Inspection on 20/08/08 for Cameron Lodge

This inspection was carried out on 20th August 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cameron Lodge 08/08/07

Cameron Lodge 08/08/06

Cameron Lodge 14/11/05

Cameron Lodge 14/06/05

Cameron Lodge 25/02/05

Cameron Lodge 05/05/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 Cameron Lodge 142 Church Path Deal Kent CT14 9TU Lead Inspector Mary Cochrane Unannounced Inspection 20th August 2008 09:30 Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 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 Lodge DS0000023372.V369028.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 Adults 18-65. 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 Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cameron Lodge Address 142 Church Path Deal Kent CT14 9TU 01304 373815 F/P 01304 373650 cameronlodge142@gmail.com 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) Cameron Lodge Ltd Manager post vacant Care Home 12 Category(ies) of Learning disability (0) registration, with number of places Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD) The maximum number of service users to be accommodated is 12. Date of last inspection 8th August 2007 Brief Description of the Service: Cameron Lodge is a detached property situated in a residential area of Deal. The home is within walking distance of local shops, a pub, and leisure facilities. Public transport is available nearby. The home is registered to provide accommodation to 12 adults with learning disabilities and complex needs, with a particular focus on those people with autistic spectrum disorder. The home is arranged in three units with the main house currently offering five spaces and each of the two smaller bungalow units providing three beds each. All three units are separate from each other, although service users can move freely from the smaller units to the main house if they choose. One of the bungalows provides accommodation to more independent service users who undertake some personal care and domestic tasks for themselves. A second bungalow, which is detached and set back slightly from the other units, provides a quieter environment for more dependent or physically frail service users. The main house provides spacious accommodation for a mixed group of five service users with more complex behavioural needs. Accommodation is arranged over two floors with two ground floor bedrooms and three on the first floor, communal space and washing facilities are adequate for the number of Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 5 service users throughout the main house and bungalows. The current fees for the service at the time of the visit are £1,045.59 to £2533.80 per week. Additional charges are detailed in the service user’s guide. Information on the homes services and the CSCI reports for prospective service users/relatives will be referred to in the statement of purpose and service users guide. Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This visit to the service was an unannounced “Key Inspection” which took place over one day. All the core standards were looked at. The people living at the home and the staff on duty were helpful and cooperative throughout the visit. To collect evidence for this report we communicated with service users had discussions with the management team and staff. We observed how staff supported service users during the day when interacting and when offering care. We looked at and discussed service users individual support plans and their risk assessments. We also looked at staff training records and the homes quality assurance. An annual service assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information received from the home since the last inspection was also used in the report. We also looked at information we have about concerns and complaints and how these have been managed. We also took into account the things that have happened in the service, these are called ‘notifications’ and are a legal requirement. What the service does well: Thorough and clear assessments have been done on each of the service users which have identified all their needs. Any complaints or concerns are taken seriously and acted on so service users are protected. The majority of the service user’s bedrooms are individualised and reflect the personalities of their occupants. More than 50 0f the staff team have achieved NVQ level2 or above. Some members of staff were seen to interact in kind, caring and respectful manner. Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 7 The service has thorough and robust recruitment practises which are adhered to. This means service users are protected. What has improved since the last inspection? What they could do better: Each service users has a care plan but these need to be developed to give staff all the information they require to support and care for the service users in a way that meets all their needs and allows them to live a fulfilling life while keeping them as safe as possible. This will promote independence and autonomy for service users while keeping them as safe as possible. They need to be used by the staff as a daily working document. The home needs to evidence that service users are involved and have more choices about what they do. The plans need to be more person centred. Key working needs to be used more effectively. The service needs to make sure that all the personal and health care needs of service users are identified and met. The medication practises and procedures need to be tightened up to make sure service users receive their medication as safely as possible. This means that the health of the service users will be promoted and they will receive all the care that they need to improve their wellbeing. The home needs to improve the lives of some of the service users who live at the Cameron Lodge. All service users need to be provided with the support, guidance and encouragement they each need to live a fulfilling, meaningful Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 8 and active life. Activities need to be developed that meet individual needs. The planned activities need to take place. The management need to organise the staff rota to make sure there are enough staff on duty at the appropriate times to support service users in meeting their needs and to undertake planned activities on a regular basis. There needs to be an on-going maintenance and refurbishment plan in place with time scales so work can be planned and the home maintained to a good standard. The management need to make sure that all staff attend the necessary training courses to keep them up to date with their practises. This will make sure they have the skills and knowledge to look after the people living at the home. There also needs to be enough staff on duty at all times to support and care for the service users in the best possible way. There are times during the day when there are not enough staff available to look after people in the way they should be. Service users might not be doing as they wish as there is not enough staff to support them. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 9 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 Outcomes Statutory Requirements Identified During the Inspection Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5 People who use the service experience good quality outcomes in this area. The Statement of Purpose and Service Users Guide provide sufficient information for service users and their family/advocates to make informed decisions about the homes ability to meet their needs. Service users know that the home will be able to meet their assessed need and aspirations. Service users know what they are paying for and their places at the home are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a statement of purpose, which includes a philosophy of care. There is a Service Users Guide, which is well written and informative. It contains all the relevant information about the home and how care will be delivered. The guide has been developed into a format which is suitable for the service users and they have been individualised for each person. They contain pictures and symbols and are easy to follow and understand. However the service users do not have easy access to guides. The manager said that this issue would be addressed. Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 11 The home has procedures and tools in place to undertake initial assessments. The most recent admission to the home was 2 years ago. This assessment was done to good standard by the manager of the home. It contains all the detailed information needed to assist in making a decision as to whether or not the home would be able to look after the person. All areas of support, care and intervention had been looked into and considered. The assessment was a good base to start developing a robust care plan. Terms and Conditions of Residence/Contract are in place and are updated. They include information on the fees that are charged by the company. They also state who pays the fees and when. The contracts include information on any additional charges made by the company stipulating the amount and the reason why. The document needs to be signed by the service user/ representative and the manager and dated. Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience adequate quality outcomes in this area. There are short- falls in the planning implementing and risk assessing the changing needs of the people who use the service. Service users are able to make some decisions about their lives but their participation is limited. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each of the people living at the home has a care plan. 3 care plans were looked at in detail. The plans contained some of the information needed to meet basic needs of the service user. But the plans did not reflect the support and care identified in the initial assessments. Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 13 Service user’s plans did not cover all aspects of health and social care, medical needs, specialised needs, behaviour management, interventions, and nutritional information. Part of the plans were individualised and attempts had been made to make them person centred but there was gaps in the information. None of the plans seen had been dated. The plans are duplicated and a copy is kept in the office and another with the daily records. This means that information and updates are often lost between the 2 files. The support care/plan is not being used as a daily working document. Daily reports are written at the end of each shift but do not reflect what is written in the plan. This means that the need of the service users are not always being met in a way that is best for them. The changing needs of the service users have not been up-dated and reflected in the plans which meant that staff were not always up to date on how best to look after the residents. Information about service users is often passed verbally or through the communication book. This book is in of breach data protection regulations and contains the information that should be written in daily reports and care plans. There was no evidence to show when the plans had last been reviewed and by whom. We saw that one service user had not had a care management review since 2006 but there was nothing recorded to say why this had happened. The company does recognise the rights of the service users to take control of their lives and make their own decisions and choices. Some of the people living are able to make decisions and choices about what they do and are given the support and assistance they need. However other service users are limited in their choices especially with regards going out and being involved in normal daily activities. The home needs to be able to demonstrate that service users are able to make decisions and choices. Some service users do have access to independent advocacy services. Care staff need to develop their understanding of how to offer choices effectively. There are some risk assessments in place for the all the service users but these do need to be reviewed to make sure that they are accurate and are tailored for individual identified risks. There was evidence to indicate the same risk assessments are in place for many of the service users and they do not give a true picture of their needs and how risks are going to be effectively managed. From discussions with staff, looking at initial assessments and reading care plans it was evidenced risks had been identified but then there was nothing in place to give the staff the guidance on how to keep risks minimise while allowing service users to live a fulfilling and active life as possible. Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 14 There was some limitations and restrictions in place but the reasons for these were not recorded. Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 16 and 17 People who use the service experience adequate quality outcomes in this area. Some of the people who use the service are limited in what they do throughout the day. They need better arrangements to enable them to participate in fulfilling activities. Family links are encouraged and maintained wherever possible. The home provides a choice of healthy, nutritious meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the inspection the home was not able to produce any activity programmes for any of the service users. This meant that some activities do occur but these are done on an adhoc basis. Some service users attend sessions with the local disability team. It was identified that one resident used Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 16 to go swimming and attend a sensory sessions. These had ended for various reasons but nothing had replaced them. Staff said that no-one attended any of the day centres in the area. And the main activities for some service users is going for walk and drink in the local area or going on a minibus ride. The service users require staff support guidance and encouragement to develop and maintain a fulfilling life style both out-side and inside the home. Activities and leisure pursuits take place on an ad- hoc basis. On the morning of the inspection there was little evidence of activities or engagement with the 3 service users who remained in the main house. They were not given the guidance and support that they needed to do anything fulfilling within the house. In the afternoon a staff member did take one of these service users out for a walk. Staff said, “We can’t take service users out very much because we don’t have enough drivers”. They said, “We cannot take service users out because there is not enough staff on duty to do it safely”. There is some restriction around access within the home. The manager is going to look into this review the reasons why these restrictions are in place. It was reported and evidenced that some of the service users do have family contact and they are encouraged to maintain family links. Some of the service users go home for periods of time. Family and visitors are welcome within the home at all reasonable times and no restrictions are imposed. Service users are supported with daily living tasks around the home and encouraged with activities such as cooking and cleaning, where they are able. The service told us they encourage people to discuss issues with them at any time and hold an open door policy that supports service users in talking to any members of staff or the Manager. The home employs a cook from Monday to Friday. There is a menu plan. The staff are keeping a record of the food that is being offered and what is chosen and eaten by the service users for the majority of service users they do not record the amount eaten. Special diets are catered for. It was documented that a service users had not eaten a main meal for a couple of days. This was not recorded in his daily records and there was no evidence to say if there was a reason for this and what action had been taken by the staff. At weekends care staff continue to do the cooking however the numbers of staff on duty at the weekend do not increase to accommodate this extra task. Therefore service users are being left without sufficient input from care staff. Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 17 Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 People who use the service experience adequate quality outcomes in this area. Service users cannot be sure that all their personal and healthcare needs will be identified and met. The homes medication procedures need to fully protect the safety of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw that the more independent people who live in the home are supported and helped to be more independent with their personal care. Staff give them the support and assistance that they need while allowing them to do a much as possible. The amount of assistance given depends on the individual service user. The personal care need of the service users varies greatly. The more dependent service users need more staff to assist them. When we looked at the duty rota and from listening to what people told us there was Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 19 evidence to show that all service users might not be getting the care and support that they need Some of the service users are involved with specialist community services. During the visit we found that some treatments had been instigated by the specialist teams but these had not been implemented and carried out within the home. One person had been reviewed by the consultant psychiatrist and his medication was supposed to have been reduced. This had not been done and there was no reason documented to say why it hadn’t happened. Some people had been diagnosed with conditions like epilepsy or were at risk of choking but there were no guidelines in place to tell staff what to do if these things happened. Another person was receiving invasive treatment from the care staff but they had not received the necessary updates in training from the district nursing team to carry out these procedures. The manager did immediately address this issue. All this means that people may not have received the input and treatment they need to best meet their needs. They may be at risk because of this. Each resident is registered with a local G.P. and any area of concern related to health is referred to the G.P. There was evidence of GP visits and also visits by the district nurses team and subsequent treatment. However care plans had not been updated to reflect the outcomes of the treatment. The service users have regular appointments with opticians, a chiropodist and dentists. The home has a drugs cabinet and fridge. Medication is stored safely. The home uses a pre-dispensed system for administering medicines. This means that the medication is administered to service users more safely as it has been pre-packed by the pharmacist in blister packs. No one administers medication unless they have received the necessary training. We looked at a sample of prescription sheets. The majority of prescriptions sheets had been signed to indicate that service users had received there medication on time and safely. There was one gap in administration of a medication. The deputy manager was going to look into this. The home does carry out medication audits. It does need to regularly check staff competencies. Some of the people living at the home are prescribed medication (this includes analgesia, topical creams, eye drops) on a ‘when required’ basis. There is no written instructions and guidance for staff to ensure that the medication is administered consistently and can be monitored. Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 20 Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use the service experience good quality outcomes in this area. The home has a satisfactory complaints system and service users are protected from harm and abuse This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a full complaints procedure in place. This does needs to be written in a format that is more understandable for the people who live at the home. The home keeps a complaints log and any complaints made to the service are fully investigated. There is evidence in place of the action taken and the outcomes reached. The Manager stated that service users are encouraged to voice their feelings throughout the day. She told us their views are listened to. There are clear guidelines in place for safeguarding adults and the home also uses the Kent & Medway Adult Protection protocols. We spoke to some of the staff and they were clear about their responsibilities with regards to protecting the people in their care. Most of the staff have received training in safe guarding adults and any gaps have been identified. The deputy manager of the home is able to audit trail monies. The home has developed systems of managing resident’s personal monies, which protects them from abuse. The home provides a safe place for the storage of monies and valuables. Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 22 Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,28,29 and 30 People who use the service experience good quality outcomes in this area. The home needs to develop maintenance and refurbishment plans to continue providing an environment that is homely, comfortable and safe for those living there. The service users benefit from living in a clean environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The properties consist of three separate properties with a main house and two bungalows located in the grounds. They are situated in a residential area in the outskirts of Deal and has easy access to local transport and shops. All of the buildings were clean and tidy and the home provides a physical environment that is appropriate to the specific needs of the service users. We saw there is well maintained specialist aids and equipment available to meet the needs of those people who need it. Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 24 Everyone has there own bedroom and most of the rooms are individualised and reflected the personalities of the service users. The bungalows allow 2 small groups of people to live together in a homely and comfortable environment. The main house is not as homely and some of the rooms are bare and stark. Most of the communal areas had no curtains or blinds on the windows. We were told this is because the service users pull them down. There are ways in which this could be addressed. There is a maintenance man who looks after the 3 properties. We looked around the home. The maintenance man is aware of the work needed within the house and bungalows maintenance required in the home, but there is currently no formal plan in place for the renewal and redecoration to make sure the home continues provide a comfortable and safe place for people to live. In the last report it was recommended that the windows at the properties needed some maintenance and in one bathroom there were no restrictors on the window. The manager told us that this had now been addressed and windows were safe and painted. There is plenty of garden area, which is reasonably well maintained. People who can mobilise independently can access the garden as they wish. The home has a separate laundry facilities with hand washing facilities and polices and procedures are in place to reduce the risk of infection. The kitchens we saw were clean and organised in accordance with health and safety. Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 25 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. People who use the service experience adequate quality outcomes in this area. There is not enough staff on duty at all times with the necessary skills and knowledge to meet the needs of the service users. Service users are protected by the homes recruitment practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff said they have developed good relationships with the service users and are able to anticipate and meet the individual needs of the client group. The service users responded positively to staff and they indicated that they like the staff. The home operates a key worker system and staff were observed supporting and communicating with service users in a respectful and caring way. Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 26 Since the last inspection the number of staff employed at the home has increased but there are still periods throughout the day when there are not enough staff on duty to meet the needs of the service users. We saw from looking at the duty rota and from speaking to staff in the main house that often in the morning there is often only 3 staff on duty until 9.00am 3 of the service users are funded for 1 to 1 care. This leaves some service users without the care and support that they need and potentially at risk. In one of the bungalows there are periods of time during the day when there is only one member of staff available. This was seen on the day of the visit. Staff told us that they often have to move from one house to another to cover sickness or shortages. They said that particularly in the main house they frequently cannot do activities or take service users out because of lack of staff. This was supported by looking at lack of organised activities that happen at the home. The numbers of staff on duty and how the duty rota is organised does not meet the needs of all the service users living at the home. Staffing at night- time in the bungalows has been reviewed and from looking at the records speaking to staff this has improved and service user’s needs are being met. We were told that this is kept under review pending on the needs of the service users. The company have a rolling training programme and training at the home has improved since the last inspection. The home has a training matrix which shows the training the staff have completed and that which remains outstanding. We saw that there are still significant gaps in training for staff both in mandatory training and specialist training. This leaves service users at risk as staff may not have the skills and knowledge to support and care for the service users in the best possible way. The manager is aware of these and has booked training places for staff. More than 50 0f the staff team have now achieved NVQ level2 or above. A sample of staff files were looked at. The home has sound recruitment practises and policies and procedures are adhered to. Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 27 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 People who use the service experience good quality outcomes in this area. The manager has the qualifications and knowledge to run the home in the best interest of the people who live there. The health, safety and welfare of the service users is promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of has completed her level NVQ4 and the Registered Managers Award. She has several years experience in working with people with a learning disability. Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 28 She has an understanding of the key principles and focus of the service. She is aware of the shortfalls within the home and told us that she has some plans on how these will be addressed. She is working to improve the service and provide an improvement in the life’s of the service users. She told us that she understands the importance of person centred care. The manager has applied to the commission to become registered and is waiting for her application to be processed. All sections of the AQAA were completed and it did give a reasonable picture of the service although it was found at the inspection that some of the information was not accurate. There were areas where more supporting evidence could have bee given. The AQQA needs to give more information on how the service plans to improve and how they are going to do this. The company has a dedicated person to undertake effective quality assurance and quality monitoring systems. The aim is to look at managerial effectiveness, improve paper work and highlight any deficits so they can be addressed. The out-come is to ensure all homes within the company are working to the same remit and working to meet the minimum standards. The manager told us that last year questionnaires to find out what people think about the home were sent to service users, relatives and staff and other stakeholders. She said she would be doing the same this year. The information needs to be collated and the outcomes passed on to those who have an interest in the service. The strengths and weaknesses of the home need to be identified and improvements made. This will make sure the aims and objective and statement of purpose of the home are being met. The home provides a safe environment for service users to live in and staff to work in. Good working practices ensure the home is free of hazards. The company’ has an induction programme which is in line with Skills for Care. Policies are in place to strengthen safe practices. All the relevant checks and inspection of equipment and systems have been undertaken and were evidenced on the day of the inspection. An accident book is maintained. Fire checks are being done. There home has also has completed a fire assessment We saw that drug cupboard and fridge temperatures are taken regularly and are within the stated ranges. The Manager is aware of RIDDOR and reporting incidences to the Commission under Regulation 37. COSSH products are locked away safely. Environmental risk assessments are in place. Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES 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. 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 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 1 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 3 X 3 X X 3 X Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO 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 YA6 Regulation 15(1)(2) Requirement The manager needs to ensure that the care plans contain the relevant information to meet the individual needs of the service users and are used as a daily working document by the service users and staff. Service users need to be involved in their own care planning and agree to the plans. Timescale for action 30/11/08 2 YA9 13(4) 3. YA12 4. YA19 5. YA33 Individual risk assessments need to be developed and implement to ensure that all risks are kept to a minimum. Risk assessments need to assist and enable service users not restrict them. 16(2)(n) Each person living at the home needs to have an activities programme tailored for their individual needs and preferences. 13(1)(a)(b) The registered person ensures that all the healthcare needs of service users are assessed and recognised and that procedures are in place to address them. 18 (1) (a) Staffing levels must reflect the needs of the service users in DS0000023372.V369028.R01.S.doc 30/11/08 30/11/08 30/09/08 30/09/08 Cameron Lodge Version 5.2 Page 31 that there is sufficient staff to support people with their programme of activities and care needs. 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 YA20 YA35 Good Practice Recommendations There needs to be individual guidelines in place for service users prescribed ‘when required’ medication. The registered person must ensure that all staff are suitably qualified and competent in meeting the needs of the service users within the home Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cameron Lodge DS0000023372.V369028.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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