Care Home: Camber Lodge

What the care home does well The home provides a relaxed and comfortable environment for the people who live there, it is well maintained and clean. Staff are experienced and demonstrate a good understanding of the needs of individuals living at the home and how these are to be supported, continuity within the staff team has been beneficial to those people with more complex needs. Staff interact well with the people living in the home, demonstrating kindness and understanding in the support they provide. Camber lodge staff are supportive of people living at the home being as independent as they want to be, when they want to be, support is flexible and responsive to changes. People living in the home help out with some household tasks. Relatives speak positively of the support and care their relative receives at the home they report that: "They take into account our relatives needs and do their utmost to see they are met. We also note the good relationship they have with all their clients and allow them to be individuals" "Our relative has been very lucky to have such a lovely place to live in and all thanks to the manager and staff who care so much to make him happy" Longer serving staff express satisfaction at the change in culture in the home and find it a more enjoyable place to work, they feel well supported and find the manager approachable, they report that: "its a very caring and relaxed atmosphere for the residents" The service demonstrates a commitment to improvement and is responsive and compliant with regulation. What has improved since the last inspection? The AQAA informs us that since the last inspection the service has developed terms and conditions of residence information into a pictorial format, and electronic versions are also available. All policies and procedures have been updated by the company, and these have been amended by the manager where they need to be more specific to the service. Internal improvements to decoration have been made and have taken into consideration the preferences of the people lwho live at the home. Trial visits have been introduced for people who want to come and live at the home. The frequency of house meetings for People who live in the home has been improved and they also receive 6 monthly reviews of their support. Support plan formats have been improved, one person has been provided with a lap top to enable skills development in this area. The AQAA also informs us that the home manager and staff have worked to develop working relationships with health and social care professionals and have actively sought interventions from health professionals on behalf of individuals living at the home. The manager meets monthly with every person living at the home. Medication recording procedures have been reviewed and amended in response to previous concerns. Since the last inspection the manager has now been registered with the commission and has completed her RMA training. A range of training has been provided to staff including Adult safeguarding. Recruitment procedures have been strengthened and two new staff have been recruited, Common induction standards in keeping with skills for care have also been introduced for new staff. Our visit to the service and examination of documentation has confirmed these improvements have been implemented. What the care home could do better: Examination of staff training matrix information has highlighted some mandatory training for staff is overdue, although the manager is able to evidence some of this is already booked to take place. New staff without benefit of training in regard to Moving and handling are currently undertaking this with some people who live at the home and we are concerned that without benefit of appropriate training this could place the person they are moving and themselves at risk of injury. A requirement has been issued for all mandatory training to be brought up to date and new staff to receive moving and handling training at the time of commencing work in the home to ensure they are able to fulfill their role effectively. We have also made some recommendations for improved practice in regard to care plans, the frequency and availability of activities, implementation of routine assessments in regard to nutrition, falls, skin integrity and continence where people in the home are experiencing health care needs in these areas to ensure this is effectively monitored. We have also suggested some improvement to the way in which staff support people in the service to make complaints, and how people living in the home are consulted with and influence service development. Key inspection report Care homes for adults (18-65 years) Name: Address: Camber Lodge 93 Lydd Road Camber Rye East Sussex TN31 7RS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Michele Etherton     Date: 1 5 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Camber Lodge 93 Lydd Road Camber Rye East Sussex TN31 7RS 01797222360 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): camber.lodge@nellsar.com Nellsar Ltd Name of registered manager (if applicable) Mrs Lesley Oliver Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 8. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Camber Lodge is a large, modern two storey detached property sited on the Main road of Camber, a small holiday village 4 miles from Rye. Sand dunes are within a 100 yards of the home accessible by crossing the Main road. A small general shop is within walking distance of the home along with a bus stop, which provides public transport to historic Rye several times daily. Rye has a mainline train Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 8 Brief description of the care home station. The home has ample off road parking facilities within its own enclosed grounds. Camber lodge was originally a Motel and has been renovated, redecorated, and refurbished to a good standard in order to provide residential care for up to 8 adults. Bedrooms are of a good size with ground floor bedrooms sufficient in size for wheelchair users. All rooms have en-suite facilities. Communal areas such as the lounge, reception, dining, and kitchen areas are spacious. The home has its own minibus type vehicle. Camber Lodge first opened in 2005, it has been under the new ownership of Nellsar ltd since August 2006. Current fees charged ranges from #860 to #1187 per week. Inspection reports are routinely sent out to families and advocates who express an interest in the home or who specifically request a report. A copy is contained with the home?s guide [Service User Guide] kept on display in the reception area of the home. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The reader should note that the Care standards Act 2000 and Care Homes regulations 2001, uses the term Service user to describe those living in care home settings. For the purpose of this report, we will use the term people to refer to those currently residing at Camber Lodge. A key inspection of this service has been undertaken that has taken account of information received about the service and from the service since the last inspection. This includes an Annual Quality Assurance Assessment (AQAA) form submitted by the Registered Manager. The AQAA has been completed to a reasonable standard, informing us of only some of what we need to know, it would benefit from improved detail and content to illustrate how the service operates on a day to day basis; and should include current and future plans for service development. The AQAA information omitted to inform us what Care Homes for Adults (18-65 years) Page 6 of 31 progress the service had made in addressing previously identified shortfalls in the service. We have discussed the need for improvement of AQAA information with the manager at our site visit, who now has an improved understanding of the level of detail future AQAAs should contain. Our inspection of the service has included a site visit to Camber Lodge conducted on 15Th June 2009 between 9:50 am and 16:00 pm. During our visit all key standards were assessed in addition to progress made by the service in addressing previous requirements in regard to medication, staff training, induction and recruitment issued at the previous inspection on 18Th June 2008. Surveys have been distributed to people living at the home, staff, and health and social care professionals. Relatives have also been asked to comment on service quality, only limited responses have been received to date to inform the inspection, responses received subsequent to the draft report will be taken into consideration prior to the publishing of the final report. During our visit to the home we were able to make observations about the environment spending time in communal areas and noting some of the bedrooms used by people living in the home during the course of our visit. During our visit we spent time with the people who live there and were able speak with them, and observe interactions between them and with staff. We spoke with four staff privately during our visit, three in depth, in addition to the registered manager. We examined a range of documentation including care plans, risk information, medication records(MAR), staff recruitment, training , supervision records, in addition to complaints and accident information to inform our judgment about the operational day to day management of the service. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? The AQAA informs us that since the last inspection the service has developed terms and conditions of residence information into a pictorial format, and electronic versions are also available. All policies and procedures have been updated by the company, and these have been amended by the manager where they need to be more specific to the service. Internal improvements to decoration have been made and have taken into consideration the preferences of the people lwho live at the home. Trial visits have been introduced for people who want to come and live at the home. The frequency of house meetings for People who live in the home has been improved and they also receive 6 monthly reviews of their support. Support plan formats have been improved, one person has been provided with a lap top to enable skills development in this area. The AQAA also informs us that the home manager and staff have worked to develop Care Homes for Adults (18-65 years) Page 8 of 31 working relationships with health and social care professionals and have actively sought interventions from health professionals on behalf of individuals living at the home. The manager meets monthly with every person living at the home. Medication recording procedures have been reviewed and amended in response to previous concerns. Since the last inspection the manager has now been registered with the commission and has completed her RMA training. A range of training has been provided to staff including Adult safeguarding. Recruitment procedures have been strengthened and two new staff have been recruited, Common induction standards in keeping with skills for care have also been introduced for new staff. Our visit to the service and examination of documentation has confirmed these improvements have been implemented. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wishing to live at the home and their relatives receive information about the service and terms of residency in accessible formats, they are encouraged to experience short stays and can be confident their needs are assessed prior to admission Evidence: People considering the home as a place of residence are provided with information about the service and the terms and conditions of of living there in an accessible format that makes use of appropriate language and picture referencing. The absence of new admissions means that we are unable to assess whether this is being conducted robustly, however discussion with staff and examination of assessment information gathered for the last person admitted confirms that that person was provided with opportunity to visit and have a short stay at the home prior to admission and comprehensive assessment information was provided to inform the decision to admit. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear and detailed information is available to inform staff how to support people living in the home in their daily routines. Personal care information needs to more fully reflect personal preferences. People living in the home have increasing confidence to express their choices and decisions and need to be supported in this by development of communication passports and more accessible information. A responsible risk strategy is in place. Evidence: Support plan formats have recently been reviewed, they are detailed and informative to staff as to how most needs are to be supported. We found that information about personal Care and hygiene is not person centred, and there is an over reliance on information about the personal preferences, of people who live in the home being verbally passed between staff. To aid continuity and ensure that all staff adhere to the stated preferences of individuals in the home, we recommend this information is clearly recorded or cross referenced in support plans; and is accessible to staff. Support plans are reviewed six monthly with the involvement of the people who live in Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: the home and their relatives or representatives. People living in the home are more confident of expressing themselves and refusing to participate, however, most do not exert control over aspects of their daily living and care routines including finances, and medication. The manager has been reminded of the need to ensure capacity assessments are in place to support these judgments and are kept under review. Risks continue to be generally well managed and staff have demonstrated their ability to cope with emergency situations. Strategies are in place that enable people living in the home to experience risk safely, and we have highlighted elsewhere in the report where we consider additional risks in relation to health are needed in view of some deterioration in health. Care Homes for Adults (18-65 years) Page 13 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home would benefit from improved activity opportunities. Records do not always make clear how the home is supporting them to improve skills and independence and involvement in daily household routines. People living at the home are supported and enabled to maintain contact with friends and family. A nutritious and balanced diet is provided but people would benefit from options being provided and accessible information to inform their decision. Evidence: From our discussions with staff, the manager, and people living in the home in addition to examination of daily record reports, we are satisfied that opportunities are provided to external activities and two people currently attend college courses. Records indicate people in the home maintain a good level of community presence by accessing local shops and facilities. Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: During our visit two people who live at the home went out with a staff member and when we asked what they had done one confirmed he had been out for a drive and had had a cup of tea whilst out. Staff survey feedback highlights a need for more activities for the people who live in the home, they report that: more activities and day trips are needed There is a need for a newer bigger van so residents can all go out together and would enable them to go out more often, as they would not have to wait for a driver with the correct insurance on their own car One person informed us that they have a lap top and are learning to use this, both at the home and at day centre, they are hoping to access the INTERNET eventually using these skills. They also informed us that they had recently attended a music concert of a favorite pop group and are intending to attend more in future with support of staff. Examination of daily report records tells us that whilst most people are provided with opportunities to access some interesting outside activities e.g swimming and horse riding, we noted from examination of records for two specific individuals that one had experienced only one external activity between the period 5/6/09 and 15/6/09, and another had experienced four external activities between 1/6/09 and 13/6/09 and had also refused two, this resident also received a therapist visit during this period. We consider that there is a need for the home to develop an activity programme for people living at the home that provides regular stimulation by participation in a range of external activities but also through meaningful in house activities linked to goals and aspirations and this is a recommendation. Some people living at the home enjoy undertaking specific household tasks and this could be extended to involve them more in the daily routines of the home. Most people are encouraged to take responsibility for maintaining the cleanliness of their own rooms in keeping with their own abilities, but records maintained do not make clear what tasks they have actually completed and this was discussed with the manager during the visit. All the people living in the home benefit from an annual holiday, one person we spoke with confirmed that they will be going on holiday soon to Cornwall,and tis was in preference to holidaying with the rest of the house who will be holidaying on the Isle Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: of Wight. The home is supportive of people who live at the home maintaining contacts with family and friends, and welcome their involvement. Relatives have informed us in survey feedback, that they feel the service does help their relative to keep in touch with them, and their are mixed views as to whether they feel the home always keeps them informed. The AQAA tells us that the service has to date been unsuccessful in gaining the services of a local advocacy service for residents, but will continue to strive for this. Consideration is currently being given to the implementation of dignity champions, to improve further the lifestyle of people living in the home. Menus are developed to take account of the individual food preferences of people living in the home, and any specialist dietary requirements they may have. The main meal is served at lunchtime and although meals offered are wholsome and generally home cooked currently only one option is offered. The menu is not currently in a format that informs people living in the home what they are being offered each day, and this is a piece of work that the home is still trying to progress. Records of food intake are being maintained and can be viewed to ensure individuals are maintaining a good diet. Whilst we commend the decision to involve someone living at the home in the project to develop accessible menu information this should not delay the process. We consider the home must take some responsibility for helping the respective individual to progress this work. During our visit we observed a staff member consulting an individual about how they might want their meal served e.g. on a plate in a bowl respecting their personal preference. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The emotional, personal and health care needs of people living in the home are well supported. Evidence: Support plans contain good detail in respect of individuals and how staff should support identified needs, but this could be improved upon in respect to personal care routines. Information recorded is not person centred and relies on information being passed between staff. We have recommended elsewhere in this report that this information is developed to aid continuity of support and is made available to staff to reference. Examination of records and discussion with staff confirmed people living in the home are supported to access routine health care appointments, and the manager and staff are proactive in seeking referral to relevant health professionals where they consider health interventions may be needed. Weights are regularly recorded. The home manager is exploring opportunities to access more appropriate weighing equipment, for those people in the home who find the current scales difficult to use. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: Whilst staff demonstrate an awareness of increasing needs for some people in respect of nutrition, falls, continence or skin integrity, which if not appropriately assessed and monitored could impact on their overall health health, the lack of routine assessments in these areas means that continuity of staff practice is not assured. We recommend the home routinely implement risk assessment around these areas to ensure residents health care needs are monitored and reviewed. The service has addressed previously identified shortfalls in regard to medication recording. We examined medication sheets and found these to be completed satisfactorily. A register of administering staff signatures is now in place. Staff have access within medication records of the appropriate codes to use. A medication profile has been developed for each person living in the home, and consideration should now be given to expanding this to inform staff of the medications administered for each person, its purpose and possible side effects. None of the present people who live at the home self medicate, we discussed with the manager how the service might work with individuals to enable their increased involvement in their medication regime, appropriate to their capacity to do so. This may include providing each person with their own lockable medication cabinet, and enabling them with staff prompting and support to undertake some of the tasks around their medication routine. The manager has expressed some enthusiasm for enabling this to happen. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are more relaxed and confident of asserting themselves but need to be more actively supported to express concerns and complaints. Systems are in place that safeguard them from harm. Evidence: The change in culture within the home means that people who live in the home are more relaxed and are being more assertive at expressing themselves either through refusal to participate or saying no. There are plans for the complaints procedure to be developed into a more accessible format making greater use of use of picture references. Currently no complaints have been received. We asked the manager, how staff could facilitate for those people who lack capacity to vocalize any concerns they may have. Some thought should be given to how staff interpret incidents hwere a person may be expressing anger or distress which can be directly linked to an incident; and affording these the same status as a complaint and this is a recommendation. All staff have now received adult safeguarding training, discussion with newer staff highlighted an awareness of multidisciplinary protocols to which they have access, and an understanding of their role and responsibilities in regard to reporting. No adult safeguarding alerts have been raised since the last inspection of this service. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: There are some restrictive practices in place, particulalry the use of listening devices used to monitor the night time movement of specific people living nin the home some of whom expereince night time disturbance. We discussed these arrangements with the manager who has agreed to ensure that such restrictions are made clear within care plan and risk information and are fully discussed and approved by a multi disciplinary meeting. The possible implementation of a pressure mat to alert staff of an individual leaving their room at night has also been proposed and the manager has looked into any implications of this under deprivation of liberty legislation. We have discussed the importance of consulting with relevant professionals to ensure support for such restrictive measures, are discussed in a wider forum and recorded in support plan and risk information and routinely reviewed for effectiveness. Satisfactory systems are in place for the safe management of residents monies. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home enjoy a safe, clean and comfortable environment where they can personalize their own space, consideration needs to be given to the changing needs of people in the home and whether aids and adaptations are suitable to meet these. Evidence: The home is generally well maintained and provides people living there with a comfortable, safe and clean home. A programme of upgrading is underway with plans for changing bathing provision for the people living there by reviewing the use of a visitors toilet and bathroom area. The manager is being proactive in anticipating that the needs of some people in the home may continue to deteriorate, and there will be a need to have the appropriate aids and adaptations in place to continue to support them. A review of storage should be considered as there is a need to ensure that clutter does not build up. We noted two hanging rails on the first floor landing, which could pose a hazard to people who live in the home who may have unsteady gaits. A new shed is needed for the garden area and this may solve the storage issue. Bedrooms viewed are reflective of individuals personal interests and tastes. Only one Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: person living at the home currently has their own bedroom key, and whilst everyone can lock their bedroom door when in their own room, they are unable to do so from the outside if they wish to secure their room when they are out. The option to have a key must be made available to all residents subject to capacity assessments which say otherwise; and records maintained of peoples preferences around this. Communal spaces are pleasant but there is a need for some furnishings to be reviewed particularly for those residents who find it increasingly difficult to get in and out of chairs. Increased levels of incontinence amongst some people living in the home requires the review of the present laundry arrangements, and their continued suitability to undertake the sluicing of soiled linen and ensure appropriate infection control, this has been discussed with the manager at the site visit. Care Homes for Adults (18-65 years) Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff on duty to support people living in the home. Staffing arrangements are flexible to respond to changes in need.Improved recruitment practice better safeguards people in the home but adherence to ensuring all necessary checks are in place first must be ensured. Mandatory training updates need to be provided in a more timely manner to ensure people who live in the home and staff are not placed at risk. Staff receive supervision but frequencies need attention. Evidence: There are enough staff on duty, and people who live at the home are informed of which staff will be supporting them at each shift by use of staff photos on a white board. Some thought should be given, as to whether people who live at the home would benefit from this information being provided on a daily basis, rather than over a whole week which can be confusing. The service has responded flexibly to changes in peoples needs which have prompted and increased use of waking night staff, it is not clear why this support is provided only five days per week with a sleeper on two nights, and clearly this needs to be reviewed, to ensure that people who are more active at night currently are not being placed at risk. A staff member who works some night time shifts reported that some nights there is very little night time activity to warrant a waking night staff, and at Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: present becasue this is new it has been difficult to judge whether it is needed all the time. A Staff training programme is in place for NVQ2 and above and the home informs us that more than 50 of the staff team are now trained. There has been an improvement in the recruitment procedures for staff, files viewed contained all relevant information in compliance with regulation 2 of the Care Homes Regulations 2001. Gaps in employment and verification of reasons for leaving previous care roles are also now being sought from applicants. We noted two new staff had commenced work at the home upon receipt of a POVA first check and two references, but before CRB information was confirmed. Whilst satisfactory CRBs are now in place for these staff, and discussion with them confirmed they were supervised at all times whilst awaiting return of the CRB. The manager has been reminded that only in extreme circumstances should staff be commencing work without a CRB in place, and in such a case this should be discussed with the Commission, and clear evidence provided of the supervision provided must be recorded. Staff we spoke with and who responded to surveys told us that there is a good range of training provided good standard of training and providing it is relevant we can do any course we need. A cursory review of the training matrix highlighted some mandatory training may be overdue,and all staff need updating in moving and handling. Particularly new staff who may not have received this training previously. We have stressed the importance of such training being given prior to commencing shifts at the service to protect the health and safety of both the staff members and those people in the home who need such support. The home has not progressed the mandatory training for another new staff member because they are awaiting certificates from a previous employer which have not been forthcoming. We have therefore issued a requirement for the service to ensure all care staff receive mandatory training in a timely manner. The manager has implemented a programme of 1-1 supervisions with staff but Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: frequency of these has slipped, we discussed the importance of maintaining frequencies to ensure staff practice and development is routinely monitored over evenly spaced periods. Examination of supervision record information found a lack of clarity as to what had been discussed and agreed upon. Arrangements as to why some of this information is not being recorded on the documentation has been discussed with the manager who has agreed to review. Staff reported to us that Carers are able to discuss and suggest things with the manager who is readily available at all times Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally managed in the best interests of the people living there. Evidence: The manager has now registered with the Commission, she has the necessary qualifications to undertake her role and continues to attend training to update practice. Since taking on the role of manager she has been instrumental in developing a caring and supportive culture, for people living at the home and staff. Staff who left the home under the previous management have now returned to work at the home as a result of these changes. Staff speak positively of the changes and enjoy the environment they now work in. The Company has updated policies and procedures, and the manager informs us that she has been consulted about any changes to these, that might be needed to more accurately reflect the service at Camber Lodge. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: The Company employs a quality assurance manager who also currently undertakes regulation 26 visits. Quality audits are undertaken regularly and six monthly reports produced with action plans. People who live in the service are surveyed annually along with other stakeholders and their feedback is analyzed. The home manager is also asked to produce a monthly report of activity in the home and plans for development, to inform the quality assurance manager. The quality assurance policy makes clear than an annual quality report is to be produced and this will be made available to the home and for inspection, a report is due in July 2009. We would recommend that the report makes clear how the feedback from people who live in the service and other stakeholders has influenced service improvement and development. AQAA information makes no reference to how quality assurance is undertaken or measured. The AQAA itself was completed to a reasonable standard and told us some of what we needed to know, future versions will benefit from additional detail to illustrate the day to day operation of the service, how this is being improved and future plans, there is also a need for the service to reflect on how it has addressed previous shortfalls and we discussed these improvements with the manager during our visit. The AQAA informs us that all Health and safety servicing and checks have been completed. We looked at the accident records and found the home currently experiences a low level, we have stressed the importance to the manager of being prepared to monitor changes in health care needs that may impact on the level of accidents recorded e.g falls, and to evidence through risk information how increasing risks have been reduced including what interventions have been sought. We found an up to date insurance certificate is displayed and an accurate certificate of registration also. The home is appropriately reporting incidents and events to the Commission in compliance with regulation 37 of the Care Homes regulations 2001 Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 35 18 The registered person must 17/09/2009 ensure that all staff are providing with mandatory training within the first six months of their employment or sooner dependent on needs in respect of Moving and Handling, food Hygiene, fire, first aid, infection control, medication, SO VA Regulation 18 care homes regulations 2001 to ensure that staff have the necessary competencies and knowledge to fulfill their role and protect people in the home from harm Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Support plans would benefit from improved detail in regard Care Homes for Adults (18-65 years) Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations to person care and hygiene that more fully reflects individuals preferences and is not reliant on the verbal transfer of this information by staff, this information should be easily accessible to staff to aid continuity in daily care routines. 2 14 People living at the home will benefit from increased opportunities for external activities and more structured in house activities People living at the home should be provided with accessible information about the menu provided to inform their choice and decision. Alternative meal options should be provided to enable people in the home to exercise choice. The service should develop assessments in relation to nutrition, continence, falls and skin integrity to determine those at risk and implement risk reduction measures accordingly There is a need for the complaints procedure to be made more accessible to people living at the home and for staff to more actively support them to express their distress, anger through the complaints stem where this can be directly linked to incidents which would prompt complaints in more able people. Annual quality report information should make clear how the views of people who live in the service and other stakeholders have been taken account of and influence service improvement and development. 3 17 4 19 5 22 6 39 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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