Inspection on 19/10/07 for Cams Ridge Nursing & Residential Care Home

This inspection was carried out on 19th October 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cams Ridge Nursing & Residential... 15/10/09

Cams Ridge Nursing & Residential... 05/06/06

Cams Ridge Nursing & Residential... 28/10/05

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Winton House

Newbeech House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Cams Ridge Nursing & Residential Care Home 7 Charlemont Drive Cams Hill Fareham Hants PO16 8RT Lead Inspector Jan Everitt Unannounced Inspection 19th October 2007 09:00 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 Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.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. Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cams Ridge Nursing & Residential Care Home Address 7 Charlemont Drive Cams Hill Fareham Hants PO16 8RT 020 7929 3444 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) www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Mr David McLaughlan Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51), Physical disability (10), Physical disability of places over 65 years of age (37), Terminally ill over 65 years of age (37) Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. All service users must be at least 50 years of age. Date of last inspection 5th June 2006 Brief Description of the Service: Cams Ridge is a care home with nursing for service users over the age of 65 years, with a condition that service users can be admitted over the age of 50 years. The Home is also registered to admit persons with physical disability. The home has been extended to provide accommodation for 51 service users. The Home is situated in a quiet residential area close to the local amenities. Potential residents are given a brochure and a Service Users Guide that provide information about the services and facilities provided by the home. The guide includes a copy of the last report of inspections of the service by the Commission for Social Care Inspection. At the time of the fieldwork visit to the home on the 19th October 2007, the home’s fees ranged from £630 to £831 per week. The fees did not include the cost of hairdressing; newspapers; chiropody and dry cleaning. Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site inspection visit to Cams Ridge Nursing and Residential Home, which was unannounced, took place over a one-day period on the 19th October 2007 and was attended by one inspector. The registered manager, Mr D McLaughlan was present in the home and assisted throughout the inspection. The visit to the home formed part of the process of the inspection of the service to measure the service against the key national minimum standards. The manager had returned the Annual Quality Assurance Assessment (AQAA) to the CSCI and the focus of this visit to the home was to support the information stated in this document and other information received by the CSCI since the last fieldwork visit, which was a key inspection, made to the home in June 2006. Documents and records were examined and staff working practices were observed where this was possible without being intrusive. The inspector toured the home and spoke to most of the residents, staff and visiting relatives in order to obtain their perceptions of the service the home provides. Those spoken to were generally complimentary about the care and services that are provided, but did voice some criticisms that have been discussed in the body of the report and with the registered manager. Surveys had been distributed to service users, relatives, care managers, GP and other visiting professionals. Twenty service user surveys, fifteen of which were returned anonymous and had been completed by the activities organiser with the assistance of the service user, eight relative/carer surveys, eight staff and one care manager surveys were returned to the CSCI. The outcome of the surveys indicated that there was a high level of satisfaction with the service and that generally residents and relatives were pleased with the care the home provides but had again highlighted some issues. At the time of the inspection the home was accommodating 48 residents. A small number of residents were unwell and unable to communicate effectively with the inspector to gain their views of the service. There were no residents from an ethnic minority group. Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? There were no issues identified at the inspection of June 06. Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.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 Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 & 3. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has systems and procedures in place to ensure that the home identifies the assistance and support that potential residents need before they move into the home. Service users have written contract with the home. EVIDENCE: We viewed a sample of contracts and these stated the room number and the costing, identifying the social and nursing cost element. The home has a number of service level agreements with the Primary Care Trust for those residents needing continuing care. The surveys returned from the service users documented that in most cases they had relied on family or close friends to organise the paperwork but were sure they did have a contract. Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 10 The manager did concede that when the company was taken over by the parent company earlier in the year, relatives were informed at very short notice about the increase in the fees and which were brought forward. This lead to some relatives feeling, as one relative comment described it as ‘left in the dark’. A sample of care plans was viewed and contained the pre-admission assessment, which is undertaken by the manager or clinical manager. These demonstrated detailed assessments and would identify the suitability of the home for that person and if the home could meet their needs. The files also evidenced that the home does receive a copy of the care needs assessment from the care manager, if one is involved. The comments from surveys returned to the CSCI by service users and relatives indicate that they considered they had sufficient information about the home to help inform the decision about moving into the home. One relative spoken with stated that she looked around many homes in the area and ‘ this was definitely the best in the area’. The surveys also indicated that many of the residents’ relatives visited the home before their admission. Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has systems in place to ensure; the personal and healthcare needs of residents are met and medication is managed safely and effectively. Staff working practice generally ensured that residents’ privacy and dignity is promoted. EVIDENCE: We viewed a sample of 4 service user’s care plans. One of the four files did not have a pre-admission assessment and the manager explained that this resident had been in the home for a considerable time and the system had changed. The care plans viewed demonstrated comprehensive admission assessments and risk assessments. Care plans had been written to manage any risks and these included tissue viability, moving and handling, mobility, nutrition. The Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 12 care plans set out clearly the action staff had to take to meet the needs of residents and where relevant, what equipment was required to promote their independence or ensure their comfort. There was also evidence in care plans that service users and/or their relatives have agreed with the care plans and participated in their evolvement. The comments back from relatives and service users indicated by tick box selection that they consider they always or usually receive the care and support they need. Conversely one resident commented ‘my care plan is not always followed’. Records indicated that care plans were reviewed at least monthly and that daily notes referred to the actions taken by staff to provide the needs set out in those plans. The care plans demonstrated that a range of healthcare professionals visited the home and that arrangements were made for treatment for service users when it was necessary. Residents said that they saw and received treatment from among others, chiropodists and opticians and when required arrangements to attend outpatient clinics were made by the home. There was evidence that specialist support was provided to the home when required e.g. dietician, occupational therapist and evidence in a care plan stated that a dentist was visiting a service user to give treatment. The service user comment surveys returned to CSCI indicate that the service users feel they always received the necessary medical attention, but one comment made on a service user survey said ‘I don’t see enough of my GP’. Other comments on relative’s survey said ‘We are always kept informed about her state of health’. ‘The medical support is very good’. Another commented: ‘My mother is not eating and has been seen by the dietician who has prescribed supplements and will review this in 3 months. The carer told me yesterday that mother is loosing more weight’. The home has written policies and procedures concerned with the management and administration of medication. Medication is kept in locked and secured medicine trolleys and cupboards on each floor, which were observed to be clean and well organised, and when required, in a medical refrigerator, for which temperatures are recorded daily. Controlled drugs were stored securely and in appropriate metal locked cabinets. Medicines were dispensed from a monitored dosage system (MDS) and the only staff responsible for the management and administration of medication are all registered nurses. Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 13 Records are kept of the ordering, receipt, administration and the disposal of medicines and these were accurate and up to date. We looked at the MAR sheets and these were recorded appropriately and are audited monthly by the manager or senior clinician. There was one service user choosing to self-medicate her own inhalers. Should service user’s wish to manage their own medication, locked storage is provided in every room. The home has a self-medication policy that includes undertaking a risk assessment of those service users wishing to self-medicate. Good practice noted during the fieldwork concerned with the management of medication included: • Recording the temperature of the refrigerator used for storing some medication • Dating of containers of certain medications when they were opened because of limited shelf lives i.e. eye-drops and magnesium hydroxide. • Permission obtained from residents’ doctors’ for the use when required of homely remedies • Sample copies of the signatures of the Registered General Nurses that dispensed medication. • Copy of a British National Formulary (BNF). The home’s Service Users Guide included information about its philosophy of care including among other things the promotion of service privacy and dignity. The service users spoken to said staff usually knocked before entering their rooms and this practice was observed during the inspection visit. Residents described the staff as generally respectful and polite. • I think that there are enough staff. They are polite and friendly” • “ They are very polite, they always knock on my door”. We observed that there appeared to be good relationships between service users and staff and there was a friendly familiarity with each other. A service users spoken to said that the staff were ‘wonderful and respected her room as being her own private space, which she enjoyed’. She described the housekeeper knocking on her door asking permission if she might vacuum her room, and she said that she felt ‘very respected’. Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 14 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. 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. The activities organiser plans a range of social activities within the home but outside and community activities are limited and do not wholly meet the service users preferences and needs. Service users are able to exercise choice about all aspects of their daily life. Service users are able to maintain links with relatives and representatives. The dietary needs of service users are catered for with a balanced and varied selection of food EVIDENCE: The home employs an activities organiser who solely undertakes this role. The care plans demonstrated that detailed social histories are recorded with details of the service users hobbies and interests in the past and of their family and working lives. The AQAA states that the activities programme is compiled after taking into account social histories but also the resident’s ability to participate in groups or individual activities. Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 15 The activities organiser was unavailable at the time of this visit and therefore no group activities were taking place on that day. An activities programme was displayed on the wall of the reception area. The manager said that the home has outside entertainers once a month some service users can attend the church tea and are transported there by taxi or relatives. The AQAA recorded that a church service is held once a month for residents to attend if they wish. We spoke to a number of service users at the time of this visit. Most of them said they had choices about joining in the activities, some saying there was plenty going on and others saying they choose not to join in. One service user said she was bed bound and chose to only get up every other day and that she wished she had someone to talk to more. The nurse accompanying the inspector said that the activities co-ordinator does visit her room for chats but it does not appear enough for her. A comment on a service user’s surveys was: ‘I stay in my room through ill health but would like some in put from the activities organiser. I have had my nails done twice in the past and would like more of the same’. The indication from the surveys returned from service users was generally that activities are arranged by the home and that they have the choice of whether to participate. Other comments about the activities from the surveys returned by staff, relatives and other service users were: ‘All staff show a professional attitude and the right degree of social inter action to make mother feel at ease’. ‘When the cook was off sick the activities lady did the meals and the service users missed out badly on activities’ ‘I think certain service users need more one to one care and attention that the staff cannot always do’. ‘Mother has no opportunity of leaving her room to go to the garden other than when I take her it would be nice for her to get some fresh air in the nicer weather’. ‘limited to bingo occasionally and a singer’. ‘I feel a lot more attention should be given to involving more residents in activities such as musical movements and gentle exercise. There is no transport to taken them out on excursions’. ‘The activities person in charge is excellent but at times there seems to be little assistance or enthusiasm from other staff and relatives who all have a part to play to enhance the quality and life of the residents’. ‘More staff is needed to spend more time with bed ridden clients’. ‘My mother is too unwell to participate in activities’. A group of four relatives spoke with the inspector during the visit. They all identified the issues of activities and the lack of availability of transport to take Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 16 the residents out. They also highlighted the issue of the garden not being maintained to its best and not being wheelchair friendly owing to the narrow paths that were not wide enough to take a wheelchair, thus prohibiting relatives from taking the residents for walks in the surrounding grounds. The manager told the inspector that the issue of the mini bus has been highlighted in relatives meetings and the mini bus the home shares with a sister home, has now been made available to the home with a driver, to enable outside outings to take place. He also said that the garden upgrade with appropriate paths being built had also be put into the annual improvement plan and costed for this work to be undertaken in the next twelve months. The manager said this information would be shared with relatives and service users as soon as possible. The AQAA identified that plan for the coming year is to increase the range of activities to encompass more outings and to make contact with more community based voluntary organisations. The home has an open visiting policy. The visitor’s book records all visitors and demonstrated that many visitors come to the home daily. It was observed that indeed many visitors did come to the home during the afternoon, many of which come daily. Relative’s comments said: ‘We are always made welcome in the home’. ‘We are made welcome when visiting and can visit at any time’. A care manager comment said: ‘The home has been very welcoming and helpful to relatives’. Some service users are able to go out independently. One service user was waiting for his brother to pick him up to go out to lunch, another had gone to a day centre and another resident was waiting for a taxi to go to town. The service users and relatives relayed to the inspector that they take their relatives out when they are able to. The home’s registered manager said that residents were encouraged to personalise their bedroom accommodation and could bring items of furniture into the home with them. Several residents spoken indicated that some furniture in their rooms belonged to them. One resident said that having her own “bits and pieces made it feel like home”. We visited a number of rooms throughout the home and service user’s rooms had been personalised with their personal belonging and some furniture if appropriate. Service users spoken to at the time of the visit said they were very happy with their rooms. Service users told the inspector they have choices of how they spend their days and where they wish to take their meals. A service user told the Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 17 inspector that she chooses to stay in her room, as she is comfortable and will occasionally go to the lounge to ‘join in the activities’. Observations throughout the day identified that service users were generally being given choices. One service user requested that she change her dress frequently, and although this particular service user is not appropriate for the home and is awaiting a more appropriate placement, the staff were observed to be communicating and managing her behaviour well, respecting her choices. The home has a planned menu. The cook told the inspector that the home has adopted a new strategy for menu planning and is it based on measuring the nutritional value of the choices service users make. This menu was displayed on the notice board in the dining room in very small print and service users would have been unable to access this easily. Another daily menu was displayed in the reception area. The cook informed the inspector that she is very familiar with the likes and dislikes of the service users and maintains records of all food eaten by the service users. The lunchtime meal was observed. Fish and chips were on the menu and the service users reported that they had enjoyed this very much. The cook also came into the dining room to ask the residents if they were enjoying their meals. From the comments received from service users and relatives and speaking to the service users and relatives at the time of this visit there are mixed opinions about the food served in the home. The comments were: Not always given morning and afternoon tea and is bed ridden and unable to cater for hew own needs’. ‘When regular cook on duty the food is good, although portions are too small’. ‘Food needs improving’. ‘Residents should be informed of choices but mother received no choices although they are available’. ‘Fresh fruit should be available’ The inspector observed a bowl of fresh fruit in the dining room. ‘Existing cook is good but menus should be worked out locally with agreement with residents not dictated from the top’. ‘Bread should be thick for toast and thin for sandwiches’. ’80 and 90 year olds do not want Indian dishes or Pasta etc’. ‘The teatime routine is poor with lots of spaghetti hoops, tinned ravioli and chicken nuggets served without bread and butter’. ‘Food lacks variety’. ‘Menu choices not given to me food is delivered to room and I have no idea what is coming!’ Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 18 A relative spoken to at the time of the visit supported some of these comments by telling us that some of the teatime menus are not appropriate for the older person, who usually enjoys the ‘old fashion foods’. We observed that packets of biscuits were being given to residents with afternoon tea and some were unable to open the seals on the packets and others were being wasted. We also observed that cake was available with the supper menu that was being served at 17:00. The remaining thirteen service user surveys returned to CSCI with boxes ticked, indicated that some service users are always satisfied with the food, some ticked usually and other sometimes. Nutritional risk assessments are undertaken on all service users and care plans written if a risk is identified and includes regular recording of weights. Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a clear and satisfactory complaints procedure and residents’ are confident about raising concerns with the home’s management. Robust procedures were in place to protect service users from the risk of abuse. EVIDENCE: The home’s complaints procedure was prominently displayed in the entrance to the building. All residents have a copy of the home’s Service Users Guide, which includes details of the procedure that states that all complaints would be acknowledged and responded to within 28 days. The manager maintains a log of all complaints, which is audited, monthly by the manager; this together with service user feedback gives an indication of where the home needs to improve. The AQAA records that ten complaints have been received and resolved within the timescale in the past twelve months. The manager told us that most of the complaints have not been major complaints and have been resolved very quickly. The CSCI have not received any complaints in that time. Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 20 The surveys returned by service users, relatives and staff indicate that people are aware of the complaints procedure and know how and to whom to complain or raise any concerns. Many of the concerns are raised at the residents/relatives meetings and discussed at that time. Comments from service users and relative say: ‘I make my complaint direct to the care home manager and receive immediate response’. ‘No major concerns’. ‘I do not think that some of my concerns have been dealt with properly’. ‘I make my complaints orally’. Relatives spoken to said that if they have an issue and raise a concern that the management are very responsive and respond to their issues. The home has written procedures concerned with adult protection and ensuring that the risk of service users suffering harm was as far as reasonably possible identified and prevented. Staff said that training in the subject of adult protection/abuse was provided and the training matrix supported this and recorded that all staff have attended this training. Staff spoken to were able to demonstrate an awareness of the different types of abuse and the action they would take if they suspected or knew that it had occurred. The AQAA records that the home is planning to continue to increase staff awareness of abuse and ensure that staff attend updated training sessions supplied by the parent company. All new staff are issued with the whistle blowing policy. Where subsequent to an assessment it was considered necessary for a resident’s safety to use bed rails written permission/consent is obtained, this was evidenced in care plans. Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s environment is clean, safe and well maintained. There are areas of the garden that do not meet the service users needs. There is an infection control policy and procedures in place and staff practices ensure that as far is reasonably possible residents are protected from the risk of infection. EVIDENCE: The general appearance of the interior and exterior of the home is pleasant. There is a programme of redecoration and refurbishment for the year which is ongoing with plans to continue to refurbish identified bedrooms. The dining room has recently been divided up into smaller areas and redecorated with plans to purchase new dining room furniture. Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 22 The bedrooms are generally well decorated and personalised and some residents have chosen to bring with them a great deal of their belongings, which has filled the rooms, and therefore made it difficult for the housekeepers to deep clean. Some areas of the home were cluttered with equipment through lack of storage areas. There were also two bathrooms not in use cluttered with equipment. This was acknowledged in the AQAA as one of the barriers to improvement that storage space was at a premium with so much equipment to accommodate. The manager discussed change of use of the two bathrooms as the home has at present got 6 assisted bathrooms and 23 bedrooms with showers or bath en-suits. He was advised to discuss this with his manager as a possibility. Residents spoken to expressed contentment with both their accommodation and the communal rooms that they could use and surveys returned by them also indicated that they were satisfied with their environment. The outdoor area and gardens are in need of upgrading. The AQAA acknowledges that the garden needs to improve and there was consultation with residents and families as to their suggestions at the residents/relatives meetings. The manager said that he now has some capital expenditure in his budget and was purchasing nursing profile bed and other equipment and hoped to include the garden upgrade within this year’s budget. Four relatives spoken with at the time of the visit were quite vocal about how the garden is not made the most of and that they are unable to push their relatives around the garden in wheelchairs because there are either no paths or the paths are too narrow, resulting in service users not having access to all parts of the home. A service user who has an electric wheelchair and is independent, commented that he is unable to go out on his own as the drive to too unsafe for him to negotiate and that the garden paths will not take the width of his chair. The home has a large conservatory that was being used by a number of service users and relatives. The inspector spoke to them and they commented that it was a pleasant area but could not be used at certain times of the year, as it was too hot in the summer and too cold in the winter. There were heaters installed and a ceiling fan, which was observed to be in need of cleaning. This issue was discussed with the manager and he said that he was considering how the temperature issue could be resolved. Relative’s comments on surveys also stated: ‘I feel the residents and the visitors would gain from seeing more shrubs and plans in the rear garden and adequate paving to wheel the residents around’. ‘It would be nice for mother to use the garden in the decent weather’. Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 23 ‘Improve ventilation when hot by opening all conservatory windows’. The home employs a separate staff group for the house keeping of the home. The home was odour free and adequately clean, although there were areas, such as the laundry room, that was in need of thorough cleaning. The manager reported in the AQAA that since the extension to the home, which now accommodates an extra 17 en-suite rooms, the laundry has been under pressure to cope with the increase in the washing demands. At the time of this visit one of the machines was under repair and it was reported that the home would need to replace the machines eventually. The home has attempted to make the laundry more efficient and there were no complaints from service users or relatives about the standard of the laundry. Residents and some of the visitors to the home said that the building was generally clean and odour free other comments on surveys said: ‘Improve general cleaning e.g. floors, chairs etc. ‘Not enough cleaning staff rooms only get a thorough clean every three months’. The home has an infection control policy and follows the DOH ‘Essential Steps’ on assessment of infection control awareness. The home has hand-washing facilities in bathrooms and toilets and the AQAA states that there are plans to increase this throughout the home together with aseptic/alcohol hand gels for staff. Staff are supplied with protective clothing and gloves. A number of staff have received training on infection control and this was evidenced on the training matrix. The AQAA states that all staff must attend this training as mandatory. Staff surveys returned to the CSCI indicated that staff have received all mandatory health and safety training, which included infection control. There were sluice disinfectors available on both floors of the home. The kitchen was inspected by the EHO and a recommendation for a deep clean and redecoration was carried out and there are no further outstanding requirements. Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.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. 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 using available evidence including a visit to this service. There is an appropriate and satisfactory level and mix of staff that ensures the needs of the residents are met. The home did not demonstrate robust staff recruitment procedures. The home has training and development programmes in place that ensure the service users are protected and supported appropriately EVIDENCE: The total number of staff employed to work in the home at the time of the visit was 60, this included 12 registered nurses and 29 health care assistants of which 17 had obtained a qualification equivalent to a National Vocational Qualification level 2 or above in care (i.e. 63 ). The manager reported that the staffing levels each day are: AM PM Night Registered nurses 2 2 1 Health care assistants 7/8 5 4 The manager is in the home five days a week. The home employs 19 ancillary staff that include: Administrator, Activities organiser, Kitchen assistant, Cook, Cleaners, Laundry assistants, Housekeeper, Maintenance person and Gardener. Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 25 At the time of this visit there were 48 service users in residence. Staff and residents said that the staffing levels in the home were sufficient and service users also expressed confidence in the abilities and competence of the staff to meet their needs. Comments from residents and relatives about the sufficiency and competence of staff included the following: ‘The standard of nursing and social care makes the service users and relatives confident that their needs are in professional and competent hands’ ‘I feel we give good care to residents and families’. ‘On the brief knowledge I have the home is excellent’. ‘Provides a good standard of care in a moderately clean environment, mainly due to insufficient staff. Most of the carers are conscientious and hard working with good relationships with residents’. ‘More staff is needed at all times to ensure appropriate supervision of less able clients and more time spent with bed ridden clients socialising’. ‘The nursing staff are good’. ‘Some of the carers are excellent’. ‘The regular staff are generally very good. Problem of communication occur with agency staff at weekends’. ‘The home should have more staff available when short’. ‘Very often not enough time is taken with the elderly person’. ‘The staff at the home provide a warm atmosphere where I am happy for my mum to be and fell confident and secure’. ‘Week-end staff can cause a problem of continuity and they are not familiar with resident’s needs’. ‘More permanent staff needed and less agency’. Comments from staff about the level and numbers of staff on duty at any time included the following: ’staffing levels depend on whether junior staff give enough notice if they are unable to cover their shift and leaves management insufficient time to get a replacement’. ‘Usually when someone is on leave or off sick we try to get week-end staff to cover but if not we all muck in’. ‘Short staff is usually due to sickness. But most of the time there is always enough staff on duty’. We observed that there appeared to be sufficient staff on duty at the time of this visit although it was noted that call bells were taking a considerable time to be answered. The home employs a multi-cultural work force and those spoken to at the time of this visit were pleasant with a good command of the English language. Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 26 The AQAA records that the home has 65 of staff training to NVQ level 2 or above. The manager reported that the home is employing staff that have already achieved this qualification but support those, who do not, to undertake their NVQ level 2 after following the Skills for Care Foundation induction programme. Records were examined of 4 staff and of those 3 had been employed since the last inspection. Of the four viewed, two references had not been received for two of these staff. The one reference received for the trained nurse was a character reference and a professional reference had not been sought. This was discussed with the manager who reported that he had taken the second reference up and had had verbal communication with the second referee, there were no records to evidence this. All other checks CRB and POVA had been obtained before employment commenced. A requirement will be made around these findings. Induction training, for the two most recently employed staff, was evidenced in the personnel files. One of these was still in the process of working through the programme. The training files evidenced that the staff have undertaken mandatory training and other training appertaining to their jobs i.e. pressure care, dementia awareness, nutrition and bed rail safety. The staff training matrix has been introduced in the previous twelve months and this enables the manager to monitor staff development and ensure that all mandatory training has been undertaken and identify where more input is required. The manager also identifies training needs from appraisal and supervision. Supervision records were evidenced and it was identified that supervision is taking place for staff and those spoken to confirm that they are supervised by a senior person on a one to one basis. Staff surveys returned and staff spoken with report that they consider they receive appropriate training and that the home should ‘continue to ensure staff are trained to a high standard’ The home had a training room equipped with TV and video player, magazines, training videos and there were charts on the wall about practice issues e.g. wound care. The AQAA records that the organisation will continue to update staff and ensure that they attend all training sessions supplied by the parent company. That all new staff receive adequate support to complete their induction programme based on the Skills for Care Induction standard. Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 27 Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s manager provided effective leadership There were systems and procedures in place for; monitoring and maintaining the quality of the service provided; safeguarding residents financial interests and promoting the safety and welfare of everyone living and working in the home. EVIDENCE: The registered manager confirmed that he had been in post for two years and has a long experience in working in health and with the elderly. He has Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 29 recently completed his Registered Managers Award (RMA). He reported that he continues to attend training courses and has attend sessions such as supervision and performance management and the new fire evacuation training in accordance with the recent changes in the fire legislation. In the last 12 months he said that he had attended training and updates in infection control practice and had also completed a diploma in neuro-linguistic programming. As a result of discussion with the manager and also from observing him in conversation with staff, relatives and residents, he appears to be motivated and considers the focus of the home must be the care of the residents. The home has a senior clinical manager who is deputy to the manager and she has worked at the home for many years and on speaking to staff and residents she is highly respected for her work. Comments from staff about the support they receive were: ‘The manager has limited time with all the paperwork but he does sometimes give me support’. ‘We have meetings to discuss anything and everything’. ‘Staff meetings take place’. Comments on the surveys from staff indicate that the manager does give them support but is very busy with paperwork. The AQAA stated that the home has a quality assurance system in place for monitoring the quality of the service that it provided, which includes monthly audits of various aspects such as, accident reports, the system for managing medication, care plans, environment etc. The registered manager also has to complete a detailed report each month that is validated by his line manager when she visits the home. The inspector viewed the records of these audits. The home undertakes a service user/stakeholder satisfaction survey every six months and the results of these are published in the Service User Guide on display in the reception area. The manager also holds six to eight weekly resident/relatives meetings and as a result some aspects of the service has been changed. The AQAA records that all policies and procedures have been reviewed in the last twelve months and copies of these are available to staff from commencement of their employment. The home looked after small sums of money for some residents that was left with or handed over by relatives or representatives. These and any valuables are kept in a locked environment. A sample of records of monies held on behalf of residents was checked and they were accurate and up to date. These records are audited monthly and validated on the Regulation 26 report. Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 30 Records examined indicated that the home’s equipment, plant and systems are checked and serviced at appropriate intervals i.e. passenger lift and hoists; boilers; fire safety equipment alarms, emergency lighting; portable electrical equipment; temperatures of fridges, freezers and cooked food etc. There were contracts in place for the disposal of clinical and household waste. Staff spoken to and surveys returned from staff say they attended regular and compulsory fire and other health and safety training. This was evidenced on the training matrix viewed by the inspector, which allows the manager to identify areas of mandatory training that need attention. There was a fire risk assessment for the premises and a risk assessment of the premises have been undertaken and copies of these are in the main office and relevant departments. The home had 2 staff trained as accredited manual handling trainers and there were hoists, and other equipment in the home to promote safe working practices. The manager was awaiting the delivery of a new hoist. The accident recording information was viewed and had been recorded well. These records form part of the monthly audit system reported by the visiting representative of the organisation. Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 32 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 OP29 Regulation Reg 19 Sch 2. Requirement The registered person must ensure that all appropriate checks and information about the staff member is received before commencement of employment. The registered person must ensure that external grounds are safe and appropriately maintained and that suitable adaptations are made to support service users who are physically disabled to enable them to enjoy the outside area of the home. Timescale for action 30/11/07 2. OP19 Reg 23 2(O)(n) 31/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Cams Ridge Nursing & Residential Care Home DS0000065930.V347191.R01.S.doc Version 5.2 Page 34 - 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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