current. The deputy manager has completed the annual fire risk assessment for 2007, the home also has a plan for evacuation if necessary. The management of the home has failed to protect people and keep them safe. We highlighted a number of serious omissions within both visits to the service that have put people at risk. The lack of required risk assessments for the safe Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 25 use of bed rails put people at risk of accident and potentially serious harm. The elderly are vulnerable to the cold and a failure to address the inadequate central heating has potentially put people lives’ at risk. In addition hot water that is too hot has also put people at risk of scalding. Unsound decisions such as sluicing soiled laundry in the only bath that people can use has put them at increased risk of cross infection. We also have previously highlighted that recruitment and selection processes were not robust and did not safeguard people at the home and although some improvements omissions in practice continue to put people at risk. The Commission is seeking urgent improvements from the home otherwise will have no choice but to undertake enforcement action. Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 3 2 X X 1 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 3 2 X 2 2 X 1 Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 27 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. Standard 1 OP7 Regulation 15 (1) Requirement To make sure that the individual needs of people who use the service are met and that they are safe a care plan must be produced for each and be regularly reviewed. To make sure that people who use the service are protected from risk of injury and are safe, risk assessments for bedrail usage must be produced and be maintained. There should be appropriate arrangements in place to check the prescription before it is sent to the pharmacy. When medication is administered it must be properly recorded to confirm that people who use the service receive their medication as prescribed by their doctor. To protect the health and welfare of people who use the service the registered person must ensure that there is adequate heating provided at all times . The hot water should be maintained within the guidelines to prevent the risk of scalding. Timescale for action 27/06/08 2 OP8 13(4)( c) 29/05/08 3 OP9 13(2) 27/06/08 4 OP9 13(2) 29/05/08 5 OP19 23(2)(p) 29/05/08 6 OP25 13(4) 29/05/08 Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 28 7 OP29 19(1)-(11) The registered person shall ensure Schedule 2 that the required records were current to comply with the standard. This is requirement remains outstanding from 20/06/06 23 (2) (b) To make sure that people are not put at risk, an appropriate door handle must be provided on the porch door. 29/05/08 8 OP38 29/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 4 5 6 7 8 9 Refer to Standard OP1 OP3 OP3 OP8 OP8 OP9 OP9 OP9 OP9 OP12 OP18 Good Practice Recommendations Statement of Purpose and service user guide should be made readily accessible to people who use the service, their relatives and visitors.. To consider a list format when completing the admission to ensure all the documents are in place. To consider recording fully the assessment details to enable a plan of care to be collated also to give pertinent instructions to the staff team Continence assessment should be available Moving and handling risk assessments should be developed Staff should record the receipt of all medicines coming into the home. Two staff should record confirmation of the accuracy of handwritten medication records. Regular audits should be undertaken of medication at the home The home should ensure that required arrangements are in place should any person required medication that is controlled To develop the social activity programme, following the consultation with the people who use the service and or relatives. To maintain separate records for inspection. For all the staff to familiarise themselves with the DS0000004926.V363069.R01.S.doc Version 5.2 Page 29 Cameo Rest Home Staffordshire Vulnerable Adults policy 10 11 12 13 14 15 16 OP22 OP26 OP27 OP30 OP30 OP33 OP35 An additional assisted bath should be available upstairs Hot water temperatures should be regularly checked and the flow and return hot water temperature recorded. All staff to be informed of the arrangements to call the Manager for assistance at night. For the provider to keep her knowledge current regarding training taken in house. The registered person shall ensure that the person employed to work at the home receive appropriate training to comply with the category and registration of the home. To develop a formal quality assurance system for feed back from other agencies, residents and relatives. Receipts are available to confirm all transactions of people’s money. Cameo Rest Home DS0000004926.V363069.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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