Inspection on 27/06/05 for Cameron House

This inspection was carried out on 27th June 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cameron House 03/03/09

Cameron House 09/05/07

Cameron House 30/01/06

Cameron House 30/11/04

Cameron House 20/04/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Cameron House Cameron Road Chesham Bucks HP5 3BP Lead Inspector Barbara Mulligan Unannounced 27th June 2005 9:30am 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Cameron House Version 1.10 Page 3 SERVICE INFORMATION Name of service Cameron House Address Cameron Road, Chesham, Bucks, HP5 3BP; Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01494 793290 The Fremantle Trust Ms Jackie White Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Cameron House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 29th November 2004 Brief Description of the Service: Cameron House is a two-storey home, owned by The Fremantle Trust, and is home to ten adults with learning disabilities. The home provides all single room accommodation And all service users rooms have been decorated and personalised for each individual. Cameron House is situated in a residential area approx two miles from Chesham town centre. The home is close to local amenities which include shops, pubs, restaurants, library and cinema. The service users in the home also have access to the local leisure centres and swimming pool. The home supports service users to access local transport such as taxis and buses. Cameron House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Monday, 27th June 2005 at 10am. The visit consisted of discussions with care staff, a tour of the home and records, policies and procedures were examined. On the day of the inspection the registered manager was on sick leave and asenior carer Mrs D. Gould assisted during the visit. What the service does well: What has improved since the last inspection? What they could do better: The staff team are caring but their numbers need to be increased if they are to fully meet the needs of the service users. Care planning documentation demonstrates how the needs of service users have and continue to increase and staffing levels must be increased to be able to meet their needs. The completion of a full assessment of needs, for all service users is essential for the home to determine appropriate staffing levels. This needs to be completed as soon as possible. It was a recommendation of the previous announced inspection report that Cameron House Version 1.10 Page 6 serious consideration is given to providing service users with comprehensive, accessible, understandable and up to date information, in a suitable format about policies, procedures, activities and services. There was no evidence that work has been carried out in this area and there was nothing available to look at. Difficulties have been experienced by the home regarding the care of one service user and decisions being made in respect of this service user. It was recommended that an advocate be found for this individual. Although an advocate was found they have since ceased this role and the manager needs to give serious consideration to finding a new advocate for this individual. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cameron House Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Cameron House Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 and 3 Prospective service users are only admitted on the basis of a full assessment and these are updated and reviewed regularly. However, staffing levels need to be in line with these needs assessments. The staff team are experienced in the care of adults with a Learning Disability but current staffing levels are not adequate to meet service users needs. EVIDENCE: Cameron House Version 1.10 Page 9 A requirement was made during the previous announced inspection for staffing levels to be reviewed in line with the assessed needs of the service users. This has not been complied with and will be a requirement of the report. Care plans were looked at and it was apparent that the needs of service users were increasing. One file looked at contained a Bucks County Council Adult Social Care Assessment. Information about this individual states “his behaviour constitutes a substantiated risk to others. He has a history of inappropriate behaviour towards others and suffers from anxiety and depression”. Another assessment by Bucks Learning Disabilities Service for this same service user states that “ there has been a deterioration in behaviours and he has become verbally abusive and threatening towards his key worker”. Another care plan shows that the needs of one service user who suffers with dementia have increased and states that “ he stays at home all the time” another entry states “he cries and becomes distressed and requires lots of patience. It can take up to two hours or more to persuade him to get up and have a shower and get dressed”. On the day of the inspection staff were unable to get this service user up until 11.45 am. Other entries state that he needs lots of 1:1 attention”, and “ sometimes when in a confused state he has attempted to leave the home and would have done so if not for the vigilance of the staff”. An Occupational therapy assessment states that “ his level of need has increased and routines can take much longer. He is putting an increased amount of pressure on staff and needs a higher level of physical intervention”. These entries in service users plans demonstrate how the needs of two service users have increased. Discussions with the senior support worker confirmed that the needs of other service users in the home have increased also. Cameron House Version 1.10 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9 and 10. Clear and consistent care planning systems are in place that provide staff with adequate information they need to satisfactorily meet service users needs. Service users are able to make decisions about their lives with assistance and communication support from staff and this allows them to influence their lifestyle and how the home is run. Service users are supported to take responsible risks within the context of the home’s risk assessments and risk management strategies that ensure service users can have independent lifestyles. Personal information is handled appropriately ensuring that personal confidences are respected. EVIDENCE: Cameron House Version 1.10 Page 11 Care plans are available for all service users. These were found to be informative, detailed and of a good standard. Each file contains an essential information sheet detailing preferred daily routines, likes and dislikes, health information, aids and equipment in use. The plan sets out in detail the action that needs to be taken by care staff to ensure all aspects of the health, personal and social care needs of the service user are met. Guidelines are in place for service users who are likely to be aggressive or cause harm. Care plans demonstrate that service users health needs are met by the care staff in the home and by a variety of specialist health care professionals. Care plans were up to date, legible and in good order. The home operates a key-worker system. There have been on-going difficulties regarding one service user who suffers with dementia. Concerns were raised during the previous inspection that decisions were being made for this service user that were not in his best interests and it was recommended that an independent advocate be found for this individual. The registered manager did find an advocate but they have since left this position. It is recommended that serious consideration is given to finding a new advocate for R.L. Finance training for service users is provided via the college and the day centre. The staff encourage and support service users to manage their own finances. Records are kept of all financial transactions and these were seen at inspection. Service users at Cameron House have monthly house meetings. Staff are able to provide service users with information and support with decisions about the day to day running of the home. Minutes of the meetings are recorded and demonstrate how choices are made. The registered manager stated that one service user had attended staff interviews and this had been a positive experience. Homes policies were not in a suitable format for service users in the home, and there was no evidence that service users were involved in policy groups and other forums. It is recommended that serious consideration is given to providing service users with comprehensive, accessible, understandable and up to date information, in a suitable format about policies, procedures, activities and services. There is an extensive range of risk assessments in place. These include risk assessments for shopping, travel, social activities, financial issues, eating to excess, the use of electrical goods, bathing, gardening, the use of sharp objects in the kitchen and walking back from the day centre. The home has a policy in place for service users that go missing, dated November 2003. This was detailed, informative and user friendly. Cameron House Version 1.10 Page 12 All files are stored in lockable filing cabinets or on shelves within a lockable staff office. Records looked at were accurate, secure and confidential. Staff training in issues of confidentiality takes place during their TOPPS induction. Further information regarding confidentiality is covered in the Fremantle Foundation induction. Staff are provided with a staff hand book and this also contains information on confidentiality. There is a policy called “Confidentiality and access to records” that is dated November 2003. This is accessible to staff in the home. Cameron House Version 1.10 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12. Opportunities for service users to take part in valued and fulfilling activities although varied were limited in some cases. EVIDENCE: The majority of day care activities for service users living at Cameron House are undertaken at the Endeavour Nursery sited next door to the home. Care review notes for one individual, dated 07/04/2004, stated that the service user does not like to attend the day centre and that he did not enjoy the activities that were available with the exception of cooking. The review notes state that consideration was being given to starting a “men’s group” at the day centre which will concentrate on activities such as shaving, football, personal hygiene and wood work and this may be more appropriate. However, there was no further documentation available about this individual’s day care activities and it would appear that over a year later this individual is still waiting to attend activities that are meaningful, valued and enjoyable to him. However, other files looked at demonstrated that service users attend the local college and another two individuals attend Chesham college for life skills training. Drama, numeracy training and youth club are also venues attended by service users, Suitable and meaningful day care activities for service users should not be restricted to the neighbouring day centre. Staff need to help service users find Cameron House Version 1.10 Page 14 and take up opportunities to attend alternative activities elsewhere. This is a requirement of the report. Cameron House Version 1.10 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 and 19. Personal support is offered in such a way as to promote and protect service users’ privacy, dignity and independence. Evidence of multi disciplinary working taking place on a regular basis ensures that the healthcare needs of service users are met. EVIDENCE: Cameron House Version 1.10 Page 16 Service users care plans contain moving and handling assessments of service users and equipment used to facilitate their needs. . Access to specialist services are made via a referral form to Community Learning Disabilities Team based in Amersham. Specialists can visit service users in their own home if necessary. Service users are able to retire to bed and rise whenever they chose to do so. Other activities are flexible, and mealtimes are arranged around service users activities. Service users are given support to choose their own clothes, hairstyles and make up. Key-workers will take service users to shop for their own clothes and other personal items. Care plans show the likes and dislikes of services users and preferences and contacts with family, friends and relevant professionals outside of the home. Personal Care needs of service users are recorded in care plans. The home employs both male and female carers allowing service users to receive intimate care by a person of the same gender if they wish. Service users are supported and facilitated to manage their own healthcare where practicable. Individuals visit their General Practitioner on a needs only basis. Chiropody services visit the home regularly. A physiotherapist visits the home for two service users. Visits to the home from healthcare professionals take place in the service users bedrooms. Staff provide support to service users needing to attend outpatient and other appointments. At the time of the inspection service users were not offered an annual health check by their G.P. surgery. Regular hearing and vision tests are accessed via the Endeavour Day Centre. Cameron House Version 1.10 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22. The home has an effective complaints procedure to ensure that service users or their representatives are listened to. EVIDENCE: The home has a complaints procedure called Fremantle Feedback. The inspector saw this on display in the entrance hall of the home. A summary of the complaints procedure is included in the statement of purpose and service users guide. This includes information on how to refer a complaint to the Commission. There is a complaints log where all complaints received by the home are recorded. This showed that there were no complaints received by the home in the previous twelve months. Cameron House Version 1.10 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 27, 28, 29 and 30. The standard of the environment within this home is good, providing service users with an attractive and homely place to live. The overall quality of the furnishings and fittings is good ensuring the safety and comfort of service users. EVIDENCE: Cameron House is situated in a residential area approx two miles from Chesham town centre. The home is close to local amenities which include shops, pubs, restaurants, library and cinema. The service users in the home also have access to the local leisure centres and swimming pool. Cameron House Version 1.10 Page 19 Communal areas are comfortable, bright, cheerful, airy, clean and free from offensive odours. The lounge was decorated tastefully and the furnishings and fittings are of good quality and domestic in character. However, the lounge is small for ten service users. The lighting in the home is domestic in character and adequate to facilitate reading and other activities. There is a bathroom on the ground floor that contains a specialist bath and a combined shower and toilet room. There are two toilets on the ground floor in close proximity to the lounge. On the upper floor there is a combined bathroom and shower room. The toilet and the bathroom are lockable, but staff can use an override device only as indicated by a service user’s risk assessment. Service users are able to meet with visitors in the privacy of their own room if they wish to. Outdoors there are mature gardens with trees, flower borders, raised beds and a large patio area. There is a green house where service users can grow their own flowers and plants. The laundry facilities are situated in the home’s utility room which ensures that soiled articles, clothing and infected linen are not carried through areas where food is stored, prepared, cooked or eaten and do not intrude on service users. Hand washing facilities are prominently sited in the toilets, bathroom and the utility room. The laundry floor finishes are impermeable and these and wall finishes are readily cleanable. The home has a sluicing facility in the utility room. Services and facilities comply with the Water supply Regulations 1999. The home does not provide its own transport for service users, but taxis and buses are used with support provided by the staff. All areas of the home are accessible to all service users. At the time of the inspection there were no CCTV cameras in use. Cameron House Version 1.10 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33. Only limited progress has been made in addressing staffing shortages resulting in staff being unable to meet the assessed needs of service users. EVIDENCE: A requirement was made during the previous announced inspection for staffing levels to be reviewed in line with the assessed needs of the service users. This has not been complied with and this has been made a requirement under Regulation 14 of the Care Homes Regulations. On the day of the inspection the staff on duty were one senior support worker and one agency worker. The registered manager had been on sick leave for four weeks. This level of staffing is not adequate to meet the needs of the service users living at Cameron House. Staff rotas were looked at and showed that at times, mostly at weekends, staff are left on their own at certain times of the day. This is an unsafe practice and unacceptable. It is a requirement of the report that at least two members of staff are on duty at all times during the day. It was pleasing to see that an Assistant Manager is now in place. Cameron House Version 1.10 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 40, 41, 42 and 43 Overall the health and safety procedures are in place, although there is a need to up date moving and handling training for several staff members, ensuring the safety of service users. The home’s record keeping, policies and procedures ensure that service users’ rights and best interests are safeguarded. EVIDENCE: Cameron House Version 1.10 Page 22 All policies and procedures are kept in the office and are accessible to all staff working in the home. Staff are encouraged to read the home’s/organisation’s policies. Service users and care staff have limited involvement in developing or formulating policies and procedures. There were no policies available in different formats for service users. If service users wish to look at their own records then this could be facilitated by the home. Records and home records were observed to be up to date, stored securely and in good order. All records were constructed, maintained and used in accordance with the Data Protection Act 1998. Moving and handling techniques and training are carried out regularly. However the moving and handling training for some staff had expired and needs to be updated. This is a requirement of the report. Fire alarm testing is undertaken weekly and fire drills are carried out with the full involvement of the service users. Records for fire training were seen and were up to date. Fire equipment was noted to be last serviced on 18/08/2004. The home was an infection control policy that was detailed and comprehensive. There was evidence that Health and Safety Checks are carried out quarterly and a Generic Health and Safety risk Assessment was observed. Certificates were seen for the servicing of the gas boiler and there was evidence of water temperature recording, work placement risk assessments, accident and incident reports, health and safety risk assessments and the maintenance of electrical systems and electrical equipment. There is evidence that gas appliances were last serviced on 22/04/2005 and PAT testing was last carried out in October 2004. Hazardous substances are stored appropriately and the COSHH sheets were looked at. These were observed to be up to date. There are insurance certificates on display in the home. The organisation’s business and financial plan was not available for inspection. SCORING OF OUTCOMES Cameron House Version 1.10 Page 23 This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 2 x x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 2 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x 3 3 3 3 Standard No 11 12 13 14 15 16 17 x 2 x x x x x Standard No 31 32 33 34 35 36 Score x x 2 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score x x x 3 3 2 3 Cameron House Version 1.10 Page 24 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 14 Requirement The registered manager is required to ensure that a full assessment of needs is undertaken for all service users and staffing levels are reviewed in line with the assessed needs of the service users. (Previous timescale of 28/02/2005 not met.) The registered manager is required to ensure that day care activities for service users are not restricted to the neighbouring day centre but expanded upon to other areas. The registered manager is required to ensure that two care staff are on duty during the day at all times. The registered manager is required to ensure that all staff receive up to date training in moving and handling techniques. Timescale for action 30/07/05 2. 12 12 16 30/09/05 3. 33 18 30/07/05 4. 42 13 30/08/05 Cameron House Version 1.10 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 8.2 Good Practice Recommendations It is recommended that serious consideration is given to providing service users with comprehensive, accessible, understandable and up to date information, in a suitable format about policies, procedures, activities and services. The registered manager is required to ensure that an advocate is found for service users R.L. 2. 18 Cameron House Version 1.10 Page 26 Commission for Social Care Inspection 8 Bell Business Park Smeaton Close Aylesbury Buckinghamshire HP19 8JR 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 Cameron House Version 1.10 Page 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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