Care Home: Camelot Rest Home

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What the care home does well The registered manager had responded to the previous inspection report with comprehensive improvements. All requirements and the majority of good practice recommendations required at the last inspection visit had been actioned. There was up to date, easy to understand information about the home, with alternative versions for people who may not be able to read or understand written information. Everyone living at the home had been given a comprehensive contracts and terms and conditions, which were clear and easy to understand. Comments were positive and included, "feel it is a well run home". The manager and staff make sure that each person, and as appropriate, their relatives are involved in the plan of how their care is to be provided. The sample of people`s care plans looked at, were up to date. Medication storage was secure, and medicine records were clear and generally accurate. This meant that each person`s medicine requirements were well managed in a safe environment. All of the improvements required at the last inspection visit relating to medication were now in place. The home had very good relationships with the local GP`s and other health care services, such as the community dietician and other specialist therapists, providing support for people living at Camelot. We spoke to the district nurse who told us that the staff were knowledgeable about the people`s healthcare needs and always sought advice for any concerns. She also told us that they managed the care of people with diabetes well. This demonstrated the very good level of trust and professional respect between the home and primary care services. The people living at the home were encouraged to treat Camelot as their own home and to be as independent as possible. People were encouraged to personalise their bedrooms with their possessions, furniture and bedding if they wished. We saw lots of examples of people being able to make choices about their daily routines, activities and meals. They were encouraged and supported to take an active part in meetings and surveys at the home. The residents meetings were well established and generally well attended, with notes of topics discussed and action taken as a result. Relatives were also welcome to attend meetings and it was positive that the registered manager had an "open door" policy to encourage relatives and people living at the home to talk to her on an individual basis. We noted that there was good involvement in the running of the home and people had contributed their views about the activities and outings planned for the spring and summer months. The home had good links local churches and small groups of people enjoyed the activities provided. There were also visits from a church group of African Caribbean people and visits from the Salvation Army at the home. Arrangements were in place for ministers from other faiths to visit individual residents at the home, at their request. The menus offered a range of options for each meal, which were well prepared andappeared appetising and well presented. We saw members of staff ask each person what they preferred at each mealtime, with each person`s preferences recorded each day. The meals were a high standard and the majority of food was prepared using fresh ingredients. The home was inspected by Dudley Environment Services and achieved 4 Stars for food safety and healthy eating. The staff monitored mealtimes and made sure each person was supported to eat with a sensitive approach. The kitchen was very well organised and there was a good budget for food. The cook took time and effort to obtain and prepare additional foods to meet individual food preferences. Comments from people during the visit were very positive and included, "meals are lovely" and "the food is good and there is plenty." The home had a relaxed, homely ambience and it was warm, generally clean and comfortable. We received comments such as, "like living here", and "This is my home now." The home has had a stable core group of staff, with many people who had worked at the home for a long time and knew the people living there very well. The staff were caring, committed and flexible, often willing to work extra shifts for the benefit of people living at the home. The following comments have been made, "very helpful" and "everyone is friendly." There was a warm and friendly rapport between staff and people living at the home. Staff were aware of individual people`s likes and dislikes and how to meet their needs. Good standards of health and safety continued to be maintained and the registered manager conducted regular quality audits and analysis of all accidents occurring in the home, any areas for improvement were identified and rectified. This inspection was conducted with full co-operation of the registered manager staff team and people living at the home. The atmosphere throughout the inspection was relaxed and friendly. What has improved since the last inspection? The management team had continued to improve care planning and care records. These provided good care planning information and clear guidance so that all staff knew about each person`s needs, preferences and wishes. The records we looked at were very well completed and kept up to date. As identified as part of "what the home does well" improvements had been put in place to make the home`s medication system, as safe as possible, so that each person received their medicines as prescribed at the right time. The programme of redecoration and refurbishment had continued in a number of areas, such as some of the bedrooms, kitchen and conservatory. The registered manager in the home`s AQAA told us, "we have a planned extension in the near future to introduce an extra 5 bedrooms and replace the current conservatory with an Orangery type conservatory with a glass roof, planning is approved, we are awaiting dates and this will increase lounge space this will enable us to make the two remaining shared rooms into single rooms". The registered manager had used the training matrix and training plan to make sure all staff were up to date with mandatory and good practice training, which meant wereknowledgeable and skilled to meet the needs of people living at the home. What the care home could do better: There were a few areas requiring improvement at this inspection. The registered manager must continue to monitor the way peoples medication is stored at the home, taking action to make sure items requiring refrigeration are stored at the correct temperatures and do not pose risks to peoples health and well being. We received some comments that suggested there was not always sufficient time for staff to organise and participate in activities and access the wider community for people living at the home. We have strongly recommended that additional staff resources should be allocated to make sure people living at the home have social stimulation. The redecoration and maintenance programme needs to be continued and improvements need to be made to the cleanliness, especially the treatment room and a small number of bedrooms with a malodour, which pose risks to people`s health and comfort. There a small number of areas of health and safety, which need improvement, such as the management of risks associated with bedrails. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Camelot Rest Home 152 Stourbridge Road Dudley West Midlands DY1 2ER     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jean Edwards     Date: 1 2 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. Copies of the National Minimum Standards – Care Homes for Older People 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Camelot Rest Home 152 Stourbridge Road Dudley West Midlands DY1 2ER 01384214290 01384256922 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Usha Odedra,Rajan Odedra care home 25 Number of places (if applicable): Under 65 Over 65 25 old age, not falling within any other category Additional conditions: 0 Service users in the category DE(E) up to a maximum of 5 can be accommodated at any one time for as long as the home can demonstate it can meet the service users assessed needs. Service users in the category MD(E) up to a maximum of 2 can be accommodated at any one time for as long as the home can demonstrate it can meet the service users assessed needs. To include 2 existing named service users with physical disabilities over the age of 65 years PD(E) and 1 existing named service user with past or present alcohol dependence A(E) for as long as the home can demonstrate it can meet the service users assessed needs. Date of last inspection Brief description of the care home Camelot is a private Care Home registered to provide residential care for up to 25 frail older people, with some provision for older people with a physical disability, mental disorder and dementia. The home has been owned by the current Registered Proprietors since October 2004.The home is located on the main bus route, close to the Merry Hill shopping centre and Dudley town centre. There is limited parking at the Care Homes for Older People Page 4 of 35 Brief description of the care home front of the Home and there are large gardens to the rear. The Home comprises a number of large traditional properties, which have been extended and adapted to provide 21 single and 2 double bedrooms, located on the ground and first floors. There is a passenger lift, and a chair lift providing access to the first floor. Communal accommodation is available in two large rooms at the rear of the property that have been extended out to meet in a large conservatory. The home offers a number of aids and adaptations, including adapted bathing facilities, floor level showers, portable lift equipment, emergency call system in every room and some adjustable beds. The Home has developed links with organisations that are able to offer some culturally appropriate diets for Afro-Caribbean elders. Care Homes for Older People Page 5 of 35 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last Key Inspection was on 3 and 5/04/06 and the CSCI undertook an Annual Service Review 17/04/08. We, the Care Quality Commission (CQC), undertook an unannounced key inspection visit. This meant that the home had not been given prior notice of the inspection visit. We monitored the compliance with all Key National Minimum Standards at this visit. The range of inspection methods to obtain evidence and make judgements included, discussions with the registered manager, deputy manager, and staff on duty during the visit. We also talked to people living at the home, and made observations of people without verbal communication skills. Other information was gathered before this inspection visit including notification of incidents, accidents and events submitted to Care Homes for Older People Page 6 of 35 the previous Commission for Social Care Inspection. A number of records and documents were examined. The registered persons submitted the homes Annual Quality Assurance Assessment (AQAA) as requested prior to the inspection visit. We toured the premises, looking at communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and peoples bedrooms, with their permission, where possible. The home had published the range of fees in the service user guide, which were from 373 pounds to 405 pounds with a premium 32 pounds each week. People are advised to contact the home for up to date information about the fees charged. What the care home does well: The registered manager had responded to the previous inspection report with comprehensive improvements. All requirements and the majority of good practice recommendations required at the last inspection visit had been actioned. There was up to date, easy to understand information about the home, with alternative versions for people who may not be able to read or understand written information. Everyone living at the home had been given a comprehensive contracts and terms and conditions, which were clear and easy to understand. Comments were positive and included, feel it is a well run home. The manager and staff make sure that each person, and as appropriate, their relatives are involved in the plan of how their care is to be provided. The sample of peoples care plans looked at, were up to date. Medication storage was secure, and medicine records were clear and generally accurate. This meant that each persons medicine requirements were well managed in a safe environment. All of the improvements required at the last inspection visit relating to medication were now in place. The home had very good relationships with the local GPs and other health care services, such as the community dietician and other specialist therapists, providing support for people living at Camelot. We spoke to the district nurse who told us that the staff were knowledgeable about the peoples healthcare needs and always sought advice for any concerns. She also told us that they managed the care of people with diabetes well. This demonstrated the very good level of trust and professional respect between the home and primary care services. The people living at the home were encouraged to treat Camelot as their own home and to be as independent as possible. People were encouraged to personalise their bedrooms with their possessions, furniture and bedding if they wished. We saw lots of examples of people being able to make choices about their daily routines, activities and meals. They were encouraged and supported to take an active part in meetings and surveys at the home. The residents meetings were well established and generally well attended, with notes of topics discussed and action taken as a result. Relatives were also welcome to attend meetings and it was positive that the registered manager had an open door policy to encourage relatives and people living at the home to talk to her on an individual basis. We noted that there was good involvement in the running of the home and people had contributed their views about the activities and outings planned for the spring and summer months. The home had good links local churches and small groups of people enjoyed the activities provided. There were also visits from a church group of African Caribbean people and visits from the Salvation Army at the home. Arrangements were in place for ministers from other faiths to visit individual residents at the home, at their request. The menus offered a range of options for each meal, which were well prepared and Care Homes for Older People Page 8 of 35 appeared appetising and well presented. We saw members of staff ask each person what they preferred at each mealtime, with each persons preferences recorded each day. The meals were a high standard and the majority of food was prepared using fresh ingredients. The home was inspected by Dudley Environment Services and achieved 4 Stars for food safety and healthy eating. The staff monitored mealtimes and made sure each person was supported to eat with a sensitive approach. The kitchen was very well organised and there was a good budget for food. The cook took time and effort to obtain and prepare additional foods to meet individual food preferences. Comments from people during the visit were very positive and included, meals are lovely and the food is good and there is plenty. The home had a relaxed, homely ambience and it was warm, generally clean and comfortable. We received comments such as, like living here, and This is my home now. The home has had a stable core group of staff, with many people who had worked at the home for a long time and knew the people living there very well. The staff were caring, committed and flexible, often willing to work extra shifts for the benefit of people living at the home. The following comments have been made, very helpful and everyone is friendly. There was a warm and friendly rapport between staff and people living at the home. Staff were aware of individual peoples likes and dislikes and how to meet their needs. Good standards of health and safety continued to be maintained and the registered manager conducted regular quality audits and analysis of all accidents occurring in the home, any areas for improvement were identified and rectified. This inspection was conducted with full co-operation of the registered manager staff team and people living at the home. The atmosphere throughout the inspection was relaxed and friendly. What has improved since the last inspection? The management team had continued to improve care planning and care records. These provided good care planning information and clear guidance so that all staff knew about each persons needs, preferences and wishes. The records we looked at were very well completed and kept up to date. As identified as part of what the home does well improvements had been put in place to make the homes medication system, as safe as possible, so that each person received their medicines as prescribed at the right time. The programme of redecoration and refurbishment had continued in a number of areas, such as some of the bedrooms, kitchen and conservatory. The registered manager in the homes AQAA told us, we have a planned extension in the near future to introduce an extra 5 bedrooms and replace the current conservatory with an Orangery type conservatory with a glass roof, planning is approved, we are awaiting dates and this will increase lounge space this will enable us to make the two remaining shared rooms into single rooms. The registered manager had used the training matrix and training plan to make sure all staff were up to date with mandatory and good practice training, which meant were Care Homes for Older People Page 9 of 35 knowledgeable and skilled to meet the needs of people living at the home. 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 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 Older People Page 10 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 35 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. The home has a comprehensive and easy to read of purpose and service user guide and people living at the home have contracts terms and conditions of occupancy. This has the effect that people and their advocates have good information regarding their rights and entitlements, and how care will be provided. The home uses comprehensive assessment tools, which means that each persons needs are thoroughly assessed to ensure that their needs and preferences will be met. The home actively encourages introductory visits and there is evidence to demonstrate that people have been given the opportunity and time to make decisions, which are right for them. This home does not provide intermediate care, therefore Standard 6 is not applicable. Care Homes for Older People Page 12 of 35 Evidence: The information contained in the homes AQAA about what it did well stated, ensuring a full assessment on admission is completed and relevant information is gathered from others sources i.e. individual care instructions from social workers, up to date statement of purpose with all relevant information and reviewing service user guides adding extra information on external agencies and local shops, by encouraging trial visits and gaining signed confirmation offering family the chance to be involved in care planning, we ensure all service users are given a contract of terms and conditions and the including the amount that is paid each week. We provide all service users with an up to date service user guide and gain signed confirmation this has been received. We looked at copy of the homes statement of purpose and service user guide, which had been updated in April 2009 to reflect the change of regulator to Care Quality Commission, which demonstrated good practice. The documents could also be provided in alternative formats on request. The documents clearly set out the aims and objectives, admission criteria and provided good clear information about the home. Information about the range of fees and payment arrangements were included, which gave people full information about the service to help them make decisions about the choice of home. We looked at a sample of case files of people recently admitted to the home, which provided evidence that each person was provided with a contract and statement of terms and conditions. This document had also been revised and updated and was easy to read and understand. It set out in detail what was included in the fee, the role and responsibility of the provider, and the rights and obligations of the person living at the home. From the information provided at the home we noted that the majority of people were funded through the Local Authorities whilst other people were funding the costs of their own care. There was evidence from examination of a sample of care records at the home and from discussions, which confirmed the good practices claimed in the homes AQAA. Such as pre admission assessments, which were conducted professionally and sensitively and had usually involved the family or representative of the person. The pre-admission assessment documentation was well completed and individual preferences were recorded such as rising, retiring, preferred activities, likes and dislikes. This meant that staff had good and accurate information about each persons needs and preferences about how they wished their care to be provided. Care Homes for Older People Page 13 of 35 Evidence: We saw that the home had a stable core group of staff who had worked at the home for a long time and were knowledgeable about the needs of people living at the home. Care Homes for Older People Page 14 of 35 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. There is comprehensive care planning, risk management and monitoring, which provides staff with the information and guidance to meet peoples needs and preferences well. Good multi disciplinary working takes place on a regular basis, giving people assurances that their health needs care needs are identified and well met. The service has a comprehensive medicine policy that reflects good practice and people living at the home can feel confident they will receive their medicines as prescribed by their doctor. People living at this home can be assured that they will be treated with respect at all times. Evidence: We looked at a sample of care records for new people admitted to the home and people who had lived at the home for longer periods of time. We saw that people had a comprehensive care plan to meet their needs for care and support. There was evidence demonstrating the good practice of involving the person and their relatives or Care Homes for Older People Page 15 of 35 Evidence: representatives in the development and review of their planned care. We noted that the care plans were based on very comprehensive assessment information and included all essential basic information and identification of any associated risks. The addition of personal preference information and the introduction of life stories to record each persons preferred daily routines for staff guidance made sure that care was delivered with a person centred approach was a very good initiative, which was implemented well. There was evidence from records and discussions that each persons health was carefully monitored with appropriate action taken. We saw evidence of well documented health care assessments, screening, treatment and intervention. An example was where there were significant changes in one persons condition, with weight loss, loss of mobility following a fall and general deterioration. This reflected in a review of the tissue viability score, nutritional assessment and a referral to the GP and community dietician for advice and support and appropriate weight monitoring and increased calorific dietary intake. We saw that all persons living at the home had good access to health care services to meet their assessed needs both within the home and in the local community. Some people were able to choose their own GP within the limits of geographical borders and there was documentary evidence to demonstrate that all persons had good access to dentists, opticians, and other community services. The home had a key worker system and we commended this as an excellent initiative to enhance the quality of individual person centred care for people living at home. Staff spoken to demonstrated that they knew about each persons needs and preferences. We looked at the homes system to manage the medication for people accommodated. We noted that the supplying pharmacy, was local to the main GP surgery and to the home, and supported the home with advice related to medication issues at regular audit visits. We noted that the majority of medication was appropriately stored in accordance with manufacturers guidance. There was a locked drugs trolley, which was clean, tidy and well organised. There was a lockable medication refrigerator, which was checked daily, with the minimum and maximum temperatures documented and recorded. The correct temperature range should be between 2 degrees C and 8 degrees C, however we noted that in April and May 2009 the drugs fridge temperatures were intermittently recorded as 1 degree C, 12 and 13 degrees C. This meant that peoples medication Care Homes for Older People Page 16 of 35 Evidence: requiring refrigeration might not always be stored at the correct temperature to maintain its integrity and effectiveness. This was discussed with the registered manager who agreed to investigate and undertake an immediate investigation and remedial action. This residential care homes Controlled Drugs storage had previously complied with legislation. However due to updated legislation the registered persons must now provide a Controlled Drugs Cabinet to comply with the Misuse of Drugs Act 1973, with a specified lockable steel cabinet secured with to solid wall, or wall with metal plate with rag bolts. We looked at a sample of MAR (Medication Administration Records) charts, which document each persons current medicine requirements and regime. These were well maintained, which meant that there was an accurate record to show medicine prescribed by their doctor was recorded, checked, monitored and administered in accordance with instructions. There were good procedures and checks in place to make sure that each person received their correct medicine at the right time. The receipt, administration and disposal of medicine were also well recorded. The date of opening of medicine in original containers was documented, which meant it was easy to carry out audits. We carried out audits on a random sample of medication to ensure that medicine had been given to each person as prescribed by the GP. The random audits undertaken of prescribed medication were found to be accurate. We observed that the treatment room, where medication was stored needed to be thoroughly cleaned, especially the window ledge, floor area and around the skirting boards. We discussed this with the registered manager and strongly recommended additional cleaning schedules and additional staff time should be allocated to maintain good infection control measures. From our observations and in discussions it was evident that all staff were aware of how to treat each person with respect and to consider their dignity when delivering personal care. Care Homes for Older People Page 17 of 35 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. There is some evidence of planned and spontaneous activities available on a regular basis offering people opportunities to take part in socially stimulating activities. People are enabled and encouraged to maintain good contact with family and friends. The dietary needs of each person are well catered for with a balanced and varied selection of foods that meets their preferences and nutritional needs. Evidence: The homes AQAA cited the following evidence of what was done well, we try to ensure that daily routines and activities made are flexible and varied service users are given choices on meals, we do questionnaires twice yearly on food preferences and changes made accordingly we ensure that we are able to cater for special diets prior to admission we encourage service user to bring in homely belongings and to make their accommodation like home. We have pictures around the home i.e. of toilets in word and picture form. We encourage families to visit at leisure and visit in the privacy of their own bedrooms if wished if a visitor is not known to the home or staff then authorisation from service user is sought first and staff ensure friends and families are invited to join in activities arranged by our home and be involved in daily care planning Care Homes for Older People Page 18 of 35 Evidence: of relatives. Within the home there are lists of outside agencies that might be useful i.e. (advocates). Service users are encouraged to handle their own affairs as much as possible. We were able to verify the accuracy of the claims made in the homes AQAA. There was evidence during the inspection, which indicated that staff listened to people living at the home and made considerable efforts to provide flexible daily living routines, which enabled people to enjoy a good quality of life according to their personal preferences. We noted earlier in the report that the home has a key worker system, which enabled closer relationships between people accommodated and staff, where likes, dislikes and needs were known in more detail and were generally met in a person centred way. We were told that the home does not employ an activities organiser and staff at the home took responsibility for collating the information gained from residents and staff meetings and used their knowledge of peoples preferences to plan activities, which each person could enjoy. The staff team provided a range of activities and access to community, though this was sometimes limited according to staffing levels and staff availability. We were told that ideas from residents and staff meetings were discussed and planned as much as possible. We saw information displayed in the reception bringing peoples attention to community events and activities. It was positive that it was understood and respected that some people preferred to spend their time in their own bedrooms, and they were supported with individual interests. We saw evidence that the staff knew and understood about peoples faith and where this was an important part of their life, they were supported attend services as and when they wished. We also noted that each person had a life story completed on their files, which often gave staff valuable insight into each persons past life and improved the person centred aspect to their care. We looked at a sample of peoples individual activities records, which were generally well completed, with refusals recorded. We received some comments from people who felt there should be more time dedicated to activities and social stimulation, which we discussed with the registered manager and proprietor at the end of the inspection. We recommended that serious consideration should be given to the creation of an activity organiser role or the allocation of additional staff time, for a minimum 15 hours per week to develop activities and stimulation, particularly for people with dementia or sensory disabilities. We saw evidence that family and friends were welcomed and people we spoke to told us they knew they could visit the home at any time. We were told that the management and staff team always made time to talk to visitors and share Care Homes for Older People Page 19 of 35 Evidence: information where this was appropriate. During the tour of the home there was good evidence that people were encouraged to bring in their personal possessions to personalise their room. We saw inventories of personal possessions on the sample of files examined, which were generally up to date, signed and dated by the person or their representative and witnessed by the member of staff. We discussed nutrition with care staff and deputy manager, who was also the cook in charge. They were knowledgeable about each persons nutritional needs and we were told that a choice was always offered, there were also diabetic and soft diets. There was also added calorific value at mealtimes for people with poor appetite or at risk of weight loss, using cream, butter, cheese and pulses. We discretely observed mealtimes and saw that staff were aware of the needs of people who found it difficult to eat and we noted that they offered sensitive assistance with feeding. They were aware of the importance of offering food at the persons pace, so that they were not hurried. A small number of residents chose to have their meals, particularly breakfast at a different time, or in their bedrooms, to allow them time and space to eat at their own pace. Efforts had been made with the dining room to make it look inviting with attractive tablecloths, crockery and condiments. We looked at the menu for the day, breakfast options, cereal, toast, eggs cooked according to preference, fruit juice, hot drinks and this was varied daily. Lunch options were soup, which was offered every day and options of pizza and salad, cottage Pie, with fresh vegetables, or a third option belly draft. The pudding was blackcurrant cheesecake or fresh fruit salad. The evening meal was assorted sandwiches, jacket potato with fillings and supper was a list of options including sandwiches, toast, cheese and biscuits, or sweet biscuits. The meals looked and smelled appetising, and meal times were protected to provide a sociable, enjoyable experience. We asked a sample of people about the food at meal times, and received generally very favourable comments, the food here is very good and we have plenty, and we have lots of choices. The registered manager told us that pictures of meals and snacks had been put together. These were very colourful and displayed meals, which looked appetising and appealing. We were shown samples of newly devised large print daily menus, which were also being developed, to be laminated and displayed to show daily meal choices. These are good initiatives to assist people make real choices for their meals. Care Homes for Older People Page 20 of 35 Care Homes for Older People Page 21 of 35 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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 can be sure that any concerns and complaints are listened to and action is taken to look into them, with systems in place to record investigations and outcomes. There are good arrangements in place to safeguard people living at the home from risks of harm. Evidence: We saw that the home had an up to date complaints procedure, which was displayed in the reception area and contained in the service user guide. Information supplied as part of the Homes AQAA indicated that the home had received three complaints, over 12 months, which had been investigated and upheld by the provider within 28 days, with satisfactory resolutions implemented. There were complaint forms to record formal complaints, which provided detailed information. The responses during the inspection indicated that people were aware of how to raise concerns or use the homes complaints procedure. This demonstrated positive practice and the homes proactive response to peoples experiences and perceptions of the service. We were told that the home had one situation, where someone was missing from the home for a short period of time, which was considered under the Safeguard and Care Homes for Older People Page 22 of 35 Evidence: Protect multi agency procedures. The registered manager co-operated fully with outside agencies investigating the incident, remedial measures were introduced to improve security at the home and there was information to show no further action was needed. There were no other allegations of abuse of vulnerable persons. There was a copy of Dudley DACHS (Directorate of Adult Community and Housing Services) multiagency procedures relating to safeguarding vulnerable persons living at the home. The organisations policies and procedures to safeguard vulnerable people were satisfactory and had been reviewed and updated to be in line with regulations and other external guidance. The CQC had received an anonymous complaint about poor recruitment checks at the home, which we looked into as part of this inspection visit. There was evidence that the recruitment checks were robust and there were records of work permits to stay and work in the UK on files of overseas workers. However two records showed dates of leave to remain in the UK, which had expired. The registered manager contacted the staff during the inspection and the staff brought up to date evidence into the home. We recommended that a monitoring system should be introduced to track expiry dates on all work permits to demonstrate compliance with immigration legislation. We were given information that the registered Manager had attended a conference provided by Birmingham Local Authority regarding Mental Capacity Act and Deprivation of Liberty regulations in March 2009 and she told us about her plans to cascade this training to the staff team, which demonstrated a very positive proactive approach. We were given documentary evidence that all staff have been made aware and have been given time to read and understand procedures for the protection of vulnerable adults. The majority of staff had been provided with training, which provided appropriate awareness of safeguarding vulnerable adults and staff were aware of what they needed to do should an incident occur. Care Homes for Older People Page 23 of 35 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, 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. 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 a safe, homely and comfortable environment for people living there. There are effective systems in place for maintaining infection control. Evidence: The interior of the home was a bright, cheerful and homely. There are attractive, and well maintained rear gardens, with garden furniture for people to use in the warm weather. We were told that there were plans to extend the rear of the home and provide better access to the large rear garden. The registered manager told us that there were plans to have raised planters to grow vegetables as activities and to provide fresh home grown produce for people living at the home. The tour of the building identified that a number of improvements have been made and the program of redecoration and refurbishment was continuing, with the majority of requirements for repairs and redecoration issued at the last inspection completed. The homes AQAA cited the following improvements to the environment, we have currently improved the kitchen area with a new ceiling, the kitchen has new tiles and flooring, we have implemented pressure relieving mattress turns which is designed to ensure mattresses are turned when recommended, we have had new emergency lighting in the conservatory area and extra lighting in lounge we continue to do minor Care Homes for Older People Page 24 of 35 Evidence: maintenance on a weekly basis and this is reported through maintenance book. However there were some additional areas, which required attention at this inspection, such as the small exposed areas on the windowsill and around hand wash basin in the laundry, the headboard with a sharp edge exposed in bedroom 20, which needed replacing, there were a number of bedrooms which needed redecorating and there were 3 bedroom with unpleasant malodours, which needed to be remedied. We looked at a sample of bedrooms with peoples permission where possible. Some were attractively decorated and personalised according to individual preferences, such as family photographs, ornaments and small items of personal furniture. We saw two sets of bedrails, which needed attention to ensure they were fitted and maintained in a safe condition. We were told that a new set had been ordered for one set, which was faulty, and these arrived during this inspection visit. The height dimensions of another set of bedrails did not comply with requirements because of the height of the replacement pressure reliving mattress on the bed. This did not satisfactorily safeguard the person from risks of harm. The registered manager agreed to replace them with more suitable bedrails. During discussions with people some told us they did not wish us to go into their rooms, which was a decision we respected. It was positive to note that some people had their own door keys and preferred to keep their door locked, which meant that no one could enter their private room without their permission. We were told that the home was generally clean, warm, and comfortable. We noted that when someone had raised concerns about the temperature in the conservatory, this was recorded and remedial action taken, with ongoing monitoring to make sure the temperature was maintained at a comfortable level for the people living at the home. The small laundry, located on ground floor of the building was well equipped with commercial washers and tumble dryers. The laundry service was generally well organised and the staff demonstrated good standards of infection control. However we saw that there were two unlabelled containers of decanted products in a cupboard in the laundry, the registered manager disposed of the contents during the inspection visit. She gave us assurances that this matter would be raised as an issue of concern with the staff to promote better compliance with health and safety to protect people living at the home from risks of harm. There was a laundry procedure and measures in place for supplies of disposable gloves and aprons to be readily available in the laundry at all times. The kitchen was maintained in very good order, and it was clean and tidy and well organised. We noted that appropriate food hygiene and safety measures were in place, Care Homes for Older People Page 25 of 35 Evidence: with well kept records, monitored by the registered manager, and Environmental Services. The home had achieved the Dudley MBCs Environmental Health Four Star Food Award for healthy eating and food hygiene. Care Homes for Older People Page 26 of 35 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. This home continues to maintain stable substantive staffing levels and people receive consistent and excellent standards of care. The staff recruitment processes are generally robust, which means that there are effective safeguards for people living at the home. The organisation and registered manager demonstrate a strong commitment to staff training and development. Evidence: The homes AQAA cited the following as evidence of what they do well, maintain a high staffing level, all new staff are only appointed after two references and gaps in employment explored POVA check and CRB clearance which is now done through the West Midland Care Association. New staff are as part of the induction process asked to complete written and oral questioning on the GSCC standards and we have began to use the bcpc induction pack. We have a mix of qualified and unqualified staff all over the age of 18 and all staff are given the opportunities to train indifferent ways i.e. open learning NVQs. We demonstrate cover on our staff rotas and with the service user dependency level are able to ensure the correct staff coverage. We currently have 17 staff with NVQs and a further two on level three and four on a level 2, 11 staff have completed NCFE training in health and nutrition and a further 13 staff are signing up on the 15th May for health and nutrition. Care Homes for Older People Page 27 of 35 Evidence: We were able to verify the good practices claimed from observations, discussions and examination of samples of records during this visit. We noted that there were 22 people accommodated, with a variety of dependency levels and diverse needs. The registered manager told us that she reviewed staffing levels on a regular basis, taking account of the occupancy and dependency levels of the people accommodated, which demonstrated good practice. Assessment of staffing rotas and information from the AQAA and staff personnel records demonstrated that the home was generally maintaining satisfactory staffing levels. The Home had a stable staff team including 21 care staff, domestic staff, gardener/maintenance person, and the Registered Manager and catering staff. Three staff had left the homes employ since in the past 12 months for valid reasons, and there were no staff vacancies at the time of this inspection. We looked at a random sample of staff personnel files, which were generally satisfactory. The registered manager had continued to demonstrate generally robust recruitment practice, with well ordered staff files and essential documentation. We discussed a reference for member of staff, which was not from the manager of the previous service or authenticated with a letterhead or company stamp. We also looked at the Visas, permits to work in the UK and expiry dates for staff who were foreign nationals, as already detailed in the Complaints and Safeguarding section of this report. We strongly recommended that the home implements an auditing system to demonstrate compliance with immigration legislation and safeguards people living at the home. We noted that the organisation and registered manager continued to demonstrate a strong commitment to staff training and development and had continued to provide all staff with appropriate training to raise awareness and skills to respond to peoples changing needs. We saw evidence that 17 of 21 care staff had achieved an NVQ level 2 care award with new candidates registered for training. All senior staff had achieved the NVQ level 3 care award and the domestic staff had achieved an NVQ in housekeeping, which was very positive. During discussions it was evident that staff felt supported. The comments received from staff included, good teamwork people here are always well looked after, and good staff team and good management team. Care Homes for Older People Page 28 of 35 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 has effective management with good leadership and direction, which ensures continuity and consistency. There are systems for consultation with people living at Camelot, and there is evidence that efforts are made to ensure that peoples views are formally sought and acted upon. Evidence: Wendy Madeley, the registered manager at Camelot had worked at the home for more than 11 years. She had achieved the NVQ level 4 Award in Management and Care and the RMA (Registered Managers Award) and continued to demonstrate a commitment to her own professional development. It was positive that she had a good awareness of the recently implemented Deprivation of Liberty Safeguarding Regulations and the implications for people living at the home. She planned to cascade the knowledge to all staff at the home. During discussions there was evidence of an open, approachable ethos, which Care Homes for Older People Page 29 of 35 Evidence: encouraged good communication with people living at the home, their relatives and staff. We saw evidence that the registered proprietor visited the home regularly. We looked at the Regulation 26 Reports undertaken by external consultants and held at the home and noted that they were very positive. We were told that the registered persons had purchased a new quality assurance system through the West Midland Care Association, based on KLORA (Key Lines of Regulatory Assessment) and equality and diversity. We saw evidence of very positive quality audits during this inspection visit, which meant positive outcomes for people receiving the service. There were clear lines of accountability within the home, and through the management structure. We noted that the registered manager had devised and implemented the homes annual development plan for the current year. We saw very good evidence that the registered manager had used effective self auditing systems, and these included monthly audits of areas such as peoples case files, staff personnel files, staffing levels and accidents, incidents and falls, with remedial actions to minimise risks identified. The registered manager and team have continued commendable efforts to involve people living at the home, their relatives, representatives and other community stakeholders in the running of the home. We noted that there were regular residents meetings and relatives, with minutes available. The homes survey questionnaires had been distributed to residents and families and stakeholders, with completed forms returned, and results collated and published. We saw evidence that the results had been acted upon in any area where there were concerns or where performance needed improvement. For example the meals were regularly discussed and reviewed. We noted that staff meetings were taking place, with minutes posted on notice boards. The structured formal supervision system appeared to be working well with supervision sessions identifying training needs, personal development and support. This had evident benefits for people living at the home. We noted that people were offered the opportunity to manage their own money if they wished, and the home provided facilities to help keep it safe. We looked at a random sample of balances and records of monies held in temporary safekeeping on behalf of people living at the home, which were accurate, with well documented records of all transactions. Care Homes for Older People Page 30 of 35 Evidence: We looked at a sample of heath and safety, fire safety and maintenance documentation, which was satisfactory and very well organised. There was evidence that all staff receive mandatory training commensurate with their roles, such as fire training, drills twice each year, moving and handling, first aid, food hygiene, health and safety and infection control training, commensurate with duties undertaken. We discussed the concern about the height of bedrails in use with a pressure relieving mattress with the registered manager, who agreed to take action to replace them to make sure the dimension were a minimum of 220mm as specified by the HSE (Health and Safety Executive) to maintain peoples safety. There had been 63 recorded accidents involving people living at the home in the past 12 months. The registered manager had an effective system for auditing, analysing and evaluating accidents involving residents, with effective measures implemented. Care Homes for Older People Page 31 of 35 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 Older People Page 32 of 35 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 9 13 The registered persons must 01/07/2009 ensure that all medication is stored within the temperature range recommended by the manufacturer to ensure that medication does not lose potency or become contaminated. This is to ensure the health and well being of people living in the home is safeguarded. 2 9 13 The registered persons must 01/08/2009 install a Controlled Drugs cabinet, and ensure Controlled Drugs are appropriately stored in compliance with the Misuse of Drugs Act 1973. This is to ensure the health and well being of people living in the home is safeguarded. 3 38 13 The registered persons must 01/07/2009 implement management Page 33 of 35 Care Homes for Older People systems to ensure the safe use of bedrails, which includes correct fitting, rigorous risk assessments, diligently followed, documented checks and staff guidance and training relating to bedrails. This is to safeguard the health, well being and safety of people living at the home. 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 2 8 9 It is recommended that body maps should be used to record any unusual marks or bruises. It is strongly recommended that the cleanliness of the treatment room, where medication is stored, should be maintained at all times, and be thoroughly cleaned, especially the window ledges, floor area and around the skirting boards to maintain good infection control measures. It is recommended that serious consideration should be given to the creation of an activity organiser role or the allocation of additional staff time, for a minimum 15 hours per week to develop activities and stimulation, particularly for people with dementia or sensory disabilities. 3 12 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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