Care Home: Camellia Lodge

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What the care home does well A relative clearly values that some staff have been at the home for a long while and that this has helped the person they visit. They wrote to us that: "I consider [x] has been fortunate to have the same carer for many years and this has helped [X] considerably." Staff are good at supporting people with their personal and health care, including in managing epilepsy. They make sure that people have privacy when they are being helped. They know from people`s behaviour or gestures when someone is feeling unwell and support people to go to appointments with health professionals who can help keep them well. Staff try hard to help people have a fulfilling lifestyle and opportunities to go to places or events that will interest and stimulate them. They understand from people`s responses, even if they don`t speak, whether they are happy with activities and enjoy them. One staff member wrote to us that: "We give each service user the freedom to do what they enjoy" Staff know what to do if someone raises concerns about care on behalf of someone living at the home. They also know what they need to report to their managers in order to try and keep people safe. Senior managers from the company visit regularly to make sure that people are being supported properly and to look at what could be done better.The people who live at the home have things in their rooms that reflect their interests and help to show they are treated as individuals. Staff work hard to help keep the home clean and safe for people. What has improved since the last inspection? Some new staff have started work so that they do not have to work so many long shifts to make sure there is enough support for people. Keyworkers help to look at people`s support plans and try to make sure these are up to date. The things that people can do have been looked at to make sure these are realistic and show people`s abilities. A bath seat is now in place to help people who find it difficult to get into and out of the bath. The manager is more aware of how people already living at the home would get on with someone thinking about moving in, and would take this into account. This is so people do not move in who do not share similar needs, abilities and interests and would find it difficult to get on with others who already live there. CARE HOME ADULTS 18-65 Camellia Lodge 134 Holt Road Horsford Norwich Norfolk NR10 3DW Lead Inspector Mrs Judith Last Unannounced Inspection 29th May 2008 02:50 Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Camellia Lodge Address 134 Holt Road Horsford Norwich Norfolk NR10 3DW 01603 890733 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) bwadsworth@cmg-operations.com www.caremanagementgroup.com Care Management Group Ltd (trading as CMG Homes Ltd) Manager post vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st May 2007 Brief Description of the Service: Camellia Lodge is a care home providing personal care and accommodation for up to 4 people with a learning disability. People living there may also have some physical disability. There are three people living there at present. Care Management Group Limited, whose registered office is located in London, owns Camellia Lodge and four other small homes in the Norwich area. There is a lot of contact between all of the homes. This home is in the village of Horsford and not far, though a bus ride away, from the city of Norwich. Local amenities, shops and pubs are also close by. The home consists of an adapted bungalow and provides a domestic setting for the people living there. Each person has their own single bedroom. One of the bedrooms has an en-suite shower and there are plans to alter another one so it also has an en-suite facility. People have use of a lounge and dining room, which they share. There is an accessible rear garden. There is limited parking to the front of the home on a gravel driveway. The cost of the service is £700 to £1,200 per month. There are additional charges for private chiropody, hairdressing, and personal spending. When we visited there were three people living at the home. We have been told before that, given people’s communication difficulties, they try to make relatives or other representatives aware of the inspection report. It is referred to in the home’s Statement of Purpose; staff would tell people it is available. Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. We spent almost five hours in the home. Before making our visit we reviewed all the information we have about the home and looked at detailed information that the acting manager was asked to send to us. We also wrote to people before we visited to ask what they think about the service. We had written comments from five staff members and one relative. During our visit the main method of inspection used was called “case tracking”. This system is used to see what records say about people’s needs, and to find out from observation and discussion what happens in the daily lives of people living at the home and the outcomes they experience. We also looked around the home, communicated with people and watched and listened to what was going on so we could see how people were being supported. We used this information and the rules we have, to see how well people were being supported in their daily lives. What the service does well: A relative clearly values that some staff have been at the home for a long while and that this has helped the person they visit. They wrote to us that: I consider [x] has been fortunate to have the same carer for many years and this has helped [X] considerably. Staff are good at supporting people with their personal and health care, including in managing epilepsy. They make sure that people have privacy when they are being helped. They know from people’s behaviour or gestures when someone is feeling unwell and support people to go to appointments with health professionals who can help keep them well. Staff try hard to help people have a fulfilling lifestyle and opportunities to go to places or events that will interest and stimulate them. They understand from people’s responses, even if they don’t speak, whether they are happy with activities and enjoy them. One staff member wrote to us that: “We give each service user the freedom to do what they enjoy” Staff know what to do if someone raises concerns about care on behalf of someone living at the home. They also know what they need to report to their managers in order to try and keep people safe. Senior managers from the company visit regularly to make sure that people are being supported properly and to look at what could be done better. Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 6 The people who live at the home have things in their rooms that reflect their interests and help to show they are treated as individuals. Staff work hard to help keep the home clean and safe for people. What has improved since the last inspection? What they could do better: There are some things that the manager needs to make sure happen, by law. There has been some progress to make sure that staff get qualifications to help them understand and support people properly, but more work is needed in this area. The manager also needs to look at how well people understand the training they have when they first start work at the home, so staff can feel it better covers the things they need to know to do their jobs. Where people need particular prompting or support to reach their goals and potential, staff need to make sure that they give this. They need to show how people are progressing - or what other things they might need to do to support people to keep or gain new skills. Some extra advice from professionals would help show that people are supported properly if they might need to use the toilet at nighttime. This is to balance people’s comfort with the need for good quality sleep. There needs to be some more work to help people to make decisions and choices. This means looking at different ways of communicating with people who find this difficult. The staff and manager have some ideas about this but have not yet tried some of them out. Some people need special support to make sure they are not at risk when they move around in and out of the home. This is not always given (possibly Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 7 because there are so many pieces of separate information) and it means that people may be exposed to risks that could be avoided. There are some other things we suggested that the manager and staff could think about doing to make things even better and so the manager can show that she is taking responsibility for improving things even more. The manager can tell you about these, and although they are not set out in law, they would be things that could help improve the support people get Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the 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 who may want to live at the home will be sure that their needs and goals are assessed and can be met if they move there. EVIDENCE: There is one vacancy at the home but it is not being filled until an extension has been built. The manager says that she has been involved in assessing the needs of one person at another establishment and was able to tell us how important this was in identifying people’s needs and deciding whether the service would be able to meet them. At our last visit, a relative raised the concerns about the compatibility of people living at the home. This is now resolved. The manager says they have learnt from this and she would take into account how anyone wanted to live at the home get on with the existing service users. Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the support people need is set out in plans, the care delivered does not always match what they say is needed to achieve people’s goals as fully or safely as possible. People could be more encouraged to make decisions if there were more and different ways of communicating with them. EVIDENCE: Individual plans show that there are identified goals for people. They are not in a format that is accessible to service users. However, the manager and staff say people would find it difficult to understand their support plans, whether these were explained or presented in another format. Some information in support plans is not dated so does not show regular review and whether it is up to date. (For example, one persons “matrix” for goals was signed and dated August 2004, and was not reviewed until March 2008.) However, in other cases there are review sheets with regular dates. These most often show “no change”, sometimes over a period of years, as goals have not been broken down into smaller, measurable steps. We Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 11 suggested the manager might like to think about doing this at the last inspection so that she could show people were being supported to reach their full potential. Records of care given do not always show that they are working towards people’s individual goals – for example to help prepare meals, to choose their clothes or to brush their own hair. Staff and the manager say that they knew the signs and behaviours associated with people being unhappy (for example with a situation, meal or activity that they did not like) and would take action accordingly. At our last inspection the acting manager acknowledged that there was room to improve communication with people who had limited verbal skills. This has not happened yet although the manager and a staff member say that some work is being done to develop picture communications using photographs. Staff and the manager say that – as yet - objects are not used as prompts to help reinforce and communicate about choices on offer. A staff member says they think this is happening at one person’s day services but it is not happening in the home. Risk assessments do not reflect a whole activity for people. For example there are separate assessments about the risks for bathing, using the bath seat, and the temperature of the bath water rather than these being linked to the activity i.e. bathing. This means there is a lot of separate guidance for staff. A staff member said that there are “so many I can’t remember” but knew where to find them for reference. The ways risks are to be reduced are not always followed. For example, staff are to reduce the risks of one person falling by making sure that trousers are always adequately fitted so they can’t trip on them. The person has fallen since this was set out, attributed to them falling over their trousers. This means that the person was exposed to avoidable risk. We had written comments from one relative. These said that the staff “usually” met the needs of their relative and gave the person the support they expect or had agreed. Two staff told us in comment cards that they are always given up to date information about people’s needs. Three told us this happens usually. Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is room to improve efforts to enable people to make active choices about their lifestyles and to show people are supported to develop their life skills. Staff try hard to offer opportunities they think people will enjoy and to gauge from their responses, whether they have been successful. EVIDENCE: Since the last inspection, the home has acquired a small minibus, which is accessible to people with wheelchairs. One staff member identified lack of drivers as a problem in using this fully. Four out of five staff comment cards identified problems with access to it because of the gravel driveway. (See outcomes for environmental standards.) Daily records show people’s attendance at structured activities outside the home. They also show the activities people participate in. This includes things like watching television, listening to music, shopping trips, visits to the coast, meals out and a trip to a show. Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 13 Alternative methods of communication with people who have no (or very limited) verbal communication in presenting choices are not in place. Staff say they gauge people’s responses, which show whether they are happy with an activity or outing and whether this should be repeated or curtailed. Staff wrote comments to us about what they felt the home did well: “We give each service user the freedom to do what they enjoy e.g. outings. Residents are cared for in a friendly environment”. We only had one comment card from a relative. This says that staff “usually” support the person to live the life they choose and to keep in touch with them. The manager says that menus have been revised for the summer. Daily records showed a range of different balanced meals, representing an improvement on our last visit. People all need supervision with eating because they are at risk of choking. However, as at a previous visit, the staff stand in the dining room rather than sitting with the people eating their meals. We said in our last report that they should look at this so that supervision is less obtrusive and more dignified for people. Individual plans set out aids needed to help encourage independence when eating. For example, in one case a person needs their food cutting up and to use a plate guard. We saw that this happened, meaning the person was able to eat independently. Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the 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 health and personal care that people receive is based on their individual needs. EVIDENCE: Individual plans set out the support that people need with their personal care including bathing and managing continence. They reflect where people should be encouraged to do some of this for themselves. Two people use a bath seat that has recently been provided to help them get in and out of the bath more easily. Records show that a care manager and physiotherapist have been involved because of concerns about someone falling. Staff are aware of the need to supervise the person in circumstances where they may be at increased risk of harm. They told us the person is always supervised in the kitchen, toilet and bathroom as set out in their plan. Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 15 People have a “health book” recording their individual health related needs. These show there are arrangements are in place to address people’s routine health care needs (for example foot care, and dental checks). Health books also set out people’s need for support in managing continence. These and people’s individual plans do not say that people need to be toileted through the night. However, daily records show toileting by waking night staff (for example ““Bed 9.50pm, slept well, toileted x 3”). This would result in disturbed sleep patterns and so might affect how well someone feels and how they can enjoy daytime activities. Records do not show that this practice has been checked with a continence advisor to see if it is appropriate, although one person is waiting an appointment. Specialist advice is sought about managing epilepsy. Staff told us about this and there are letters on file. The manager and a staff member confirm that there is always at least one member of staff on duty who is trained to administer the medication prescribed so that the person can have the treatment they need promptly. However, we did see one inconsistency in records that might confuse staff and pointed this out to the manager. The manager and staff on duty say they do not administer medication until they are trained. One person we spoke has not been trained yet but says they watch other staff and so learn about the process while they wait for formal training. There are assessments recorded to show staff are competent to follow procedures and administer the medication people need, safely. One support plan shows that a person might have difficulty swallowing medication and that this should be “given with a spoonful of food e.g. yoghurt”. We saw this person given tablets with a drink and were told the person has no difficulty swallowing their medication. We discussed with the manager the removal of the guidance if it was not needed and so it could not be misinterpreted and led to covert administration – where the person could not say if they wanted their tablets or not. Records are complete and clear. There are sample signatures for staff so that the manager can track who is responsible for administering medication on each shift. Medicines are stored in a kitchen cupboard provided with a padlock. We discussed with the manager, changes in the rules that mean a proper medication cupboard is needed. She is aware of this and says this is being discussed within the company so we have not made a requirement about it. They are considering how they can do this without impacting too much on the “homely” aspects that the staff and manager try to cultivate. Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the 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 who use the service are not able to express their concerns but staff are aware what they should do if they have concerns themselves or a relative raises them. There is a robust, effective complaints procedure, and measures are in place to help ensure people are protected from abuse EVIDENCE: There are no records in the complaints folder. We were not able to tell from people living at the home, whether they would know how to complain and their cognitive abilities mean that they would have to enlist assistance from staff or other representatives in order to get their concerns across. However, a relative says they know how to complain and that they have always received an appropriate response if they have raised any concerns. All of the staff completing comment cards say they know what to do if someone raises concerns about care, confirmed by people we spoke to. These staff were both clear about the kind of things they should be reporting if they had concerns and say that they have covered this in training. They also say that they have contact details of company managers outside the home and could raise concerns if they were not able to go to the home’s manager. The regional operations director monitors incident and accident records on monthly visits. One person is prone to bruising because of unsteady gait and falls. Body charts are in use to record these each shift. The charts can then be linked to accident records and daily reports. The manager says she is confident that Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 17 staff would report any particular issues that were of concern. We checked this with a staff on duty who were able to give us examples that they would not only document but would report to the manager. This confirmed guidance we saw in the individual plan and shows staff understand how to help protect people. The manager is aware of the importance of completing proper checks on staff to make sure they are suitable to work with vulnerable people. Staff say colleagues are not left to work with service users unsupervised while they are completing their probation period. Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 23 and 30 People who use the 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 physical design and layout of the home supports people to live in a safe, well-maintained and comfortable environment, which encourages independence inside the home. There is room to improve the exterior including the driveway. EVIDENCE: The manager says there are plans to extend the home so that another bedroom has an en-suite facility. This room is vacant at present. One person already has their own bathroom. This means that the bathroom and toilet will continue to be shared by only two people. The paintwork to the exterior is peeling in places. The manager says that this will be attended to as part of the refurbishment when the room is extended. For this reason we have not made a requirement, but work needs to be carried out in the near future. Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 19 Staff comment cards and discussion with them and the manager, show there are problems using the tail lift on the minibus because this is being lowered onto the gravel driveway. Staff say one person does not like to walk across the drive as they find this distressing and feel they may fall. They say wheelchairs are difficult to move on the gravel and the person does not like these either. One staff member told us the person would be able to walk to the minibus on a firmer surface. This means that the outside of the home is adversely affecting the person’s mobility – despite the ramp to the front door. We have asked the manager to consider this when the extension is being built so that people feel as secure as possible and as independent as they can be. There are regular checks on fire safety equipment so that a fire would be detected promptly and people could be evacuated to safety. There are also audits of health and safety. Representatives of the company from outside the home check this when doing quality audits and monitoring visits to make sure the home is safe for the people living there. A bath seat has been provided to help two people who have difficulty getting in and out of the bath. There is advice within one individual plan about not moving furniture around because this disadvantages one person who can get around communal areas because they know where things are. Staff told us that they have not had formal training in infection control but they have guidance and tell us there is protective equipment (gloves and aprons) for them to use if they need it. There is a risk assessment about the use of the washing machine (because this is located in the kitchen and could present a hazard for food safety and cross infection). There is guidance for staff in the company’s policy manual, including an HIV and AIDS policy. (This also states that anyone who had this would not be discriminated against because of his or her condition.) There is a “weekly audit” of food safety measures to ensure that hazards are controlled. The manager had last completed and signed it on 28th April. However, there are records showing cleaning schedules and that the temperatures of fridges, freezers and cooked food are monitored to help make sure food staff prepare is safe for people to eat. Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by staff who are clear about their roles and have some training to help them understand people’s needs. The manager is working hard to make sure that staff can also achieve qualifications they need to increase their knowledge and competence so that they can support people better. EVIDENCE: The manager sent us information that shows few people have formal qualifications to show they have the underpinning knowledge and skills to support them in their work. She says that one person has just finished a qualification and two more are working towards it. There are 8 staff currently working at the home. The requirement that we made at our last inspection has not yet been met but progress is being made. There are records to show staff have completed induction to help them understand their roles that are signed by the staff themselves. The manager says that people are asked questions about the areas covered and any shortfalls would be addressed then. However, there is no evidence to show this. We had written comments about induction – two out of five people say it Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 21 covered what they needed to know “very well”, two say “mostly” and one says “partly”. We looked at recruitment files for three staff who have been appointed recently. These showed that checks are made to show applicants have not been banned from working with vulnerable people. There are references, proof of identity and photographs to help with these checks and show that recruitment takes into account the safety of people living in the home. Last time we visited we were concerned that shifts were only covered by virtue of staff working double shifts and long hours. This impacted on the quality of care that people received in that staff said they were too tired to organise evening activities. The duty rosters supplied before the inspection did not show that this happened so much. However, when we visited, two people were working double shifts and the manager will need to continue monitoring this. Written comments from staff show they do not always feel that their manager meets with them to discuss their work on a regular basis. Only two out of five were able to confirm this happens regularly, two said “sometimes” and one said “never”. However we saw some records of supervisions of staff by the team leader. This shows that staff do have the opportunity to have meetings with the team leader on a regular basis and one staff member we spoke to confirms this. They were aware that the standards said this should happen at least six times a year and say in practice it happens more frequently. Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the 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 benefit from a home that is run in a way that generally promotes their welfare and safety. The manager is aware that she needs to look more thoroughly at how she reports to us about the quality of the service although company checks show it is monitored to see how well it supports people who live there. EVIDENCE: There has been a change in management of this home since our last visit. The acting manager is not yet registered with us but is in the process of sorting this out. She says she is also due to start the training she needs to get formal qualifications to help her in her role. Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 23 Staff tell us that they are able to raise issues of concern and to approach her with problems. They also say they have access to other more senior managers in the organisation. There are regular audits by the organisation’s quality assurance team. These reflect that the service is improving but has more work to do. There are also regular visits by the regional operations manager to see how well the home is running and make sure people are supported properly. Where remedial action is needed, this is recorded in both these visits and those of the organisation’s quality auditors. The acting manager sent us information about the service before we went. However, this did not always reflect the standards that we have set out as important in promoting people’s safety and welfare (Key Standards). It did not tell us about the full range of evidence that would support how outcomes are met in the interests of people living at the home. There was no reference for example to individual plans being a source of evidence about how people were supported and their needs taken into account. The manager does not have access to a copy of the national minimum standards and regulations at the home. This means she did not have information to hand to refer to when she was looking at how well the service was doing. We know that this is the first time that she has needed to complete this information for us, and talked about how this could be better. She has agreed to get a copy of these so she can improve the information she sends to us in future. The manager carries out internal audits of health and safety issues, for example on equipment, risks in different areas of the home, hygiene, and the content of first aid boxes to help promote people’s safety. Staff records show that they have training (e.g. in health and safety, moving and handling, fire safety) to help them promote the safety of people living at the home. However, the food safety audit marked as due weekly, has not been done since 28th April, when action was considered necessary to clean behind the fridge. A recent accident had not been recorded in the accident book, despite guidance in the support plan that the person was vulnerable to bruising and occasions when they had knocked themselves or fallen should all be monitored so that causes of any bruising on body charts could be identified more easily. However, it was recorded in the person’s individual notes. There are arrangements to service equipment to make sure it is safe. We saw certificates for checks on the electrical installation (May 08) portable electrical appliances (Oct 07), and the boiler. There was also information about testing of water for legionella bacteria (Oct 07). Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 24 Staff have guidance about using and checking the safety of wheelchairs where people need these when they are out of the home. Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x 2 x 3 x x 3 x Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 26 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 YA6 Regulation 12(1) Requirement People must be given the support identified as necessary to achieve the goals that are set out in their individual plans. If this is not done people are at risk of not achieving their full potential or from not having their needs fully met. Support must be given in a way that takes into account risks and the written guidance about how these are to be kept to a minimum or avoided. If this does not happen, people will be exposed to avoidable risk and potential injury. Support with managing continence at night must be checked with professional advisors to make sure that waking them for toileting is the best way of promoting continence. This is so staff deal with this in a way that balances properly the management of continence with people’s wellbeing. Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 27 Timescale for action 10/07/08 2. YA9 13(4) 10/07/08 3. YA19 13(1) 10/08/08 4. YA32 18(1)c Outstanding requirement Staff must receive training appropriate to their work. In this instance at least half of the staff should be supported to study for their NVQ. This is so staff have underpinning knowledge and training to help them understand and support people fully. 31/12/08 5. YA35 18(1)c(ii) Previous timescale of 31/12/07 is unmet There must be evidence to 31/08/08 support that staff have understood the induction training they are given and are competent in the areas covered. This is so staff who are new to care can feel confident their induction training has helped them understand what is expected of them in supporting people properly. 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 YA6 Good Practice Recommendations Individual plans should break down goals into realistic steps so that progress is more easily identified and people’s achievements are recognised. Efforts need to be made to increase the range of communication in use, so that people are supported as much as possible to make choices and decisions. Staff who are responsible for supervising or assisting people at mealtimes should sit with people rather than standing, in order to help promote social skills, and a more DS0000027558.V365420.R01.S.doc Version 5.2 Page 28 2. YA7 3. YA17 Camellia Lodge homely routine and environment for people to eat in. 4. 5. YA20 YA39 Guidance about use of emergency medication for epilepsy needs to be consistent in all cases so that staff do not make mistakes. The manager should have her own copy of the standards and our rules. This is so she can see what she needs to do to improve the service people are receiving and can look at evidence she has for this. Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Eastern Regional Contact Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Camellia Lodge DS0000027558.V365420.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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