CARE HOMES FOR OLDER PEOPLE
Cameron House Plumleys Pitsea Essex SS13 1NQ Lead Inspector
Nikki Gibson Unannounced Inspection 6th July 2005 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 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. Cameron House I56 I06 S18044 Cameron House V230541 060705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Cameron House Address Plumleys, Pitsea, Essex SS13 1NQ 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) 01268 556060 01268 556161 Ashbourne Healthcare Mrs Debbie Skeats CRH Care Home 44 Category(ies) of OP Both 44 registration, with number of places Cameron House I56 I06 S18044 Cameron House V230541 060705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14 February 2005 Brief Description of the Service: Cameron House provides care and accommodation for forty four older people, it is not registered for people with dementia. It is a modern, purpose built home comprising of two floors with a passenger lift and stairs access to both floors. There are 42 single and 2 double bedrooms all with ensuite facilities. There is a dining room and separate sitting room on both floors. There is a range of bath and shower facilities and a separate hairdressing room. The home is situated in a residential area and is close to local shops in Basildon town centre. Cameron House I56 I06 S18044 Cameron House V230541 060705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection, which lasted eight hours. During the inspection there was a tour of the premises and records and documents were looked at. Time was spent in the lounges and dining rooms and with residents in their own rooms. Seven residents were spoken with in depth about life at Cameron House and the care of other residents was observed and they were chatted with. The manager and three members of staff were also spoken with. The manager, staff, and residents were most helpful and this was greatly appreciated. Discussion of the inspection findings took place with senior staff and the manager throughout the inspection and guidance was given. What the service does well: What has improved since the last inspection?
The home has revised the Statement of Purpose and Service User Guide so the new residents have useful information about the home before they move in. A single complaints policy has been provided so that those who may not be happy with the service know how to complain. The manager now has the authority to use agency staff to ensure that staffing levels never fall below the agreed level and there is always sufficient staff to care for the residents. Apart from the manager, all staff have regular supervision where training, and good and bad practice can be discussed. A new quality assurance audit has been
Cameron House I56 I06 S18044 Cameron House V230541 060705 Stage 4.doc Version 1.40 Page 6 introduced and in time a report on its findings will be sent to the Commission for Social Care Inspection. Door wedges have been removed where they may have been a hazard in the case of a fire. What they could do better: 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. Cameron House I56 I06 S18044 Cameron House V230541 060705 Stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Cameron House I56 I06 S18044 Cameron House V230541 060705 Stage 4.doc Version 1.40 Page 8 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 standard(s) 1 3 4 6 Communication both internally and externally was very good. Careful preadmission assessments take place resulting in appropriate admissions. Individuals’ needs were being well met within the home. EVIDENCE: Copies of the updated Statement of Purpose and Service User Guide were studied. Due to the recent change of ownership and the amalgamation of documents some duplication and some errors were noted. Some were rectified immediately and the manager said she planned to review both documents shortly. The manager assesses each prospective resident personally and ensures that the home will be able to fully meet their needs and expectations before a place is offered. A new resident spoken to expressed satisfaction with the support they were given to help them settle. A visiting social worker praised the hard work of the staff in addressing the challengers of another new resident. Staff showed great understanding and compassion for all the residents and were particularly sensitive to the concerns and wishes of new residents. Standard 6 is not applicable, as Cameron House does not provide intermediate care.
Cameron House I56 I06 S18044 Cameron House V230541 060705 Stage 4.doc Version 1.40 Page 9 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 standard(s) 7 8 9 10 11 Residents’ health care needs were well met. Staff treated residents with sensitivity and respect. Staff enabled residents, who wished, to maintain control of their health care needs. High levels of care and support were provided for the most frail residents. EVIDENCE: Staff were positive about the new care plan format which Ashbourne Health Care Ltd have introduced. Four care plans were studied and it was clear that staff knew the residents well. Staff had recorded in a clear manner and had provided good detail of the action required by staff to meet the residents’ needs and wishes. Appropriate risk assessments were also in place. The manager said she had a very good working relationship with the GPs and District Nursing team. The Crisis team were actively supporting one resident and working in partnership with the home to provide a good standard of care and comfort to an unwell resident. Ashbourne also provide health care advice and support if required. No residents had pressure sores and appropriate pressure relieving equipment was in place. Records showed that residents were regularly weighed and changes were investigated and acted on.
Cameron House I56 I06 S18044 Cameron House V230541 060705 Stage 4.doc Version 1.40 Page 10 Medication procedures in the home were studied with a senior member of staff. There was clear evidence from study of records and storage that medication procedures were generally safe and well maintained. However, further advice was given with regard to some aspects of medication administration. The Home is referred to sections 4.3 and 8.1 of the Royal Pharmaceutical Society of Great Britain guidelines ‘The Administration and Control of Medicines in Care Homes and Children’s services.’ This is in relation to warning notices where oxygen is stored and the availability of Patient Information leaflets for all medication in the home. One resident was please to show that she administered her own medication and had been provided with a small safe in her room for the secure storage of the medication. Some medication was noted on the bedside table, however the resident said that she always locked her bedroom door when leaving the room. Details of the risk assessment were not requested at this inspection. Policies and procedures on dying and death were not inspected on this occasion however from observation and discussion with residents and staff there was evidence that residents were supported and remain in the home until their death if this is their wish. Two residents who were remaining in bed were visited and both were seen to be receiving a very good standard of care. Cameron House I56 I06 S18044 Cameron House V230541 060705 Stage 4.doc Version 1.40 Page 11 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 standard(s) 12 14 15 Daily routines were flexible and the ethos in the home was to support and encourage independence. A range of activities were provided which improved the quality of life of most residents. The choice, quality and quantity of the meals had deteriorated and caused dissatisfaction with most residents. EVIDENCE: From discussion with residents and staff, routines in the home were flexible and residents’ individual choices were accommodated. Residents said they could get-up or retire at a time to suit them. The activities co-ordinator was popular with residents and very hard working. However, some residents complained of being bored, it was disappointing to be informed that ‘activity staff hours’ have been reduced by the new owners. One resident said that she generally chose not to join in group activities, however she was pleased that staff kept her in formed of what was available. Resident interests and hobbies were recorded in their care plans. Some residents said that staff did take time to sit and talk to them while others said they were sometimes lonely and bored and would like staff to be able to spend more time with them. Most residents complained about the lowered standard of quality of the food since Ashbourne Healthcare Ltd became the owners. The catering arrangements had been subcontracted and the kitchen staff were struggling with a much reduced budget. The previous menu and the present menus were
Cameron House I56 I06 S18044 Cameron House V230541 060705 Stage 4.doc Version 1.40 Page 12 studied and residents’ comments were noted. Choice had clearly been reduced, and the quality of ingredients was not to the standard residents had been used to. One resident said after dinner that he was still hungry as there was very little meat in his meat pastie. Staff said there was no extra food that could be offered as a second helping. Another resident said she was often still hungry after Sunday lunch and it was noted that there was no choice on the menu on a Sunday. One resident said she was never hungry as she had a poor appetite, but the choice of food did not tempt her to eat. The Chef was described by a resident as, ‘very helpful and willing’. It was noted that residents were provided with cups without saucers. One resident said that this was something she would never have done before coming to the home. On a positive note residents who were able were provided with a teapot and milk jug on the dining table. Cameron House I56 I06 S18044 Cameron House V230541 060705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 16 18 The ethos of the home protected residents and gave them confidence that their complaints would be appropriately addressed. EVIDENCE: These standards were not inspected in any depth at this inspection. Some confusing and out of date complaints policies were removed at the time of the inspection. It was noted that the policy for the protection of vulnerable adult from abuse was out of date and made reference to the previous registration authority. The manager said that she has an open door policy and encourages staff, residents and visitors to discuss concerns with her before they become an actual complaint. One resident said, ‘if I had a problem I could talk to any of the staff’. These standards will be covered in detail at the next inspection Cameron House I56 I06 S18044 Cameron House V230541 060705 Stage 4.doc Version 1.40 Page 14 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 standard(s) 19 20 21 23 24 25 26 The home was generally safe and well maintained and provided residents with a homely and pleasant environment. The lack of storage space however posed a risk as a bathroom was inappropriately being used for storage. EVIDENCE: Cameron House was purpose built and provides a pleasant and clean environment which met residents needs. Maintenance standards were generally good and small shortfalls noted by staff were recorded and swiftly addressed. Dining rooms and lounges were pleasantly furnished and decorated. Residents spoke of enjoying spending time in the garden. Some urgent action is required in both shower rooms to ensure the health and safety of the residents. Due to the lack of storage space one bathroom contained beds, mattresses, scales, broken furniture and pads etc. Any resident entering the room would be at risk of a fall or other injury. This was raised at the last inspection and no progress has been made. Urgent action is required and details of the
Cameron House I56 I06 S18044 Cameron House V230541 060705 Stage 4.doc Version 1.40 Page 15 timescale to address this is required. Details of the interim action taken to protect residents is also required. The new arrangements for the supply of continence aids will increase the storage problems in the home and this will need to addressed in a discreet manner. Residents spoken to were very happy with their rooms. Each room was fitted with a door lock and residents who wished could hold their own key. Residents had been encouraged to personalise their rooms. One new resident was looking forward to choosing the colour of the paint for his bedroom walls. One resident spoke of being cold and her window was immediately closed and arrangements made for the maintenance person to check her radiator. The upper floor of the home was very warm and some staff complained of the heat. There was an apparent lack of ventilation and fans had been installed, however at the time of the inspection this did not appear to be adequate and there was a slight generalised odour. A tour was made of the kitchen and it was noted to be very clean and well organised. The laundry was inspected and seen to be clean and well organised. It was noted the residents had their name or room number written with marker pen on their clothes. This did not maintain the dignity of the resident and appropriate name labels would be a discreet method of addressing this problem. Cameron House I56 I06 S18044 Cameron House V230541 060705 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 Care staffing levels and staff competency were sufficient to meet the needs of the residents. Staff morale was high resulting in an enthusiastic workforce that worked positively with the residents to improve their whole quality of life. EVIDENCE: The required minimum staffing level is: 2 senior care staff and 4 care staff 6.45 to 21.00 1 senior care staff and 3 care staff 21.00 to 7.00 The deputy manager is supernumerary 2-3 days per week The manager is supernumerary. The manager stated that minimum staffing levels would be maintained with the use of agency staff if necessary to ensure the welfare of the residents. The home is reminded that the staff rota must identify the actual times each member of staff is in the home. A record of ‘early’ or ‘late’ is not adequate and does not meet the required standard. Two domestic staff worked from 9.00 to 15.00 or 8.00 to 14.00. There was no domestic staff in the evening, which leaves the home with long periods without domestic staff on duty. The provision of evening domestics should be considered to ensure standards of cleanliness and hygiene are maintained without taking care staff away form the care of the residents. The home has a stable staff group who work well as a team to the benefit of the residents. Staff were undertaking NVQ level 2 in Care training. Four
Cameron House I56 I06 S18044 Cameron House V230541 060705 Stage 4.doc Version 1.40 Page 17 members of staff had successfully completed the training and ten more members of staff had registered to start. Staff have undertaken a range of external training courses relevant to the care of the elderly. There are plans for two members of staff to be trained as in–house trainers. While this will be good for induction and refresher sessions it should not replace the statutory professionally recognised training courses, eg moving and handling, medication, food hygiene etc. Cameron House I56 I06 S18044 Cameron House V230541 060705 Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 32 33 36 The manager had a clear vision for the home which she effectively communicated to the residents and staff. She was well supported by senior staff who demonstrated a high level of care and commitment, which resulted in a positive experience for the residents. EVIDENCE: The manager was well trained and experienced in the care of the elderly. She was clearly committed to offering a very good service with particular emphasis on providing individual care. This ethos was shared with staff who were seen to work well with the residents. Staff have every right to feel proud of the home and the care they provide. Communication in the home was good at all levels. The change in ownership was bound to raise some anxiety, however the manager’s positive approach has helped to smooth the transition. Roles and responsibilities have changed
Cameron House I56 I06 S18044 Cameron House V230541 060705 Stage 4.doc Version 1.40 Page 19 and the registered managers role is now more administrative. This will need to be reviewed carefully to ensure that standards do not fall. The home has several systems for monitoring the quality of their service and the standard of care provided. Audit records were made of falls, pressures sores and weight loss so these could be monitored. As well as a key point audit, stakeholder questionnaires were used. One visiting professional with experience of homes for the elderly wrote ’this is an excellent home’. Within the next 6 months the home will provide a report of the findings of Quality Assurance system in line with regulation. Staff receive regular supervision, which was planned at times, and places to suit the staff and appropriate records were maintained. Supervision was comprehensive and covered a wide range of subjects including care practice, training and the aims and objectives of the home. Cameron House I56 I06 S18044 Cameron House V230541 060705 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 1
COMPLAINTS AND PROTECTION 3 3 2 x 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 3 3 3 x x x x Cameron House I56 I06 S18044 Cameron House V230541 060705 Stage 4.doc Version 1.40 Page 21 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 9 Regulation 13(2) Requirement The Registered Person must make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home This relates to refering to the RPSGB guidelines as detailed in the report. The Registered Person must provide in adequate quantities, suitable, wholesome and nutritious food, which is varied and available as may be reasonably required by the residents. Meals should be in line with the residents wishes and preferences. (Previous timescale of 18.3.05 not met) The Registered Person must ensure that the homes policy on the protection of vulnerable adults is reviewed and up to date The Registered Person must make suitable provision for the storage of aids, pads and equipment (Previous timescale of 18.3.05 not met) Details of immediate action Timescale for action 25 August 2005 2. 15 16(2)(i) 25 August 2005 3. 18 13(6) 25 August 2005 25 August 2005 4. 21 23(2) Cameron House I56 I06 S18044 Cameron House V230541 060705 Stage 4.doc Version 1.40 Page 22 5. 27 17(2) taken to protect residents to be sent to the CSCI within 7 days The Registered Person must provide a staff rota which details the actual times worked. 25 August 2005 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. Refer to Standard 28 27 Good Practice Recommendations 50 of care staff should have NVQ 2 in Care or equivalent A review of domestic duties and times is recommended to ensure there are adequate cleaning staff throughout the day Cameron House I56 I06 S18044 Cameron House V230541 060705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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