Care Home: Cambrian House

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What the care home does well The manager and staff good ideas about how to improve some of the areas of the service so that people have more personalised support There is a new deputy manager to support the managerComplaints are responded to and resolved quickly The quality of the food has improved Staff observe hygienic and safe working practices when supporting people What the care home could do better: The manager should make sure all staff and the deputy manager are aware of when they should notify CQC of incidents affecting the well being of people who use the service. The service needs to improve how they offer a personalised service, particularly for care planning and for leisure activities and social stimulation The service may need to review its staffing levels in accordance with people`s needs and to be able to offer a more personalised service The service must review its policy and procedure to comply with the Mental Capacity Act 2008 and offer staff training so that they understand mental capacity assessments Recording of information should be more detailed and the systems for doing this should be more consistent and avoid duplication. This will ensure people`s support needs are monitored and a more personalised service can be offered Random inspection report Care homes for older people Name: Address: Cambrian House 294 Chester Road North Kidderminster Worcestershire DY10 2RR two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Emily White Date: 1 1 1 1 2 0 0 9 Information about the care home Name of care home: Address: Cambrian House 294 Chester Road North Kidderminster Worcestershire DY10 2RR 01562825537 01562825537 Telephone number: Fax number: Email address: Provider web address: None Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Kidderminster Care Ltd care home 25 Number of places (if applicable): Under 65 Over 65 0 25 0 dementia old age, not falling within any other category physical disability Conditions of registration: 25 0 25 The maximum number of service users to be accommodated is: 25. The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 25, Old age, not falling within any other category (OP) 25, Physical disability (PD) 25 Date of last inspection Brief description of the care home Cambrian House is a care home providing personal care and accommodation for up to twenty-five older people of either sex, who may have a physical disability or a mental health need associated with old age. It is located in a residential area on a main road about a mile and a half from Kidderminster town centre. The home is a large threeCare Homes for Older People Page 2 of 10 Brief description of the care home storey house, which has been adapted and extended for its current purpose. Accommodation for the residents is provided on the ground and first floor. On the first floor there are seven single bedrooms, six of which are en-suite and there are eighteen single bedrooms on the ground floor, seventeen of which are en-suite. There are communal bathrooms fitted with Parker baths and one conventional bathroom, and there are separate communal toilets provided in addition to those ensuite. Communal lounges, a coffee shop and dining areas are also provided. Access to both floors is provided by a shaft lift and handrails are appropriately placed through the home. There is parking at the front and side of the house and at the rear there is a good-sized level enclosed garden with seating and tables. On 08/07/2008 the scale of charges for the home as quoted from their guide is #400 per week. The CSCI inspection report is also available within the guide. Care Homes for Older People Page 3 of 10 What we found: During March to September 2009 we received several complaints that the quality of the service at Cambrian House had deteriorated as the manager had been away from work for some time. Concerns included poor hygiene and manual handling practices, poor communication between staff, people using the service not being given the appropriate stimulation, and the choice of food had become very limited. Three complaints were sent to the owner of the home to investigate ad were not upheld. These complaints have not been logged at the home as they had been dealt with by the area manager. We received a response to every complaint we raised with the area manager. However we also noted that during the managers absence we did not receive any regulation 37 notifications. In one persons care file we saw an example of an incident in August 2009 where injury had occurred. This was during the time that the manager was away from work and should have been reported. The manager returned to work in September 2009 and staff received some training and support in personalisation and dignity in care. We received feedback from this training which told us that staff morale had improved since the manager had returned, people using the service appeared happy and well cared for and practices regarding food and hygiene had improved. Feedback from this also suggested that while staff have good ideas for personalising the service, care plans are not personalised and staff have little time to implement their ideas. During our visit we observed practices in the home, looked at some peoples care plans and spoke to staff about the support they provide. The home is clean, warm and homely. Staff were observed carrying out medications administration and other practices in a safe and hygienic way. One member of staff who has been promoted to a senior carer described how she had had training and opportunities to shadow colleagues. Care plans provide a lot of detail about peoples care needs, with separate sheets for each identified need. One care file had different information about a persons manual handling needs on different sheets in the care plan. We spoke to staff who were helping this person in the right way, however it is important that care files show the correct information about a persons needs to avoid confusion and errors. We also saw that everyone in the home has had a mental capacity assessment carried out. These assessments did not identify why the assessments had been done, what specific decisions they related to, and when the assessments were due to be reviewed. Staff carrying out the assessments had not received appropriate training. The Mental Capacity Act 2005 states that everyone should be treated as able to make their own decisions until it is shown that they are not. A persons capacity to make a decision must be established at the time that a decision needs to be made, and this decision must be regularly reviewed. Around the home we observed notices for different activities such as art, craft, cooking and pets visiting. Records show that visiting musicians and entertainers come to the home and we observed staff spending some time chatting with people who live at the home. We met one person who chooses not to join in the organised activities of the home and they told us they were very happy and got on well with the staff. Staff told us that they check on people who stay in their rooms every hour and try to make time to sit and Care Homes for Older People Page 4 of 10 chat with them. Staff also told us that with only three staff working in the afternoons time for supporting stimulation and occupation in a personalised way is limited. The home does not have a designated coordinator for this, and staff should be supported to incorporate this into their daily tasks. Although there is a brief life story at the front of the care files, people do not have a summary of their needs, likes and dislikes and what is important to them for their support. Monthly key worker reports show that staff know people well and are sensitive to the things that matter to them. However daily records are very brief, for example slept well no concerns. Care files contain very little information about peoples preferences and leisure interests, for example records contain comments such as enjoys all activities, chatting and watching telly. The manager has introduced another file to be kept in the persons bedroom, which includes other information such as a more detailed life story, more detailed notes on how the person spent their day, and records as needed by that person such as food records if they have not been eating well. This shows that the manager and staff understand what is meant by personalised support, however this has not been fully developed yet. We also noted that one person who spends a lot of time in their room had records which stopped in October 2009. We spoke to staff and people using the service the quality of the food. Staff confirmed that food choices had been poor in recent months but since the manager had returned a new menu had been introduced. We saw morning coffee and cakes being provided and saw that people had two choices at lunchtime. After lunch we asked people what they thought of the food, people said they enjoyed it and they had enjoyed the home made apple pie. We visited the kitchen and saw lunch being prepared, and had a look at the new four weekly menu which offers two choices of main meal and a variety of meat, fish and vegetables. We saw that the cupboards and fridges were well stocked and there were no budget items. We discussed the quality of the service with the manager. She told us that she has returned to work with the support of a deputy manager which she did not have before. The manager told us that they work well together. The manager confirmed that some areas of the service needed to be improved when she returned but she has been able to identify areas for improvement and has either addressed them or is in the process of doing so. Staff confirmed that they felt more supported and the service was on its way to improving. Areas identified for improvement include food, staffing, and personalisation of care plans and activities. Staff and the manager confirmed that staff had had mandatory training in manual handling and infection control. Staff confirmed that they had all the gloves and other equipment they need. The home has a number of more dependent people whose physical needs are likely to deteriorate over time. Staff raised a concern that they would like to have a modern standing frame or hoist in the event that someones needs suddenly deteriorated. What the care home does well: The manager and staff good ideas about how to improve some of the areas of the service so that people have more personalised support There is a new deputy manager to support the manager Care Homes for Older People Page 5 of 10 Complaints are responded to and resolved quickly The quality of the food has improved Staff observe hygienic and safe working practices when supporting people 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 set out on page 2. Care Homes for Older People Page 6 of 10 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 10 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, 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 14 12 A system for personalised 11/02/2010 care and support which suits peoples needs, preferences and capacities must be developed and maintained. This will ensure that peoples interests and opportunities for stimulation through leisure and recreational activities, as well as their preferences for personal care and support are met by the service. 2 14 12 The service must review and 11/12/2009 amend its policy and procedure for the assessment of peoples mental capacity in accordance with the Mental Capacity Act 2005 and the Code of Practice. This is to ensure that people using the service are supported to make their own decisions for as long as they are capable of doing so and receive the appropriate individual support when they Care Homes for Older People Page 8 of 10 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 have been assessed as not able. 3 38 37 All serious accidents, 12/11/2009 injuries, incidents of illness or communicable disease or other event which adversely affects the well being of people who use the service must be reported in writing to the Care Quality Commission. This will ensure that the health, safety and welfare of people using the service are promoted and protected. 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 7 It would be good practice for the service to consider how peoples care files can be more personalised and simplified, to avoid errors in recording information and to avoid duplication in the two systems that are being used. Staff would benefit from training in the Mental Capacity Act 2005 ad Deprivation of Liberty Standards, to ensure that people using the service receive the correct support to make their own decisions and maintain independence. The service should consider the purchase of a modern standing frame or hoist in the event that the needs of more dependent people suddenly increase. This will ensure that staff are able to carry out support in a safe manner. 2 18 3 38 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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