Inspection on 27/06/06 for Cameron House Nursing Home

This inspection was carried out on 27th June 2006.

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

Cameron House Nursing Home 25/07/07

Cameron House Nursing Home 16/03/06

Cameron House Nursing Home 22/09/05

Cameron House Nursing Home 27/01/05

Cameron House Nursing Home 11/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Cameron House Nursing Home Cameron Street Bury Lancashire BL8 2QH Lead Inspector Kath Smethurst Key Unannounced Inspection 27th June 2006 09:30 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 Cameron House Nursing Home DS0000017340.V294636.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. Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cameron House Nursing Home Address Cameron Street Bury Lancashire BL8 2QH 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) 0161 764 8571 0161 763 6395 Ringdane Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (39), Terminally ill (1) of places Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 40 service users, to include: Up to 39 service users in the category of OP (Older People); Up to 1 service user in the category of TI (Terminal Illness under 65 years of age). The service should employ a suitably qualified and experienced Manager, who is registered with the Commission for Social Care Inspection. 16th March 2006 2. Date of last inspection Brief Description of the Service: Cameron House Nursing Home provides nursing and personal (‘residential’) care for older people. Both permanent and respite places are available. The home is owned by Four Seasons Healthcare (a large national company). It is a modern, detached building on two floors (with a lift). All the bedrooms are singles. There is a small, enclosed garden to the rear and car parking to the front and side. The home is in a residential area, with a main road and public transport nearby. Bury town centre is approximately one mile away. Fees range from £339 to £440 per week. Additional charges are made for chiropody, hairdressing, newspapers and toiletries. Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a day and a half days. A total of ten hours was spent in the home. The home had not been told that the inspector would visit. The inspector looked around parts of the building and checked some paper work about the running of the home and the care given. To get more information about the home five residents, six visitors, the regional manager, the acting manager and three staff were spoken with. Carers were also watched as they went about their work. Before the inspection comment cards were sent to residents, their relatives and people such as social workers, district nurses and doctors. Four residents and three general practioners returned comment cards. What the service does well: What has improved since the last inspection? What they could do better: There were still some things needing to be put right in the home, which should have been done by May 2006. Staff need to make sure that before residents come into the home that the assessment information includes all the things they need help with and like. Staff need to make sure that when a resident rings for help they respond more quickly so they get the help they need. Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 6 The records kept on residents (care plans) needed improving to make sure staff had all the information they need so they could give the right care. Staff also need to make sure that residents and their relatives have seen the care plans. Staff need to make sure risk assessments are completed, ensure they review them more often to make sure any risks to residents safety is known and planned for. Staff need to make sure they weigh residents more often to make sure they haven’t lost weight. Staff also need to make sure that when a resident has lost weight they write down what they have done about it. Staff need to make sure that when residents are visited by the chiropodist, dentist, optician and doctor this information is written down. Some residents felt there was not enough going on in the home to keep them occupied. One resident said she was “bored” another that “nothing much goes on”. One resident wrote, “ I would like to go out more”. While a resident spoken with said “nothing much goes on”. Outings outside the home need to be arranged and the type of social activities for residents with special needs (those with memory difficulties) need to be increased. Staff need to make sure residents know what is on the menu. The home did not always have enough staff on duty to make sure the residents received the help they needed and this was also one of the reasons staff didn’t have the time to spend with people and organise things for the residents to do. Staff need to have more training in order to better look after residents (such as medication, NVQ, infection control and what to do if a resident isn’t being treated properly). Staff also need training in how to look after residents with memory problems. Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 7 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 Nursing Home DS0000017340.V294636.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 Cameron House Nursing Home DS0000017340.V294636.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&4 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. Systems are in place to ensure assessments take place but staff need to complete all sections of the assessment document in order to ensure all needs are identified and planned for. Generally, a good standard of care was received. However, at times, some residents indicated personal support needs were not being met. Also, the specialised and complex needs of some residents were at risk of not being met, as relevant training had not been provided to most care staff. EVIDENCE: The assessment records of three recently admitted residents were examined (1 rapid response, 1 nursing & 1 residential). The home now provides an emergency service to residents admitted through “Rapid Response” arrangements. Currently there are two “ Rapid Response” residents. The care file for one of these residents was looked at. The Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 10 assessment document was thorough and comprehensive and gave staff clear information in regard to care needs. Since the last inspection new assessment documentation has been introduced. The assessment document was very detailed and included reference to physical needs, social needs, preferences and chosen lifestyle. The care files of three permanent residents were examined. Social work assessments were in place and had been taken note off. While the assessment document was detailed it was noted that not all sections had been fully completed. For example in one of the documents examined the sections covering nutrition and social care needs had not been completed. This needs to be addressed to ensure detailed information relating to all care needs are identified, recorded, and planned for, in order to guide staff providing care. The acting manager offered assurances that this would be addressed. Discussion took place in respect of the assessment process undertaken. The acting manager advised that if possible prospective residents were visited prior to admission at home or hospital, whether they are paying for themselves or the local authority funds their care. The acting manager said that trial visits are available where prospective residents can come for a meal and spend some time in the home. This is not always possible but relatives usually visited and looked around the home prior to their relative’s admission. Two visitors spoken with confirmed they had had the opportunity to visit the home prior to their relatives being admitted. Feedback in returned resident comment cards indicated the majority had received sufficient information before coming to live at the home. However one said they hadn’t and was unclear as to whether a contract had been issued. This should be addressed with residents/relatives individually when care is reviewed. From talking with residents, a visitor and staff, and observing how staff worked, residents’ needs appeared to be generally met. One visitor described the care as being “good” and feedback from residents spoken with and in returned comment cards was on the whole positive. However one resident indicated that at times when using the call system staff did not always answer promptly. This was also observed during the inspection. When speaking to one resident in her room it was noted the assistance call from another resident was not attended to for a considerable time. The inspector went to investigate and the resident in question said she needed assistance to go to the toilet. Just as the inspector was going to find a member of staff one arrived. This was discussed with the regional manager and acting manager who offered assurances this would be addressed. During the previous two inspection it was identified staff were caring for residents with specialist needs, but had not been provided with relevant training. Requirements were made but to date have not been met. This in part Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 11 could be due to the fact that the manager has resigned and a lack of clarity as to whose responsibility it was to arrange training. During the last inspection the former manger advised that the deputy manager had responsibility for training. However the deputy manager said she had been unaware that it was part of her role to arrange training. Discussion with the regional and acting manager indicated this was now in the process of being addressed. Given the circumstances relating to management in the home, a new timescale for this requirement has been made. Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. Care plans need to be improved, as some records had not been completed, this meant important and significant information had not been documented which could lead to residents needs not being fully met. Health care needs were on the whole being met but relevant records were not always completed, this meant important information was not recorded or easily accessible. The management of medication in the home is satisfactory as a result any potential risks to resident’s health have been reduced. Although most staff provided personal support respectfully, at times, some staff did not answer calls for assistance in a timely manner, which could result in resident’s dignity not being upheld. Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 13 EVIDENCE: The acting manager advised that new care plans were in the process of being introduced. Pre-printed, general (‘core’) care plans were in use covering areas such as personal care, continence, nutrition, dependency, health care, weight, risk assessments, social needs and daily progress records. Three care plans were examined. The majority of care plans looked at were poorly maintained. They were not being updated (either monthly or after external reviews, or where changes to care practices had been agreed). Significant information had not been recorded and entries available gave little indication of the actual care needed or given. In one of the files examined there was only basic information and no details of any personal care needs. In two of the plans social care assessments had not been completed. Additionally key worker diary entries had not been completed. This was unfortunate as the completion of the social care assessments and key worker diary would provide useful information relating to resident’s likes/dislikes, preferences and chosen lifestyle. Risk assessments had not been updated. For example in one of the plans risk assessments relating to moving and handling, nutrition and tissue viability had not been reviewed since March 2006. In another plan risk assessment documents had not been completed. These shortfalls must be addressed as a priority to ensure any risks to resident’s safety is identified and planned for. It was also noted that residents were not being weighed on a regular basis. For example in one care plan it had been identified that the resident was at high risk nutritionally. However this resident was last weighed in February 2006. Staff need to ensure residents are weighed regularly in order to ensure they don’t loose too much weight and to ensure action is taken if weight loss is identified. It was also unclear in some plans as to the personal care residents were receiving (baths). Discussion with the acting manager took place on how best to record details of areas such as bathing. The acting manager offered assurances this issue would be attended to. Most care plans did not reflect any resident or family involvement regarding individual care preferences. Discussion with staff suggested that some needs were being addressed even though there was a lack of clear plans and guidance. This approach is dependent on staff memory and good verbal communication. The reliance on verbal instruction and memory could easily break down resulting in residents Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 14 not having their needs met. The regional manager indicated he had already identified care plans needed to be improved upon. He had arranged for the acting manager to work on a supernumery basis whereby she could concentrate wholly on up dating the plans. This is a positive initiative as if the care plans were fully completed they would provide staff with detailed information and guidance when providing care. Given that the acting manager has a great deal of work to complete to update the care plans the timescale for this requirement has been extended. All the above areas need to be addressed to ensure residents care needs are not compromised. With regard to regular health care checks, there was evidence of doctors’ visits being recorded. However, details of visits made by the chiropodist, dentist etc had not been entered in healthcare records (although information was being recorded elsewhere). Staff need to ensure these records are completed in order to provide easily accessible information of health professionals visits. Prior to the inspection comment cards were forwarded to local General Practitioners in order to obtain their views. Three comment cards were returned. Two felt unable to comment, as they had not visited the home recently. One GP indicated there were some concerns as to whether staff always understood care needs but was on the whole satisfied with the care provided. On the 6 January 2006 the CSCI pharmacist inspector undertook an inspection. In the main medication procedures were on the whole found to be satisfactory. The requirements and recommendations resulting from the pharmacy inspection were followed up during this visit and all had been addressed. Nursing staff were responsible for administering medication to ‘nursing residents’ and senior care staff to ‘residential’ residents. The home has recently changed the supplying pharmacist. Additional training was provided to staff in regard to the new system. A detailed medication policy and procedure is in place covering all relevant areas including controlled drugs, selfmedication and homely remedies. The home uses a monitored dosage system supplied by Boots. Accurate records were in place for the receipt and disposal of medication. The supplying pharmacist has recently undertaken an audit but the home has yet to receive the report. A list of signatures for staff responsible for administering medication is maintained. Medication storage is provided in a dedicated treatment room. Two lockable drug trolleys are provided which when not in use are securely stored. A lockable medication fridge is provided and is used to store eye drops, insulin and antibiotics. Fridge temperatures were monitored. A metal locked cupboard is provided for the storage of controlled drugs. A separate system for recording the administration of controlled drugs. The controlled drug record for one Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 15 resident was examined and found to be in order. Storage was orderly with no evidence of over stocking. A sample of MAR (Medication Administration Records) were examined and found to be in order. Visitors spoken with during the inspection were happy with the care their relatives were receiving and confirmed the home kept them informed of their relatives health and well being. One visitor said her relative was “always well cared for”. Those residents spoken with who were able to comment were in the main positive about how most staff assisted them with personal tasks. For example staff did not make them feel embarrassed when assisting with intimate care tasks. Staff were observed knocking on toilet doors before entering. Residents were observed to be nicely dressed. Issues surrounding how promptly calls for assistance are answered need to be addressed to ensure resident’s dignity is maintained. Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. An activities programme is in place, but the provision of activities outside the home needs to be improved upon to ensure residents fulfilment needs are met. Visiting arrangements in the home are good ensuring links between residents and their relatives and friends are maintained. In the main personal choice is offered in such a way as to enable residents to exercise choice and control over their lives. However the absence of information in care plans regarding personal preferences could led residents to not having control over their lives. Meals are good and the needs of residents are well catered for with a balanced and varied selection of food provided. However the way liquidised meals are presented needs to be reviewed to ensure they look more appetising. Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 17 EVIDENCE: An activity co-ordinator is employed three days a week. Advertised activities included quizzes, reminiscence, gardening, musical entertainment and themed events (Royal Ascot-Ladies Day), father’s day, the Queens birthday and the world cup). For example when England was playing a recent match the lounge was decorated and a buffet tea was provided. Activities residents take part in are documented. One to one activities are also provided. For example on the first day of the inspection the activity co-ordinator was observed spending time with individual residents performing hand massages and manicures. Residents appeared to enjoy this activity and a good level of conversation was noted between residents and the co-ordinator. Trips outside the home were limited although the home had access to a company mini-bus. It was evident from speaking with residents and feedback in returned comment cards that more trips out would be appreciated. One resident wrote, “ I would like to go out more”. Residents also indicated that when the activity co-ordinator was not working not many social activities took place. One comment card read, “Only one member of staff organises activities. If on holiday or the home is short staffed then nothing is arranged”. While another resident said “nothing much goes on”. This is an area, which needs some attention. The provision of activities for residents with more complex needs should be looked at. One highly dependent resident was seen to spend most of the day unoccupied. While staff were kind to this resident and spoke to her time spent socialising with her was brief. Residents wishing to maintain their religious links were encouraged and enabled to. Care plans take note of resident’s religious preferences. Religious festivals and occasions were observed and celebrated. The home has an open visiting policy. There are no restrictions on the time people visit and this was evident, with visitors observed during various times during the course of the inspection. Further evidence was highlighted in the visitor’s book where entries showed residents friends and relatives visiting at different times during the day and the evening. The only time restrictions would be imposed is when requested by residents. Anecdotal evidence from residents and visitors indicated staff encouraged links with families to be maintained. Six visitors were spoken with and all confirmed they were made to feel welcome when visiting. One visitor said, “I’m always made welcome”. Staff were also observed offering visitors refreshments. Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 18 The routines of daily living were observed to be flexible. It should be noted a number of residents have memory and communication difficulties so were unable to confirm they were able to exercise choice. Nevertheless observation of care practice indicated residents could make choices. For example residents were observed getting up in the morning at times that suited them and to choose where they spent their day. For example a number of residents were observed using the privacy of their own rooms. Resident’s rooms are personalised and residents are able to bring personal items in the home. Two residents confirmed they were able to get up and go to bed when they wished and a choice of menu was available. However the absence of information in care plans relating to preferences, likes and dislikes could impact on resident’s personal autonomy and choice, particularly if they were unable to verbalise their wishes. There is a four-week menu cycle, which offered a varied choice of nutritional food. Meat or fish was offered on a daily basis, as well as a good assortment of vegetables. Milk puddings, custard, fruit and fruit crumbles are also offered. Breakfast is served on a flexible basis, the main meal being served at around 12.30, and a lighter tea being served at around 5.00 p.m. Drinks and snacks are provided throughout the day. Meals are home cooked and the use of convenience foods is limited. A choice is offered at every meal. Details of the menu were not displayed but a record of menu choices is maintained. The lunchtime meal was observed. It was noted that some residents were sat at the dining table for some time before the meal was served. The dining area was clean and tables were set with linen tablecloths. The cook served the meal. On the day the meal consisted of lamb chops or casserole, cauliflower, broccoli, new potatoes or mashed potatoes followed by crumble and custard. Good practice was noted in that other choices were offered including soup, sandwiches and prawns. The inspector sampled the food and it was found to be very tasty. Residents were given time to enjoy their meal and no one was rushed. A number of residents chose to have their lunch served in their rooms. One of the residents required a liquidised meal and also required assistance with eating. This resident was not brought to the table through personal choice. It was noted that the meal had been liquidised together, which is not in line with recommended practice and it looked unappetising. When residents require a liquidised meal the each element should be liquidised separately in order to make the meal look as appetising as possible. The member of staff assisting did not tell the resident what the meal consisted of. At one point this member of staff and another carried on a conversation over the resident’s head. The majority of residents spoken with and who returned comment cards expressed satisfaction with the quantity, quality and choice of food provided. One resident described the food as being “good”. Only one resident had any Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 19 adverse comments and wrote, “ Some of the food is difficult to chew such as sausages. Not enough variety to choose from”. This is an area the acting manager needs to explore with residents to make sure all are happy with the food provided. Surveys and residents meetings would provide an ideal opportunity to seek opinions. Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. The home has a satisfactory complaints procedure but steps need to be taken so residents know how to make a complaint and to ensure their views are listened to and acted upon. The policies and practices of the home protect residents from abuse, but some staff need training so they are fully conversant with the procedures, and are aware of what action to take in the event of an allegation or suspicion of abuse. EVIDENCE: A complaints procedure is in place. Details of how to complain are contained in the “Service User Guide”. The complaint log could not be located on the day of the visit (possibly due to records having been moved due to re-decoration). No complaints have been made directly to the CSCI (Commission for Social Care Inspection) since the last inspection. The acting manager advised that one formal complaint had been made directly to the home. The regional manager was currently undertaking an investigation. Those residents who were able to comment had not made a complaint but all indicated they felt able to approach staff with any concerns. Visitors spoken with also confirmed they knew who to complain to. None of the visitors spoken with had made a complaint but all said they and would not hesitate to discuss any concerns with staff if the need arose. One visitor said, “If there are any Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 21 problems staff sort them out”. Of the returned comment cards two residents indicated they didn’t know how to make a complaint but knew who two speak to if they were unhappy. A response in one of the comment cards indicated that staff did not always listen and act on what they said. A corporate Adult Protection and Prevention of Abuse policy is in place, which incorporates, whistle blowing. In addition a copy of Bury Social Services Protection of Vulnerable Adults policy is available in the home. Examination of the training matrix indicated the majority of staff undertook POVA training in 2004. It was however noted that some staff have not completed recent refresher training. Lack of awareness could potentially jeopardise any adult protection investigations. It is therefore important staff undertake updated training in this area and this is recommended. Resident’s monies are securely stored with records kept of monies credited and debited. Company representatives of audit monies on a regular basis. Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. In the main the standard of the environment within the home is good providing residents with an attractive, safe and homely environment. EVIDENCE: Cameron House is in the main well maintained internally and externally. The Home has a number of lounge/dining areas. These areas are furnished with domestic style furniture. Ornaments, pictures and flowers enhance the homeliness of these areas. The garden areas are tidy, well maintained, safe, secure and accessible for residents. Residents spoken with made no adverse comments about environmental standards in the home. During the inspection extensive redecoration was being undertaken (entrance and corridors). New carpets had also been fitted in the lounge and corridors. During the last inspection it was noted that the lounge chairs were beginning Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 23 to show signs of wear and tear. The regional manager advised new chairs had been ordered and were due to be delivered in the near future. A sample of bedrooms was examined. All showed evidence of personalisation with photographs and personal mementoes on display. All bedrooms are lockable and lockable storage space was available for residents to store items for safekeeping. It was also observed that some residents like to spend time in their bedrooms and they preferred to have their doors open. In order to ensure their safety in the event of a fire (and to allow them to have the door open) consideration should be give to providing either self closing devices or fire stops, which are activated by sound. Standards of hygiene were in the main good. Residents spoken with and feedback in comment cards regarding the cleanliness of the home was in the main positive. However the response in one comment card indicated that the home “was not always” clean and fresh and “sometimes the smell is a bit off putting”. Due to the home being painted it was difficult to assess odour control. However in the areas not being painted odour control was in the main good. A slight malodour was noted in the corridor downstairs (near to one of the bedrooms). The acting manager advised the odour emanated from a bedroom carpet. The acting manager said she was in the process of discussing with the resident and relatives the possibility of providing more suitable flooring. Policies and procedures were in place with regard to infection control. Staff were provided with protective aprons and disposable gloves. Liquid soap and paper towels were provided near to hand washing facilities. Staff were observed to be maintaining good hygienic practices. All laundry is undertaken on site and residents spoken to had no complaints about the standard of laundry service provided. Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. On occasions the home has operated under required staffing levels, which means the needs of residents are not being fully met. Staff have not received appropriate training, which could compromise the quality of care provided to people living in the home. While recruitment polices and procedures are robust they had not always been followed which could potentially put residents at risk of harm. EVIDENCE: A written rota is maintained. The deputy manager has taken on the role of acting manager and arrangements have been made for her to work on a supernumery basis. Domestic and catering staff support nursing and care staff seven days a week. In addition an administrator, activity co-ordinator and maintenance person are also employed. Information provided in the pre-inspection questionnaire indicated that thirteen staff had left the home since the last inspection in March 2006. This is quite a high number. As the manager had left and no reasons were indicated in the pre-inspection questionnaire it was not possible to ascertain the reasons for Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 25 such a high percentage. The introduction of exit interviews would provide the company with useful information in this respect. The rota was examined to find that on occasions the number of staff working in the afternoon fell below the guidelines set by the previous health authority inspection unit. For example on both days of the visit there were only three staff rotered to work (in the afternoon) where health authority guidelines indicated there should be four. Discussion with staff indicated also indicated that staffing levels in the afternoon were being reduced from four to three. One member of staff said that if this happened they would “not have time to bath residents”. It was also noted staff were very busy and did not have time to spend quality time with residents. It was observed (in the morning of the first day of the inspection) that a visiting nurse was having difficulty in obtaining the records she needed, as staff were very busy. The inspector eventually intervened and the deputy manager assisted her. As previously noted calls for assistance made by residents were not answered in a timely manner. All this could be suggestive of insufficient staffing levels. The acting manager must take steps to ensure adequate staffing levels are maintained at all times A copy of the former health authority inspection unit guidelines was forwarded to the home following the inspection. It should be noted that the ratios set in the guidelines do not preclude additional staff from working. For example the needs of older people can increase suddenly as a result of an accident, illness or as part of the ageing process resulting in additional staff being required. During the last inspection the former manager advised that the deputy manager had designated responsibility for training. Discussion with the deputy manager (now acting manager) indicated she had not been aware of this. The acting manager advised that she had responsibility for moving and handling training but had not been aware of any other responsibilities. While most of the residents indicated staff looked after them examination of the training recording matrix showed that both mandatory and specialist training require attention. The percentage of staff in receipt of NVQ (National Vocational Qualification) level 2 is very low. The matrix indicated that only four care staff were in receipt of NVQ level 2 and 3. Information provided in the pre-inspection indicated ten staff were waiting to begin NVQ training. This could not be confirmed but the regional manager said he would check. This needs to be monitored to ensure progress in meeting the required 50 target is met. While some mandatory training needs are being met the training matrix 2005 shows a number of gaps. For example moving and handling, basic first aid, food hygiene, infection control, health and safety and death and dying. All this needs to be addressed in the staff development programme. Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 26 During previous inspections it was identified that staff had not received training to work with residents with specialist and complex needs. For example dementia care, including how to understand and support residents on both a practical and emotional level. This still needs to be addressed. Some residents living at the home have communication and memory difficulties but staff have not received appropriate training. While staff were seen to be kind towards residents contact related mostly to personal care and meal times and social interventions were brief. Discussion took place with the regional and acting manager on how this could best be approached. The personnel files of four staff were examined and some shortfalls were noted. While the company has a comprehensive policy and strict guidelines in regard to the recruitment and selection of staff it was evident they had not always been followed. All the files contained application forms however in some forms gaps of employment had not been explored. In two of the files there was only one reference. One of the files showed correspondence relating to a disciplinary meeting but there were no details for the reasons or the outcome. All this needs to be addressed. There was evidence in the files checked that POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) had been undertaken. Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. The Registered Manager has recently resigned. Satisfactory temporary management arrangements are in place. An application for a new manager to be registered with CSCI must be submitted once a manager has been appointed. While quality assurance systems are in place they could be further improved to ensure the home is run in the best interests of the residents. Money kept on behalf of residents is managed properly, which ensures the residents financial interests are protected. Shortfalls were identified regarding the health, safety and welfare of residents and staff, which need to be addressed in order to minimise the risk to all parties. Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 28 EVIDENCE: Since the last inspection the registered manager had resigned from her post. The deputy manager has been appointed as ‘Acting Manager’ until a permanent arrangement is made. The Acting Manager has worked at Cameron House for a number of years and is a registered nurse. Support is provided from the regional manager through regular visits and telephone contact to the home. Interviews for the manager’s post were taking place during the week of the inspection. The Inspector was satisfied with these temporary arrangements. An application for a new manager to be registered with CSCI is required once a permanent appointment has been made. A number of concerns were raised in regard to the way the home has been managed in the past. Some of the record keeping was poor and staff gave examples of how concerns and issues brought to the former manager had not acted upon. A small number of staff demonstrated a level of apathy towards their work, but, in the main, staff remain caring and committed. It was clear, however, that standards need to be improved upon. The regional manager is now fully aware of the situation and is providing support. It is hoped that with the appointment of a new manager standards will improve. Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 29 Some internal and external quality systems are in place such as staff and resident meetings. However it was noted that it was some time since a residents meeting took place. The last residents meeting took place on the 22/11/05. These meetings need to recommence in order to ensure the views of residents are taken note of. Senior staff meeting had been held in April 2006 and the acting manager had arranged a full staff meeting for the following week. The acting manager has also recommenced formal supervision. A company representative visits the home on a monthly basis to audit records and speak to residents and staff. A written report is then produced of the findings, which is then forwarded to the CSCI. Discussion with the regional manager indicated that he was seeking to improve quality assurance systems so that shortfalls such as those relating to care plans and training can be identified sooner. While it is evident residents, their representative and other stakeholders are consulted informally, it needs to be acknowledged that some people are reluctant to voice their opinions. Anonymous questionnaires provide individuals the opportunity to comment on aspects of the care and service without having to be identified. It is understood that the company undertake surveys. However there was no evidence of any feedback from these in the home or when they were last undertaken. A satisfactory accounting system is in place. Relatives manage the finances for the majority of residents. However if possible residents are encouraged to look after their own money. A record is kept of monies credited and debited and receipts are obtained for financial transactions. Company representatives audit resident’s monies regularly. Discussion took place in respect those residents whose finances are managed by their relatives. The administrator advised that currently there were no issues with residents having access to their personal allowances. With the pre-inspection materials, the manager provided a list of maintenance and associated records. A number were checked on the site visit and were found to be up to date. The home employs a handyman who undertakes regular checks of the water temperatures, window restrictors and call systems. As previously noted some staff need updated health and safety training. See standard 30 for details. The fire safety log was examined to find all tests had been carried out at the required frequencies. Staff have recently completed fire safety training. The last recorded fire drill took place on the 10/5/06. A fire risk assessment is in place and has been recently reviewed. There were satisfactory policies and procedures in place relating to the recording and reporting of accidents to residents and staff. Samples of accident records were examined and were found to be appropriately maintained. Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 30 Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 31 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 X X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 2 Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement Assessments must cover all areas indicated in National Minimum Standard 3. Timescale for action 15/08/06 2. OP4 12, 14, 18 Additional training must be provided to care staff working with residents with specialised needs (e.g. dementia). Timescale 30/06/06 extended. 12, 13 To ensure residents personal care needs are met and to preserve their dignity calls for assistance must be answered in a timely manner. Care plans must reflect full details of service users assessed needs, be kept up to date and reviewed regularly; that residents are weighed regularly and care plans are drawn up with and signed by residents or representative and be reviewed on a monthly basis. Timescale 31/12/05 & 01/05/06 not met. Timescale extended. 01/09/06 3. OP4 10/07/06 4. OP7 15 31/08/06 Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 33 5. 6. 7. 8. 9. OP7 OP19 OP27 OP28 OP30 15 23 18 Risk assessments must be completed and regularly reviewed. New lounge chairs must be provided. 31/07/06 31/08/06 31/07/06 01/12/06 01/09/06 10 OP29 11 OP31 Adequate staffing levels must be maintained at all times 18 50 of staff must be in receipt of NVQ level 2. 12, 14, 18 The ongoing programme of staff training must continue so that all staff members have received up to date training in all the mandatory topics including, first aid, food hygiene, health and safety and moving and handling. 7.9,19 Two written references must be received prior to a new member of staff commencing employment. 8&9 An application for a suitably qualified, competent and experienced manager to be registered with the CSCI should be submitted. 31/07/06 01/08/06 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 OP8 Good Practice Recommendations Individual health care records should be maintained in order to provide staff with easily accessible information about residents well being. The activity programme should be reviewed to ensure more trips outside the home are provided. A programme of activities should be implemented which better meets the needs of residents with memory and communication difficulties. DS0000017340.V294636.R01.S.doc Version 5.2 Page 34 2. 3. OP12 OP12 Cameron House Nursing Home 4. 5. 6. 7. 8. 9. OP15 OP15 OP18 OP19 OP22 OP33 Details of the menu choices should be displayed. To make liquidised meals more appetising each element should be liquidised separately/ To ensure staff are fully conversant in abuse procedures staff should be provided with updated training. As part of the planned programme of renewal and refurbishment consideration should be given to redecorating the lounge. Consideration should be given to providing doorstops, which are activated by sounds for residents who like to spend time in their rooms. (See body of report for details) The current quality assurance system should be expanded in order to obtain feedback from a wider variety of stakeholders. Cameron House Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 Nursing Home DS0000017340.V294636.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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