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Inspection on 06/06/06 for Camplehaye Residential Home

Also see our care home review for Camplehaye Residential Home for more information

This inspection was carried out on 6th 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Camplehaye delivers care of a good standard in accommodation that is spacious, homely and comfortable. One person commented: "Our relative has always been given the best of care in all senses, especially on a personal level." There are attractive level gardens which residents can use or look out on. Meals provided are of good quality and quantity and are described as "good home cooking" by "a very good cook".

What has improved since the last inspection?

There is an ongoing programme of decoration and upgrading at the home. One visitor said: "It does seem to be warmer this winter". There is a more consistent staff providing an increased continuity of care. Provider`s visits are now undertaken and a copy of the report sent to the Commission. Policies and procedures continue to be reviewed and updated.

What the care home could do better:

Camplehaye Residential Home DS0000060069.V291112.R01.S.doc Version 5.2 Page 6Contractual arrangements between the provider and resident need to be clear, and fairly balanced so as to protect the resident as well as the provider. The needs of residents must be clearly assessed, any risks identified and care planned so that all health, personal, and social care needs can be met consistently. Care plans are presently rudimentary and lacking sufficient detail. Medication management must be improved for safety. All medicines received into the home must be checked as correct on arrival. Medicines administered must be signed for at all times, and the home needs a system for removing out of date medicines promptly. A medicine prescribed for one person must not be given to another and all medicines must be labelled. Personal information about residents must not be on display where inappropriate persons might see it. The dignity of residents must be better considered. Where residents are socially isolated, either through their own preference to stay in their room or as a result of their condition, they should have the opportunity to spend time with other people, and this needs to be a part of care planning. The manager and senior staff should attend the multi agency adult protection training so that they are fully able to protect the vulnerable adults in their care. If it is considered necessary to restrict a resident`s liberty in any manner, this must be risk assessed and only undertaken in agreement with professionals involved in their care. This includes locking wardrobe doors, and bedroom door alarms. The home environment should meet the needs of residents. Adaptations would improve the lives of residents with dementia, who find orientation within the building difficult. Rooms must be fit for what they are intended; if a room is a shower room it must be possible for the resident to have a shower in it. For fire safety all rooms must have a smoke detector. Fire safety checks must be undertaken and recorded correctly, and all staff receive a minimum of six monthly fire safety training. Where fire safety risks have been identified the risk must be removed or reduced promptly, not left for months. Trip hazards, such as worn carpet and clothes left on the floor in corridors, must be removed. Furniture must be replaced if it is worn and shabby. That found in a double room where residents with dementia sleep was especially worn. Bathrooms must be clean, pleasant and hygienic. There must be good infection control measures in place, with staff able to wash their hands after providing personal care or handling soiled laundry. Protective clothing must not be worn from room to room increasing the probability of cross infection and clothes must not be left o n the floor in the laundry.Hot water outlets must have safety control valves to remove the possibility of scalds and the programme to cover radiators and pipe work must be completed to protect residents from contact burns. Staffing numbers and skill mix must be sufficient at all times of day and night so that residents` health, safety and welfare are fully promoted. Staff induction and training must ensure staff knowledge and competence. Staff must be regularly and sufficiently supervised in their work to ensure standards of care and service consistency. Recruitment must be robust and so ensure that only those persons suitable to work with vulnerable adults are employed by the home. The manager must ensure that all serious accidents are reported to the Commission so as to protect the residents in their care. Health and safety concerns need to be addressed to protect residents. Three concerns were made Immediate Requirements following an inspection visit. Concerns identified included: fire safety, trip hazards, the servicing of equipment, hygiene, training, risk assessment of Legionella and the use of bed sides and the testing of portable electrical equipment, such as television, used within the home.

CARE HOMES FOR OLDER PEOPLE Camplehaye Residential Home Lamerton Tavistock Devon PL19 8QD Lead Inspector Anita Sutcliffe Unannounced Inspection 6th June 2006 10:00 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 Camplehaye Residential Home DS0000060069.V291112.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. Camplehaye Residential Home DS0000060069.V291112.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Camplehaye Residential Home Address Lamerton Tavistock Devon PL19 8QD 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) 01822 612014 01822 611480 Avens Care Homes Ltd Mrs Samantha Avens Care Home 28 Category(ies) of Dementia - over 65 years of age (28), Old age, registration, with number not falling within any other category (28), of places Physical disability (28), Physical disability over 65 years of age (28) Camplehaye Residential Home DS0000060069.V291112.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. PD category is for people who are over 55 years of age. Date of last inspection 9th December 2005 Brief Description of the Service: Camplehaye is a large detached period house set in its own grounds on the outskirts of the village of Lamerton. It is registered to provide residential accommodation and personal care, for a maximum of 28 persons over the age of 65 for reasons of old age, physical disability or dementia. In addition the home may provide accommodation for Service Users with a physical disability from the age of 55. The home provides 2 lounge rooms and dining room on the ground floor and 24 single bedrooms and 2 double bedrooms. All of the bedrooms have en suite facilities or a toilet and sink for personal use close by. The home has 5 bathrooms, and 3 shower facilities. Stair lifts provide access to the upper floors, however a small number of rooms are accessible by a short flight of stairs. The gardens are attractive with seating provided. Information provided May 2006: Fees are between £260 and £500 per week. Additional charges are made for hairdressing, chiropody, toiletries, papers and magazines. Prospective residents are sent a brochure including the home’s Statement of Purpose, Service Users’ Guide, confidentiality, privacy and dignity policies and the summary of the most recent inspection report. Camplehaye Residential Home DS0000060069.V291112.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of the inspection was to assess the homes compliance with Key National Minimum Standards. The inspectors also reviewed progress on previously set requirements and recommendations communicated following the homes last inspection in December 2005. The inspection took place over several weeks and included two unannounced visits to the home. Prior to those visits the organisation provided up to date information about the service at Camplehaye. The local GP surgery, district nursing service and social services were given the opportunity to comment on the home. Comment cards were made available for the use of family and visitors. Staff views were also surveyed confidentially. Two regulation inspectors visited the home unannounced. The premises were toured, service users spoken with. Staff were observed and spoken with in the course of their daily duties. Records were examined. A second visit took place a Sunday evening to observe the routine during that period of time. What the service does well: What has improved since the last inspection? What they could do better: Camplehaye Residential Home DS0000060069.V291112.R01.S.doc Version 5.2 Page 6 Contractual arrangements between the provider and resident need to be clear, and fairly balanced so as to protect the resident as well as the provider. The needs of residents must be clearly assessed, any risks identified and care planned so that all health, personal, and social care needs can be met consistently. Care plans are presently rudimentary and lacking sufficient detail. Medication management must be improved for safety. All medicines received into the home must be checked as correct on arrival. Medicines administered must be signed for at all times, and the home needs a system for removing out of date medicines promptly. A medicine prescribed for one person must not be given to another and all medicines must be labelled. Personal information about residents must not be on display where inappropriate persons might see it. The dignity of residents must be better considered. Where residents are socially isolated, either through their own preference to stay in their room or as a result of their condition, they should have the opportunity to spend time with other people, and this needs to be a part of care planning. The manager and senior staff should attend the multi agency adult protection training so that they are fully able to protect the vulnerable adults in their care. If it is considered necessary to restrict a resident’s liberty in any manner, this must be risk assessed and only undertaken in agreement with professionals involved in their care. This includes locking wardrobe doors, and bedroom door alarms. The home environment should meet the needs of residents. Adaptations would improve the lives of residents with dementia, who find orientation within the building difficult. Rooms must be fit for what they are intended; if a room is a shower room it must be possible for the resident to have a shower in it. For fire safety all rooms must have a smoke detector. Fire safety checks must be undertaken and recorded correctly, and all staff receive a minimum of six monthly fire safety training. Where fire safety risks have been identified the risk must be removed or reduced promptly, not left for months. Trip hazards, such as worn carpet and clothes left on the floor in corridors, must be removed. Furniture must be replaced if it is worn and shabby. That found in a double room where residents with dementia sleep was especially worn. Bathrooms must be clean, pleasant and hygienic. There must be good infection control measures in place, with staff able to wash their hands after providing personal care or handling soiled laundry. Protective clothing must not be worn from room to room increasing the probability of cross infection and clothes must not be left o n the floor in the laundry. Camplehaye Residential Home DS0000060069.V291112.R01.S.doc Version 5.2 Page 7 Hot water outlets must have safety control valves to remove the possibility of scalds and the programme to cover radiators and pipe work must be completed to protect residents from contact burns. Staffing numbers and skill mix must be sufficient at all times of day and night so that residents’ health, safety and welfare are fully promoted. Staff induction and training must ensure staff knowledge and competence. Staff must be regularly and sufficiently supervised in their work to ensure standards of care and service consistency. Recruitment must be robust and so ensure that only those persons suitable to work with vulnerable adults are employed by the home. The manager must ensure that all serious accidents are reported to the Commission so as to protect the residents in their care. Health and safety concerns need to be addressed to protect residents. Three concerns were made Immediate Requirements following an inspection visit. Concerns identified included: fire safety, trip hazards, the servicing of equipment, hygiene, training, risk assessment of Legionella and the use of bed sides and the testing of portable electrical equipment, such as television, used within the home. 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. Camplehaye Residential Home DS0000060069.V291112.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 Camplehaye Residential Home DS0000060069.V291112.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): 2 & 3. 6 does not apply to Camplehaye. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Contractual arrangements at the home do not fully protect residents. Lack of adequate assessment restricts good care planning, from which care is delivered. EVIDENCE: A contract is always provided prior to moving into Camplehaye and new contractual arrangements made as deemed necessary by the providers. In one case the large raise in fees could not have been expected based on the existing contract. This has caused distress to both resident and family who subsequently sought advice from the Office of Fair Trading. Assessment prior to admission, and reassessment of changing needs after admission, has been very limited in depth and breadth of information. This was despite assurances from the provider at the inspections of 18th August, 9th December and 17th January that a new system would be put in place. In Camplehaye Residential Home DS0000060069.V291112.R01.S.doc Version 5.2 Page 10 January poor assessment of risk was a contributory factor in a serious accident resulting in the death of a resident. A recently appointed manager to the home has taken steps to achieve improvement, and some was noted during this inspection. This will be more fully inspected after the full period given for compliance with the Statutory Notice. This is the 3rd. July. Camplehaye Residential Home DS0000060069.V291112.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected 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 using available evidence including a visit to this service. The health and personal care needs of residents are generally well met, but the plans setting out how care is to be delivered are not adequate to ensure consistent, safe delivery of care. The system used for the recording and storage of medicine to be administered to the residents had the potential to place the residents at risk. The dignity of residents is not always upheld. EVIDENCE: A district nurse rated the home’s management of health and personal care as good; a social worker rated the home’s management of resident’s needs as excellent and residents and family members said that health and care needs were being met. One person commented: “Our relative has always been given the best of care in all senses, especially on a personal level.” Evidence was seen of assessments sought and assistance provided from the primary care Camplehaye Residential Home DS0000060069.V291112.R01.S.doc Version 5.2 Page 12 team and community psychiatric team for service users whose needs had changed. The home’s method and procedure for care planning was under review during the inspection period. Plans examined during the inspection visit did contain important and relevant information, but also lacked important details. These included end of life wishes, religion, the rationale for locking a resident’s wardrobe door and a resident’s bedroom door being alarmed. Poor assessment of risk and care planning has led to inadequate management of risk at the home and a recent serious accident. Following an inspection visit on 16th January a Statutory Notice for improvement was issued. The planning of care will again be inspected after the full period given for compliance with the Statutory Notice. This is the 3rd. July. The home uses a monitored dosage medication scheme on the whole diligently managed by experienced carers. Medication storage was found to be safe on this occasion and the medication policy contained some very detailed and useful information, from which staff could safely administer. Staff have undertaken distance learning in the safe handling of medicines. However, full audit was not available, and therefore safety compromised because not all medicines were checked into the home. There were also gaps in signature with no explanation of whether the medicine was actually given. Where information had been hand written the accuracy of this was not checked by a second person. In the bathroom a medicated ointment was found many months out of date, with the prescription label removed, and in an unclean state. This put any resident to whom it was given at risk. Prescribed medicines should only given to whom they are prescribed. Staff were observed treating residents respectfully and residents confirmed that staff knock before entering their rooms. Visitors confirmed that they could visit in private. However, signs were displayed of a personal and private nature in residents’ rooms. A visitor would see them, and this could cause embarrassment to the resident. Camplehaye Residential Home DS0000060069.V291112.R01.S.doc Version 5.2 Page 13 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): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged and supported to lead fulfilled lives. The food at the home is of a good standard and is enjoyed. EVIDENCE: Routines within the home are flexible to enable service users to choose how they spend their time. Residents were observed chatting and enjoying social interaction with each other, staff and visitors. Organised activities also took place during the inspection and the home has recently started a ‘film’ afternoon. Residents benefit from large, enclosed gardens with good visual and physical access to outside space. Residents who prefer to spend time in their rooms felt more socially isolated. One lady commented that staff no longer have the time to stop and chat – “no companionship” - and her daughter said: “they don’t provide any mental stimulus and one-to-one is totally lacking”. (See also Standard 27). It was confirmed that a rector visits for Communion, although care plans see did not provide detail of religion (see Standard 7). A social Camplehaye Residential Home DS0000060069.V291112.R01.S.doc Version 5.2 Page 14 worker commented that staff demonstrate care and understanding of the needs of residents with dementia. Residents said that they enjoyed the food at the home and the place and time for eating is made as flexible as possible. Where lack of appetite is identified as a concern steps are taken to ensure that an adequate diet is achieved. Camplehaye Residential Home DS0000060069.V291112.R01.S.doc Version 5.2 Page 15 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 using available evidence including a visit to this service. Residents benefit from an open approach to accepting and handling complaints. Protection for residents from abuse cannot be assured through policy and procedure at the home and staff lack adequate training. EVIDENCE: Residents feel confident that staff listen and act on what they say and family confirmed that they haven’t needed to make a complaint. The home has 8 complaints recorded in the last 12 months with 7 substantiated. This demonstrates an open approach to accepting and handling complaints. The Commission received an anonymous complaint In January, which led to requirements for improvement; the Commission upheld six allegations, one allegation was not upheld and one was inconclusive. The home provided a plan for improvement. A second complaint was received by the Commission following a raise in room charge. The complainant was advised to contact the Office of Fair Trading for specialist advice. There is an adult protection policy and procedure which is accessible to staff. All staff have not yet received adequate training in adult protection although the ‘No Secrets’ (protection from abuse) training video is “watched in the lounge or taken home” by staff. This is not sufficient training to fully inform Camplehaye Residential Home DS0000060069.V291112.R01.S.doc Version 5.2 Page 16 staff of safe practice and it is therefore a continuing requirement that the manager and senior staff attend the multi agency adult protection training. It is the home’s practice to use forms of restriction and restraint, examples being: placing a resident in a wheelchair to ‘contain’ them, the use of bedrails, a locked wardrobe door and an alarmed bedroom door. There must be clear rationale for any restriction or restraint to residents’ liberty. The resident and/or their representative, plus professionals involved in the resident’s care, must be involved in the decision. There must also be assessment, and removal or reduction, of any identified risk. Camplehaye Residential Home DS0000060069.V291112.R01.S.doc Version 5.2 Page 17 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, 25 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents benefit from a homely and spacious environment, but facilities are not always adequate and safety is not fully maintained. Hygienic practice is sometimes compromised, potentially placing service users at risk. EVIDENCE: Many aspects of the home present as comfortable and pleasant. There is good internal and external space for residents’ use; this continues to be upgraded. Residents said the home was fresh and clean. Each room of the home was inspected. Some bedrooms were very pleasant and appeared comfortable. Some contained furniture in a poor condition, for example drawer handles missing, or stained and badly worn carpet. The majority of rooms were clean but two had an unpleasant odour. Some areas, especially the bathrooms, appeared grubby and needing a ‘spring clean’. Camplehaye Residential Home DS0000060069.V291112.R01.S.doc Version 5.2 Page 18 Hygienic practice was not adequate putting residents’ at risk from cross infection. The laundry room was inspected two separate days and on both there was no soap or hand towels available for staff use. Bathrooms also lacked liquid soap for staff hand washing. Staff were observed wearing protective gloves outside bedrooms and unnamed creams and soaps were left in bathrooms, not kept for individual use. Clothes were left on the floor in the laundry. Two newly built shower rooms also contained toilets. The rooms are very small, and it would not be possible to take a shower in them without removing towels, toilet paper and toiletries. This rendered the shower unusable for its purpose. There was also insufficient room for assistance to be given if the toilet or shower were used. Residents with dementia benefit from the spacious nature of the home, but there were no specific adaptations, such as pictorial signs, to aid their orientation within the building. The hot water temperature in showers was in excess of 43C therefore placing service users at risk of scalding. Pre set valves had not been fitted to provide a fail-safe device. The explanation by a heating engineer cited difficulties because of varying water pressure at the home, and he said this would be resolved in the near future. The home was unable to find an assessment of risk associated with the water borne infection Legionella and the programme for covering radiators and pipe work to protect residents’ from contact burns remains unfinished despite previous timescales of 18th December and 15th May passing. Some fire safety concerns were identified. One bedroom and the laundry had no smoke alarm. Fire safety was audited in February and some work had been undertaken toward meeting risks the home itself had identified. However, some of those risks continued unchanged with no corrective work undertaken. The fire safety log did not state which call point was being checked when routine fire alarm tests were undertaken, and not all staff have received twice yearly fire safety training in order to update their fire safety knowledge. (See Standard 30). Camplehaye Residential Home DS0000060069.V291112.R01.S.doc Version 5.2 Page 19 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 poor. This judgement has been made using available evidence including a visit to this service. Residents benefit from staff competence and experience. Staffing numbers are not sufficient to protect residents at all times of the day and night. Residents welfare is not protected through safe recruitment, or through the staff training programme. EVIDENCE: Staff confirmed that they are never asked to care for people outside their level of expertise and the providers report that almost half the care staff have now attained NVQ level 2, or equivalent, in care. Residents, health and social care professionals and visitors are happy with the level of staff competence. Only two staff have left employment at Camplehaye since December 2005, so there is improved continuity of staffing at the home. Visitor surveys indicate that there are sufficient staff on duty, but staff surveys state there are insufficient staff during the morning period when getting people up. Because of a recent serious accident during an evening period the inspector visited during an evening to observe staff/resident ratio and how staff work at that time. There were many residents in and around the hallway, Camplehaye Residential Home DS0000060069.V291112.R01.S.doc Version 5.2 Page 20 dining room, kitchenette and lounge. Some were unsupervised and all, including those with confusion, had access to kitchen/tea making equipment. One resident, who has a history of aggression to other residents, was mostly unsupervised. The two care staff on duty intermittently walked through the area during supper time but would be un able to do so when getting the three residents ready for bed who required a minimum of two staff for the task. Two staff voiced concerns about staffing numbers in the evening saying: “it is an accident waiting to happen”. A different member of staff said that three residents would: “turn on each other” and need supervision to ensure safety. The registered providers must provide sufficient staff to protect residents at all times of the day and night. Staff surveys indicate that recruitment at the home is undertaken to a satisfactory standard but a Statutory Requirement Notice was issued prior to visiting the home as part of this key inspection. This is still within the timescale for compliance. Recruitment records were not examined during this inspection but will be so when that timescale is reached. A Statutory Requirement Notice in respect of induction and training was issued prior to visiting the home as part of this key inspection and is still within the timescale for compliance. There is a comprehensive training plan in place at the home, but some important training has yet to be undertaken (see Standards 18 & 19). Camplehaye Residential Home DS0000060069.V291112.R01.S.doc Version 5.2 Page 21 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, 37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents do not benefit from consistent and reliable management at the home or a well-managed service. Systems for resident consultation are limited. Residents are supported to handle their finances safely. Residents are at risk from poor health and safety and management. EVIDENCE: Shortly before this inspection a new manager was appointed and Mrs Avens, the registered manager, handed over the role of management to him. She has chosen not to commence training to achieve NVQ 4 or the Registered Managers Camplehaye Residential Home DS0000060069.V291112.R01.S.doc Version 5.2 Page 22 Award. There continues to be a lack of clear, positive leadership at the home as its management changes hands on a frequent basis. Residents are now given more opportunity to voice their opinion about the home. There are now monthly resident and staff meetings, and from this positive changes have been implemented, one being a film afternoon. The home still lacks regular confidential survey of opinion about the service it provides, but these are planned and the provider now completes a monthly visit report and sends a copy to the Commission. Few residents are able to safely manage their own financial affairs and the home will keep a secure allowance available for their use with up to date records of transactions. The providers failed to inform the Commission, as required, of a serious accident, which resulted in the death of that resident. They did, however, correctly inform the Health and Safety Executive. Mrs. Avens stated that she was unaware she had to inform the Commission, but this had been a requirement issued at the previous inspection 17th January. Serious health and safety concerns were identified during the inspection three of which were subject to Immediate Requirements for improvement. The concerns are: the hot water temperature in showers was in excess of 43c therefore placing service users at risk of scalding. An electrical shaver was left switched on by a sink. The risk of using bedrails was not assessed for each service user where the need for them was identified. Items of clothing were left on the floor, and a badly worn carpet, was a trip hazard. Not all staff have received six monthly fire safety training. Control of infection was inadequate with staff not able to wash their hands after providing personal care or handling soiled laundry. Electrical items were not always tested for safety. There was no smoke detector in the laundry or a bedroom, the fire log lacked some information and identified fire safety work was not complete. There was no record found of service of a hoist or risk assessment for Legionella. Camplehaye Residential Home DS0000060069.V291112.R01.S.doc Version 5.2 Page 23 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 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X X X 2 1 STAFFING Standard No Score 27 1 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 1 1 Camplehaye Residential Home DS0000060069.V291112.R01.S.doc Version 5.2 Page 24 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 Timescale for action 03/07/06 2 OP3 14 You are required to produce an admissions policy and procedure, which states when and how assessment of service users and risk assessments are to be undertaken and reviewed. A copy of this procedure must be forwarded to the Commission and be available at the home for inspection. This Statutory Requirement Notice is still within timescale for compliance at the time of the inspection site visit. The policy and procedure have been received. You are required to produce a 03/07/06 policy and procedure that ensures that each service user has a comprehensive assessment of his/her needs, and a risk assessment, which are reviewed and revised according to any changes in the needs. A copy of this policy and procedure must be forwarded to the Commission. This Statutory Requirement Notice is still within DS0000060069.V291112.R01.S.doc Version 5.2 Camplehaye Residential Home Page 25 3 OP7 15 4 OP7 15 5 OP9 13 (2) 6 OP9 13(2) 7 8 OP9 OP10 13(2) 12(4) timescale for compliance at the time of the inspection site visit. The policy and procedure have been received. You are required to ensure that each service user has an up to date care plan, which is drawn up with the service user (or their representative) and provides the basis for the care to be delivered. The care plan must be reviewed a minimum of monthly, or more frequently if needed. This Statutory Requirement Notice is still within timescale for compliance at the time of the inspection site visit. Service user’s care plans must set out, in detail, the actions, which need to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the service users are met. This Statutory Requirement Notice is still within timescale for compliance at the time of the inspection site visit. A record must be made of all medicines received into the home. This must be dated and signed. Medicated must not be used and must be returned to pharmacy within a reasonable timescale when out of date. Prescribed medicines must only be used by those for whom they are prescribed. Information of a personal nature must not be displayed where visitors, and those without the need to know the information, can view it. DS0000060069.V291112.R01.S.doc 03/07/06 03/07/06 11/06/06 11/06/06 11/06/06 11/06/06 Camplehaye Residential Home Version 5.2 Page 26 9 OP18 13 10 OP18 13 11 OP18 13 12 13 OP19 OP19 23 23 14 15 OP19 OP19 23 23(4) 16 OP19 23(4) 17 18 OP19 OP25 23(4) 23 Any form of containment (for example in this case the use of a wheelchair or bedrail) must be subject to risk assessment and the agreement of the service user and/or their representative and professionals involved in their care. Carried forward from 17th April 2004. There must be a clear rational, as part of the care planning process, for any restriction imposed (in this case locking a resident’s wardrobe so they cannot access their belongings, and alarming a bedroom door) and this must be subject to risk assessment and the agreement of the service user and/or their representative and professionals involved in their care. All staff should receive multi agency adult protection training. Carried forward from 17th May 2006. Bathrooms must be kept clean. Rooms must be fit for purpose. In this case it must be possible to have a shower in a shower room. Worn and damaged furniture and carpets must be replaced. The laundry and every bedroom must have a means for detecting fire in line with Fire Authority regulations. Fire safety risks identified, according to the home’s own risk assessment, must be removed or reduced within a reasonable timescale. Fire safety checks must include call points in a sequenced order with accurate records kept. The programme to install covers to radiators and pipe work must be completed. DS0000060069.V291112.R01.S.doc 11/06/06 11/06/06 31/08/06 11/06/06 31/10/06 31/08/06 31/08/06 31/07/06 11/06/06 31/07/06 Camplehaye Residential Home Version 5.2 Page 27 19 OP25 23 20 OP26 13(3) 21 OP27 18 22 OP29 19 Carried forward from 18th December 2005. The programme to install temperature control valves to hot water outlets accessible to service users must be completed. This Requirement is still within timescale for compliance at the time of the inspection site visit. The registered provider must make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. On this occasion: -Staff must have hand-washing facilities where personal care is delivered or soiled washing handled. -Staff must not wear protective gloves from one room to another. -Laundry must not be left on the floor. You are required to review the numbers and deployment of staff to ensure that the number of staff on duty and their skill mix is sufficient to meet the needs of service users by day and by night. Particular consideration must be given to increasing the number of staff on duty during the evening. A copy of this review must be provided to the Commission. This Statutory Requirement Notice is still within timescale for compliance. You are required to develop a policy and procedure, which explains the recruitment procedure for new staff along with a checklist to ensure that the procedure is followed, for all newly recruited staff and provide DS0000060069.V291112.R01.S.doc 16/06/06 11/06/06 03/07/06 03/07/06 Camplehaye Residential Home Version 5.2 Page 28 23 OP29 19 24 OP30 18 25 OP30 18 26 OP30 18 the Commission with a copy of the policy and procedure. This Statutory Requirement Notice is still within timescale for compliance. You are required to review existing staff records to ensure all existing staff have been recruited with the prescribed documentation as described in Schedule 2 of the Care Homes Regulations 2001. Write to the Commission to confirm that the prescribed documentation has been obtained. This Statutory Requirement Notice is still within timescale for compliance. You are required to provide a staff training and development programme, which ensures that staff fulfil the aims of the home and the changing needs of service users. Provide a copy of this programme to the Commission, explaining how the programme will be monitored. This Statutory Requirement Notice is still within timescale for compliance. The training and development programme is received. You are required to ensure that all new staff receive a planned induction, which is recorded. This Statutory Requirement Notice is still within timescale for compliance. You are required to develop a policy and procedure that ensure all staff will receive regular supervision. Provide a copy of the policy and procedure to the Commission. This Statutory Requirement Notice is still within timescale for compliance. DS0000060069.V291112.R01.S.doc 03/07/06 03/07/06 03/07/06 03/07/06 Camplehaye Residential Home Version 5.2 Page 29 27 OP36 18 28 OP37 37 29 OP38 13 30 OP38 13 31 32 OP38 OP38 13 13 33 34 OP38 OP38 13 13 Staff must receive supervision 6 times a year, which is recorded. Carried forward from 17th April 2006. CSCI must be notified of any serious incident. Carried forward from 18th December 2005. The risk of using bedrails must be assessed for each service user where the need for them is identified. Immediate Requirement Items of clothing should not be left on the floor, as they are a trip hazard. Immediate Requirement All portable electrical appliances must be tested to ensure safety. The risk from Legionella must be assessed and any necessary actions taken to reduce identified risk. All staff must receive fire safety training at least twice a year. Equipment must be regularly serviced with records available for inspection. 31/07/06 11/06/06 08/06/06 06/06/06 31/10/06 31/08/06 31/08/06 31/08/06 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 OP2 Good Practice Recommendations The clarity of the contract should be increased so as to protect both the resident as well as the proprietor of the home and be based on the guidelines of the Office of Fair Trading. Handwritten entries on the medication sheet should be checked and signed by two staff so as to confirm accuracy. Socially isolated residents should have the opportunity to spend quality time with other people should they wish. DS0000060069.V291112.R01.S.doc Version 5.2 Page 30 2 3 OP9 OP12 Camplehaye Residential Home 4 5 6 OP19 OP31 OP33 The home should be adapted, as part of the continuing upgrading, to more effectively meet the needs of its service users with dementia. There should be a consistent management at the home. Quality assurance systems should be expanded so that all who have contact with the home are given the opportunity to comment on the service provided. Camplehaye Residential Home DS0000060069.V291112.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. 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