Care Home: Cameron Lodge

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What the care home does well What has improved since the last inspection? The care plans have been improved and risk assessments are used to minimise risk rather than stop an activity. Activities are better planned and are based on individual needs and preferences. Health `action plans` are now used to make sure that health needs are identified and responded to. What the care home could do better: There are no formal requirements from this inspection. We discussed with the manager the need to review and update the statement of purpose and she confirmed she would do that. Within the AQAA the manager has identified the following things for improvement or building upon:- to continue to expand activities and opportunities for residents, to continue to build on the person centred approach, encouraging and enabling people to make more choices and decisions and to continue with planned redecoration. Key inspection report CARE HOME ADULTS 18-65 Cameron Lodge 142 Church Path Deal Kent CT14 9TU Lead Inspector Christine Lawrence Key Unannounced Inspection 14 July 2009 10:30 Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cameron Lodge Address 142 Church Path Deal Kent CT14 9TU 01304 373815 F/P 01304 373650 cameronlodge142@gmail.com 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) Cameron Lodge Ltd Ms Treena Partridge Care Home 12 Category(ies) of Learning disability (0) registration, with number of places Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD) The maximum number of service users to be accommodated is 12. Date of last inspection 20 August 2008 Brief Description of the Service: Cameron Lodge is a detached property situated in a residential area of Deal. The home is within walking distance of local shops, a pub, and leisure facilities. Public transport is available nearby. The home is registered to provide accommodation to 12 adults with learning disabilities and other needs. The home is arranged in three areas with a main house having six places and each of the two smaller bungalows providing three places each. One of the bungalows provides accommodation to more independent people who undertake some personal care and domestic tasks for themselves. The second bungalow provides a quieter environment for more dependent or physically frail residents. The main house provides spacious accommodation for a mixed group of six people with more complex behavioural needs. Accommodation is arranged over two floors. The current fees for the service at the time of the visit are £900 to £2600 per week. Additional charges are detailed in the service user’s guide. Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a 2 star good service. We, that is the Care Quality Commission (CQC), visited the home unannounced on the 14 July. We were in the home from 10:30 until 15:30. The manager sent us an annual quality assurance assessment (AQAA) when we requested it. This is a self assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we get information from providers about how they are meeting needs and wishes, and achieving positive outcomes for people using their service. The AQAA also provides us with statistical information about the service. The AQAA completed for Cameron Lodge was clearly written but could have contained more information as not all of the core standards were reflected. Five residents either showed us their rooms or permitted us to see them, and answered our questions about the home. Two others were around at various times and also spoke to us about Cameron Lodge or answered our questions. Four other people were also around at various times during the day but did not speak with us directly. We sent out six surveys for residents, four surveys for relatives and four surveys for staff. Two staff surveys were returned as were two residents’ and two relatives’ surveys. We spoke to four staff. The responsible individual for the organization visited during our visit and we spoke briefly to him. The registered manager, Treena Partridge, was not present at the time of our visit but we spoke with her on the phone the following day. During the visit we looked at care plans, daily reports, risk assessments, incident and accident reports, records of activities and participation, records of plans for activities, menus, the rota, a training matrix and medication administration records. What the service does well: People who live in Cameron Lodge said the following things, either through completing a survey or by making a comment on the day of the inspection visit – “…I want to stay here, I like here…” “…this is a good place and staff are good…”. Relatives made the following observations in their completed surveys – “…our son is happy there…” “…they do very well with xxx …he needs one to one attention and requires help in so many things…” “…our impression was of a very happy, warm and well run home…”. Staff comments included – “…staff work well as a team and management is reliable and professional…” and “…staff are consistent and work well together…”. Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 6 We observed staff talking to people with respect and giving them opportunities to express themselves. This enabled and encouraged people to make choices. We saw that staff know individuals and how to communicate with them or understand what they are trying to express. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 7 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 Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 8 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using 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. Each person has an assessment before moving into the home to make sure their needs can be met and their wishes identified. EVIDENCE: We looked at five care plans for this inspection, one of which was for someone who had more recently moved into Cameron Lodge. The assessment was detailed and focussed on the individual and included information from the previous place they lived. There was also information from the care manager involved from social services. The assessment included noting some ‘favourite things’ and also provided information about communication needs. The statement of purpose needs some updating. We discussed this with the manager the day following the inspection and she said she would arrange for this to happen. Cameron Lodge does not offer respite care. Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using 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. Residents can be confident that their changing needs will be noted in their individual plans and that they will be supported to make decisions and take risks to enable as independent lifestyle as possible. EVIDENCE: We looked at five care plans for this inspection. The care plans are based on detailed assessments. The plans are written in a ‘person centred’ way which means they put the person at the centre of their care and support, ensuring that everything that is done is based on what is important to that person from their own perspective. They are based on information called About Me and My Life, which is gathered for each person. Not everybody is able to express their opinions verbally so the care plans are very clear about how individuals do communicate. There is guidance for staff about communication relating to things like facial expressions, gestures and prompts, as well as body language. Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 10 Staff explained to us how important it was to know people and what might distress or please them. Daily records are maintained for each person covering the following things:- current support plan, accidents/incidents, health and medication, mood, diet, medical appointments, social visits, activities and complaints. This makes sure that staff are all aware of current things for the individuals they are supporting. We saw that the care plans were up to date and reviewed regularly. We saw and heard staff asking people what they wanted to do and the questions in the surveys relating to making decisions and doing what you want were answered positively. Staff described different individuals’ ways of indicating their wish to have a bath or go to bed, if they were not able to express this verbally. There are risk assessments in place which make sure that people are supported to do things as safely as possible rather than stopping a particular activity Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 11 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): This is what people staying in this care home experience: People using 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. Activities and involvement in the local community, as well as support for personal relationships are provided for residents. They will benefit from having the option of a healthy diet. EVIDENCE: Each person has a programme of activities through the week and this includes the local day centre, sensory and cooking sessions, using local community facilities and leisure activities. Two staff members in their completed surveys, highlighted ‘community participation’ as something they thought the home did well. Hydrotherapy, swimming, horse riding and IT sessions have been added to activities available over the last twelve months. We saw that expectations about how residents will be involved in domestic chores, both personal and communal are noted in their individual plans and activities programmes. Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 12 Restrictions and limitations are also noted and these are based on an assessment of risk. We saw that staff knocked on doors before entering residents’ rooms, respecting their privacy. Staff always engaged with residents; we never saw staff talking over people’s heads but always involving them in conversations. Three residents we spoke to said they enjoyed the food at Cameron Lodge and that there was enough to eat. One person said there were always cups of tea as well! Special diets can be catered for such as diabetes and staff explained about how some individual idiosyncrasies can be catered for. Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using 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. Residents are protected by the homes policies and procedures regarding medication and their physical and emotional needs will be responded to. Their preferences and requirements for support are respected. EVIDENCE: Cameron Lodge provides a home for people whose needs and wishes vary considerably. The individual support plans, including the activities support plans, health action plans and person centred information, all combine to provide relevant and appropriate information and guidance to staff. As noted previously we saw and heard staff asking people what they wanted to do and the questions in the surveys relating to making decisions and doing what you want were answered positively. Staff described different individuals’ ways of indicating their wish to have a bath or go to bed, if they were not able to express this verbally. Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 14 The individual records showed that the residents have access both as required and routinely, to a range of health care professionals. Medication is appropriately stored and the records of administration were properly recorded. We saw that there are clear guidelines for giving medication prescribed as ‘when required’. Staff told us that only people who have received training give out medications. Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using 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 home has a satisfactory complaints system and arrangements are in place to safeguard the people living there. EVIDENCE: Two residents who completed surveys answered yes to the question “Do you know how to make a complaint?” and relatives answered ‘Yes’ to the questions in the survey about knowing how to make a complaint and about whether the service responds appropriately to any concern. The complaints procedure specifies the time period by which complaints will be responded to (28 days, but the manager informed us that in practice this would be much quicker). There is now an easy read/pictorial version of how to complain. The team leaders on duty explained that staff listened to residents throughout the day and if any concerns were identified they would try to resolve things before they became problems. There are policies and procedures in place, including disclosure of abuse and bad practice (whistle blowing), which underpin the training that staff receive. We spoke to the two team leaders on duty as well as to another staff member and they all confirmed their awareness of the adult protection procedures as well as their responsibilities. All three said they had received training. One person said “…all of us are responsible for keeping people safe…” and other comments included “…wouldn’t hesitate to whistle blow...” and “…I would talk Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 16 to team leaders or manager if worried...” The home has improved facilities regarding residents’ monies subsequent to an incident of money going missing. Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using 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 standard and cleanliness of the home is very good providing people with an attractive, safe and homely place to live. EVIDENCE: Cameron Lodge is comprised of two bungalows, each for three people and the main house. There is access to local amenities and public transport as the home is close to the centre of Deal. A full time maintenance person is employed as are domestic staff. The maintenance person has recently upgraded the kitchen in one of the bungalows. We noted from the AQAA that various areas of the home have been redecorated and some carpets have been replaced and more work is planned. The manager explained that there is an ongoing programme of redecoration and replacement of carpets and furnishings. We saw some residents’ rooms which were individual and reflected the personalities and needs of the people living there. Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 18 The laundry facilities are satisfactory. Staff have received training with regard to infection control and hand washing facilities are appropriate. There are policies and procedures in place to provide guidance to staff when required. We saw that the home was clean and fresh at the time of our visit and two residents ticked ‘always’ in answer to the question “Is the home fresh and clean?” Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using 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. Residents can be confident that that there will be enough staff on duty at all times to support them and that the staff are competent and properly trained. They can be assured that the home carries out checks to make sure staff are suitable. EVIDENCE: We saw that staff were respectful and polite when talking to residents. This was so even when trying to redirect someone’s attention or asking them to stop doing something that was not acceptable. When we asked questions of staff it was clear that they know people and the things that are important to them. Eighteen staff have achieved their national vocational qualification (NVQ) in care at level 2 or above. We were not able to see staff records during this visit. We spoke to four members of staff who confirmed that their recruitment included application forms, interviews, references, criminal record bureau checks and terms and conditions of employment. One member of staff also informed us that the Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 20 providers have a company staff handbook which is given to all new staff. It was also confirmed that staff are given copies of the General Social Care Council’s code of practice. All the staff spoken to said that supervision forms part of the management of staff and we saw a plan on display for this. This standard was met at the previous inspection. We saw a training matrix and a copy of a memo booking training, which showed that there is an ongoing training programme for staff in both mandatory and specialist subjects. Staff spoken to also confirmed that there were opportunities for training. This included autism, epilepsy, diabetes and the deprivation of liberty safeguards. Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using 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. Residents benefit from a well run home and their health and safety is promoted and protected. EVIDENCE: The manager, Treena Partridge is now registered. She has the level 4 NVQ in care and has achieved the registered manager’s award. She has many years experience of working with people with learning disabilities. We spoke with her on the telephone the day after the inspection visit to the home. She confirmed that she takes opportunities to keep up to date with training such as autism and learning disability, epilepsy and diabetes, as well as ongoing things such as health and safety, first aid and infection control. Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 22 There are regular audits undertaken by the company and these are used by the home to identify any improvements or changes needed. Questionnaires are sent out regularly to relatives and the information from them is also used by the home to judge how they are doing. In completed surveys, residents told us that the carers ‘listen and act on what (I) say’ and during the inspection three residents said they felt that what they said was listened to. One person said “…they listen to you, you can talk to them…” and another said “…of course they listen!” One person nodded yes when asked if staff listened to what she asked for. The AQAA showed that policies and procedures are kept up to date. The training matrix showed that there is a programme of training staff in subjects relating to health and safety such as first aid, infection control, manual handling, food safety etc. There are policies and procedure is place to underpin the training. Checks on fire safety equipment as well as water temperatures are undertaken by the maintenance person. He provided records for this and other things, including the gas safety certificate and the electrical installation inspection. Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 23 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Version 5.2 Page 24 Cameron Lodge DS0000023372.V376443.R01.S.doc NO Are there any outstanding requirements from the last inspection? 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cameron Lodge DS0000023372.V376443.R01.S.doc Version 5.2 Page 25 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 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. 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