Inspection on 18/10/05 for Royal Cambridge Home

This inspection was carried out on 18th October 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Royal Cambridge Home 18/10/07

Royal Cambridge Home 18/04/06

Royal Cambridge Home 04/05/05

Royal Cambridge Home 14/09/04

Royal Cambridge Home 07/04/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Royal Cambridge Home 82-84 Hurst Road East Molesey Surrey KT8 9AH Lead Inspector Denise Debieux Unannounced 18 October 2005 : 10.00am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Royal Cambridge Home H58 H09 S13775 Royal Cambridge V244170 181005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Royal Cambridge Home Address 82-84 Hurst Road East Molesey Surrey KT8 9AH 020 8979 3788 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Royal Cambridge Home for Soldiers Widows Mrs Irma Odette Yarnell CRH - Care Home 30 Category(ies) of DE(E) - Dementia - over 65 (5) registration, with number OP - Old Age (30) of places PD(E) - Physical Disability - over 65 (2) SI(E) - Sensory Impairment - over 65 (1) Royal Cambridge Home H58 H09 S13775 Royal Cambridge V244170 181005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 - Of 30 service users accommodated, up to 5 may fall within the category DE(E) - Dementia over 65. 2 - The age/age range of persons to be accommodated will be 65 years and over. 3 - The gender of those accommodated will be female. 4 - Of the 30 service users accommodated, up to 2 may fall within the category PD(E) - Physical Disability over 65. 5 - Of the 30 service users accommodated, up to 1 may fall within the category SI(E) - Sensory Impairment over 65. Date of last inspection 4 May 2005 Brief Description of the Service: The Royal Cambridge Home was founded in 1851, originally to provide a home for the widows of NCOs and private soldiers in the British Army. The home is now a registered charity and accepts applications from any widow whose husband has served in the ranks and also from women who have themselves served in the regular, territorial or reserve army. Care and accommodation is provided in single bed-sitting rooms in the two Victorian houses that are interconnected by a corridor link of more modern rooms. The property is situated in large attractive gardens near to Hampton Court. There is ample car parking space available on the site. Service users are encouraged to maintain their independence in a comfortable environment. Personal care is given when service users are no longer able to care for themselves, without restriction to the rights of the individual and with respect to the service user’s own chosen lifestyle. Royal Cambridge Home H58 H09 S13775 Royal Cambridge V244170 181005 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6.75 hours and was the second inspection to be undertaken in the Commission for Social Care Inspection year April 2005 to March 2006. This inspection was carried out by Denise Débieux, Lead Inspector for the service. Mrs I. Yarnell (Registered Manager) and Ms Sylvia Smithies (Care Manager) were present as the representatives for the establishment. A tour of the premises took place. Six of the nineteen service users were spoken to at length, with a further six service users and seven on-duty staff being spoken with during the tour. Some of the comments made to the inspector during the inspection are quoted in this report. The terms and conditions document, policies and procedures, staff training log, activity records and staff recruitment records were all sampled. The inspector would like to thank the staff and service users for their time, assistance and hospitality during this inspection. What the service does well: What has improved since the last inspection? Work continues on increasing the activity provision at the home with all service users spoken with commenting on the improvement with one service user stating that the new activity co-ordinator is ‘very good-she tries to get you going’. Other improvements include obtaining required CRB certificates for all staff and the introduction of formal supervision. Royal Cambridge Home H58 H09 S13775 Royal Cambridge V244170 181005 Stage 4.doc Version 1.40 Page 6 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. Royal Cambridge Home H58 H09 S13775 Royal Cambridge V244170 181005 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Royal Cambridge Home H58 H09 S13775 Royal Cambridge V244170 181005 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 The home’s written terms and conditions document has been revised and now contains all required information except for the room number. EVIDENCE: The new terms and conditions document for the home was seen at this inspection. Once the home have included the allocated room number in the document and issued all service users with their own copy, this standard will be met. Royal Cambridge Home H58 H09 S13775 Royal Cambridge V244170 181005 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none EVIDENCE: These standards were all assessed and met at the last inspection and were not inspected on this occasion. Royal Cambridge Home H58 H09 S13775 Royal Cambridge V244170 181005 Stage 4.doc Version 1.40 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 The ongoing development of the home’s activity provision is leading to a more varied and individualised activity programme and includes contact with the local community both within and outside the home. Contacts with family and friends are encouraged. Meals are well-balanced and varied with individual choices and preferences catered for. EVIDENCE: The new activity coordinator works two to three days per week and has now finished meeting with each service user to gather information regarding their previous hobbies and interests. New and more varied activities are being introduced within the home and positive comments were received from all service users spoken with. One service user commented that ‘The new activity’s lady is good, she does all interesting things.’ Another service user, whilst agreeing that the new activities were good, did comment that it was difficult to join in some activities due to failing eyesight. A recommendation has been made and is detailed at the end of this report. Local community involvement is varied and includes local clergy, boat club, nursery, schools and brownie pack. Royal Cambridge Home H58 H09 S13775 Royal Cambridge V244170 181005 Stage 4.doc Version 1.40 Page 11 The lunchtime meal was taking place during this inspection. The food was well presented with service users commenting that the meals were nice and varied. The meal was liver and bacon that day, most service users stated that it was lovely and tender, although a couple of services users did comment that their liver was tough and difficult to chew. This comment was passed to the chef by the staff. All service users said that the chef will always prepare an alternative to the main course, if requested. During the meal the atmosphere in the dining room was pleasant and relaxed, with ample staff available to offer help and assistance as needed. Royal Cambridge Home H58 H09 S13775 Royal Cambridge V244170 181005 Stage 4.doc Version 1.40 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Policies and procedures are in place to ensure that service users are safeguarded from harm or abuse but the policy on the protection of vulnerable adults needs some revision. EVIDENCE: The manager and two care managers have all attended the Surrey course on the protection of vulnerable adults and the latest version of the Surrey Multiagency Procedure for the Protection of Vulnerable Adults is now available to all staff in the staff room. All staff have been asked to read the procedure. Staff who are currently participating in National Vocational Qualification (NVQ) training will have covered basic prevention of abuse but provision needs to be made to ensure the remaining staff members receive training and that all staff are aware of local Surrey procedures. The home has their own policy on the protection of vulnerable adults. However, this needs to be revised to reflect the Surrey local procedure. Requirements and a recommendation have been made regarding these issues. All service users spoken with stated that they felt safe at the home and that the staff were very kind. Royal Cambridge Home H58 H09 S13775 Royal Cambridge V244170 181005 Stage 4.doc Version 1.40 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none EVIDENCE: Standards 19 and 26 were fully assessed and met at the last inspection and were not inspected on this occasion. Royal Cambridge Home H58 H09 S13775 Royal Cambridge V244170 181005 Stage 4.doc Version 1.40 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 The numbers and skill mix of the staff meets service users needs. The home has a comprehensive staff recruitment programme which incorporates all areas needed to ensure, as far as reasonably possible, that service users are in safe hands at all times. The home needs to take steps to ensure that service users’ well-being is protected by the staff training programme. EVIDENCE: The staffing at the home comprises one care manager and three care assistants from 7.30am until 8.30pm, the night shift is covered by two care assistants with one care manager on call on the premises. One service user commented ‘The staff couldn’t do more, they always have a smile.’ Eight of the sixteen care assistants are currently undertaking their National Vocational Qualification (NVQ) level 2 or above in care. The inspector was advised that it is hoped that these care assistants will have completed their training by the end of the year. The home have revised their recruitment procedure and now have enhanced criminal record bureau (CRB) certificates for all staff. Royal Cambridge Home H58 H09 S13775 Royal Cambridge V244170 181005 Stage 4.doc Version 1.40 Page 15 The staff training log was sampled. Not all staff have been provided with the mandatory safe working practise training or updates and a formal training plan needs to be developed and implemented as a matter of priority. The need for protection of vulnerable adults training has been addressed in a previous section. All staff must have a training needs assessment carried out and an individual training plan developed, mandatory safe working practise training and required updates must be planned and provided in a timely manner and all staff must be provided with additional training appropriate to the work they are expected to perform which is based on the needs of the individual service users accommodated at the home. Requirements regarding staff training have been made at previous inspections and not yet fully met. These requirements have been carried forward to this report with a limited extended timescale but must now be actioned within this extended timescale and in full. All interactions observed between the staff and service users evidenced that the home has a close and caring staff team. Royal Cambridge Home H58 H09 S13775 Royal Cambridge V244170 181005 Stage 4.doc Version 1.40 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 36 and 38 The home has a quality assurance and monitoring system in place that is based on seeking the views of the service users. Service users’ financial interests are safeguarded by the policies and practices of the home. Formal staff supervision needs to be fully implemented to ensure that service users benefit from well supervised and supported staff. Most, but not all, policies, procedures and practices are in place to ensure, so far as is reasonably practicable, the health safety and welfare of service users and staff. EVIDENCE: The home carried out a survey of service users last autumn and a copy of the resulting report was available at this inspection. The inspector was advised that the home plan to carry out the next survey before the end of this year. Royal Cambridge Home H58 H09 S13775 Royal Cambridge V244170 181005 Stage 4.doc Version 1.40 Page 17 During this inspection seven of the nineteen service users were spoken with at length. During these conversations four of the seven service users raised the subject of possible plans for the future of the home and expressed some concerns. However, the inspector has not been informed by the organisation of any future plans for the future of the home and is therefore unable to comment. From other comments made to the inspector it was apparent that the service users are very happy living at the home and will be more settled when future plans are finalised. At the last inspection it was noted that the home had purchased a new and comprehensive administration package to cover all areas of the administration and management of the home and which included new policies and procedures. This package has not yet been fully implemented and some policies are still not in place, specifically: • Management of service user’s money • Recruitment and employment • Referral and admission • Working with volunteers The requirement made at the previous inspection has been carried forward to this report with an extended timescale and must now be actioned. The home do not handle financial affairs for service users. However, on occasions when service users want valuables stored securely for a short period of time, the home lock them in a safe in the main office and full details are recorded in a receipt book. The manager and the two care managers have now completed supervision training. Formal supervision has already been introduced with two care assistants, with plans to carry out formal supervision with all staff over the next few months and to continue on a two monthly basis thereafter. The home had inspections carried out by the local Environmental Health Officer (EHO) last September and December, with requirements and recommendations being made. Since then some of the requirements have been carried out, the catering staff have now received basic food hygiene training and the floor in the main kitchen has been totally replaced. Some of the remaining requirements have yet to be actioned. However, the inspector was advised that the home is expecting a return visit from the local Environmental Health Officer in November or December. The requirements made at the last inspection have been brought forward to this report with an extended timescale, pending the outcome of the EHO visit. Royal Cambridge Home H58 H09 S13775 Royal Cambridge V244170 181005 Stage 4.doc Version 1.40 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x 2 x 3 2 x 2 Royal Cambridge Home H58 H09 S13775 Royal Cambridge V244170 181005 Stage 4.doc Version 1.40 Page 19 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 18.1 18.2 18.1 18.2 Regulation 13(6) Requirement The registered person must ensure that all staff have received training in the protection of vulnerable adults. The registered person must ensure that all staff are aware of the Surrey Multi-agency Procedure for the Protection of Vulnerable Adults. The registered person must send, to CSCI Eashing office, a list of all staff, together with details of the dates each member of staff was provided with mandatory safe working practise training (e.g. manual handling; first aid; fire safety; infection control; basic food hygiene.) The registered person must develop individual training assessments and profiles for all staff. (Timescales of 07.07.04, 14.11.04 and 04.08.05 not met) Timescale for action 18.01.06 2. 13(6) 18.01.06 3. 30.1 38.9 18(1)(a) (c)(i) 15.11.05 4. 30.1 18(1)(a) (c)(i) 18.12.05 Royal Cambridge Home H58 H09 S13775 Royal Cambridge V244170 181005 Stage 4.doc Version 1.40 Page 20 5. 30.1 38.2 38.9 18(1)(a) (c)(i) 6. 30.1 38.9 18(1)(a) (c)(i) 7. 33.9 12(1)(a) (b) 8. 9. 36.2 38.1 38.4 18(2)(a) 12(1)(a) (b) 23(5) The registered person must ensure that staff working at the care home receive training appropriate to the work they are to perform and receive required training and updates in all safe working practices. (Timescale of 04.06.05 not met.) The registered person must develop and implement a staff training and development programme that meets current legislation and guidelines and includes the following: · Training in all safe working practices · Identified training to ensure the needs of current service users are met · Protection of vulnerable adults training · All staff to have an individual training and development assessment and profile. The registered person must ensure that all policies, procedures and practices are in place and regularly reviewed, in line with current legislation and good practice guidelines. (Timescale of 04.08.05 not met) The registered person to fully implement formal supervision with all staff. The requirements and recommendations made by the Environmental Health Officer (EHO) on 19.09.04 and 09.12.04 to be actioned as soon as possible. 18.01.06 18.01.06 18.01.06 18.01.06 18.01.06 Royal Cambridge Home H58 H09 S13775 Royal Cambridge V244170 181005 Stage 4.doc Version 1.40 Page 21 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 2.2 Good Practice Recommendations Brought forward from 14.09.04 and 04.05.05 It is recommended that the home develop and issue a contract/statement of terms and conditions with each service user that includes all details listed in National Minimum Standard 2.2. It is recommended that the activity co-ordinator draw up individual activity care plans with each service user. These care plans should take into account the identified preferences of the service user with particular consideration being paid to any individual needs. I.E. Dementia; physical disability; sensory impairments. It is recommended that the home revise their policy on the protection of vulnerable adults to reflect the Surrey local procedure. 2. 12.3 3. 18.1 18.2 Royal Cambridge Home H58 H09 S13775 Royal Cambridge V244170 181005 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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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