Cameron Park Nursing Home Care Home Service 70 Peffermill Road Edinburgh EH16 5LP Telephone: 0131 667 2032 Type of inspection: Unannounced Completed on: 7 November 2018 Service provided by: Sheila and Campbell Normand, a partnership trading as Cameron Park Nursing Home Service provider number: SP2003002445 Service no: CS2003010619
About the service Cameron Park Nursing Home is registered to provide care and accommodation for up to 24 older people. The service is provided by a partnership trading as Cameron Park Nursing Home. The home is situated in Edinburgh. There is a small car park at the entrance and two patio gardens. There are 24 single bedrooms, 12 of which have en-suite toilet facilities. A large sitting room, dining room, conservatory and communal bathrooms are available. The service aim to "look after our residents in the best possible way in a home from home environment, creating an atmosphere to meet all nursing, social, spiritual and psychological needs of the individual." During this inspection the new quality framework for care homes for older people and the Health and Social Care Standards were used to look at the care people received. These standards focus on the experience of people using services and describe what they should expect, these can be found at http://www.gov.scot/publications/ 2017/06/1327/downloads for Cameron Park Nursing Home page 2 of 8
What people told us At this inspection there were 24 people using the service. We spoke with nine residents in some detail about their experience and we chatted with or observed the care of the other residents. We did not receive any questionnaire responses from residents. All of the residents told us they had a good or very good experience of receiving care at Cameron Park. The residents spoke highly about the staff. We saw that staff knew residents well and used their knowledge of each individual to have positive and warm interactions at every opportunity. We spoke with five family members during this inspection. We also received questionnaire responses from family members. Families we spoke with were pleased with the care their relative received. All felt that the care given was of a high standard and communication with them was good and appropriate. Some comments which reflected relatives views were: "Having looked at several nursing homes I could not have found anywhere more homely and caring than Cameron Park", "Staff are always friendly and helpful. Staff are long-serving..." and " Very good care". We received responses from three professional visitors to the home which we have taken into account in our assessment of the service. All spoke very highly of the way that the staff communicate with them and how they respond to health care advice they give to help with residents care. To make sure we involved as many people as possible in the inspection we also used the short observational framework for inspection. This observes staff interactions with people and helps us evaluate experiences of people who cannot always verbally tell us what it is like to live in the care home. During our observations we saw that residents were highly regarded by the staff who took time to help them in a discreet and dignified way. We saw residents have fun with the staff which included using the sensory table to help make connections with each other. Residents appeared very comfortable with staff and staff were aware of how much support to offer to meet residents fluctuations in mood and abilities. From this inspection we evaluated this service as: In evaluating quality, we use a six point scale where 1 is unsatisfactory and 6 is excellent How well do we support people's wellbeing? How good is our leadership? How good is our staffing? How good is our setting? How well is our care and support planned? not assessed not assessed not assessed Further details on the particular areas inspected are provided at the end of this report. for Cameron Park Nursing Home page 3 of 8
How well do we support people's wellbeing? Cameron Park Nursing Home provides warm, compassionate and nurturing care and support. This is led by staff who understand and are sensitive to residents and relatives needs and wishes. Personal care was carried out discreetly and in a dignified way, with privacy and personal preferences respected. Staff were able to adapt their approach to a wide variety of needs and conditions to ensure residents receive the right support and care at the right time. Participation and consultation was integral to the ethos of the home with residents and families supported to make informed choices and decisions about care. Residents were encouraged to shape decisions made about the way the service is provided and developed. A range of ways to contribute were available to encourage suggestions and feedback from everyone. Residents collective and individual wellbeing was considered and people were encouraged and helped to maintain links with family, friends and the local community. Staff made time for residents and we saw that this helped to maximise their mental and physical wellbeing through a range of planned and ad-hoc activities. The need for flexibility and spontaneity for people with a cognitive impairment was well understood and seen in staff practice. We saw that staff and residents enjoyed each others company and had fun together. Staff were confident to discuss residents wishes for the future and their preferences around hospital admission should this be needed. Importantly we heard that staff also respected those residents and families who did not wish to discuss future plans or were not ready. This showed the dignity and respect that each persons wishes were afforded as well as staff's skill in responding to different emotional and psychological needs. Where the General Practitioner (G.P.) had completed do not attempt cardio-pulmonary resuscitation or an Adult with Incapacity certificate (AWI) we found these were kept up to date, regularly reviewed. This helped to ensure care was well planned. There was a good relationship between the staff of the home and the local G.P. and other healthcare professionals who visited the home. Residents received responsive and preventative healthcare by staff who felt supported by healthcare professionals. We received positive comments from visiting health care professionals about how their specialist advice was used to improve the care of residents. An electronic care plan system was well established. A good range of information, including preferences and choices about how care should be carried out was held within these plans. Staff could easily access the information at the point of care through their hand-held devices and this helped to ensure up to date personcentred care was consistently given. Staff were knowledgeable about the risks of skin damage and pressure ulcers due to the advanced age and frailty of their residents. These risks were routinely assessed for and preventative steps taken to protect residents skin. A range of specialist mattresses and beds were used and daily skin care carried out. Staff who gave medicines were trained. Regular audits were carried out by the pharmacist who supplied medicines to the home to continue to improve the home's medication systems. We have made suggestions about improving some as required medicine protocols, use of medicine codes, handwritten prescriptions and updating covert medication protocols. This will help to further improve the care. We made these suggestions during the inspection and found that these had been implemented before the inspection was completed. The for Cameron Park Nursing Home page 4 of 8
manager has agreed to improve the system for implementing changes from the home's medication audits. This should help to ensure medication systems are safe and consistently effective. See area for improvement 1. Assessment for under nutrition was carried out and those at risk were identified. Comprehensive information was completed and available to staff which combined a daily calorie target with likes, dislikes and the nutritional content of each residents preferences. This helped staff promote high calorie meals and snacks for those who needed them. The community dietician was consulted where needed and supplements were given as prescribed. Meals appeared appetising and nicely served. Residents received any assistance they needed at mealtimes and this assistance was well organised. Residents were invited to make suggestions for meals and we saw that all of their suggestions were all included in the current menu. The service used a toaster in the dining area as they found the smell of toast stimulated the appetite of some people who were reluctant to eat because of their condition. Residents were encouraged to maintain their mobility with staff support where needed. A risk assessment was in place to try to reduce residents risk of falling. These showed that staff could balance safety without imposing unnecessary restrictions. Staff demonstrated that they could tailor the supervision and assistance offered to residents according to each residents fluctuating abilities. The number and nature of any falls which occurred were analysed and reviewed. Regular maintenance checks were carried out thereby ensuring that the environment was safe and service users and staff were protected. A new inventory was to be introduced to keep an organised record of equipment and checks. Records relating to the management of the hot and cold water systems were being reviewed so that this information could be more readily available. Routine drain cleaning was being implemented to reduce the risk of blockage in a sink area. The provider continued to make investment in and improvements to the environment. Since the last inspection bedroom windows, furniture and carpets had been renewed. Flooring in the hallway leading to the bedrooms had been replaced and the main kitchen had been refurbished. Painting and redecoration took place regularly which helped to keep the home's appearance. The garden was well tended and garden furniture had been painted in bright colours at the request of the residents. Residents had been involved in a meaningful way in decisions about the home which promoted their comfort, independence and wellbeing. Because the management and staff in the home understood the residents and the care they needed they were able to provide enough staff to carry out the care needed. Staff appeared to have enough time to care for residents during the day. There was a low turnover of staff and this helped to ensure continuity of care for the residents. Staff responses to residents showed they were committed to providing high quality care in a compassionate and understanding way. The provider was good at listening to staff feedback about residents changing needs, and we found this resulted in changes to the service which improved residents care. Relatives we spoke with said they would feel comfortable raising any concerns with staff or the management in the home, but said they had never needed to. When we looked at how complaints would be dealt with we saw that there was a policy and procedure in place. We made suggestions that this could be updated using best practice guidance on complaints guidance produced by the Scottish Public Services Ombudsman. See area for improvement 2. Areas for improvement 1. The provider should improve certain aspects of medication management in the home. This is to ensure care and support is consistent with the Health and Social Care Standards which state that "Any treatment or for Cameron Park Nursing Home page 5 of 8
intervention that I experience is safe and effective"(hscs 1.24), "I have confidence in people because they are trained, competent and skilled, are able to reflect on their practice and follow their professional and organisational codes" (HSCS 3.14) and "I experience high quality care and support based on relevant evidence, guidance and best practice." (HSCS 4.11). 2. The provider should improve how complaints would be responded to. This is to ensure care and support is consistent with the Health and Social Care Standards which state that "I know how, and can be helped, to make a complaint or raise a concern about my care and support."(hscs 4.20) How good is our leadership? This key question was not assessed. How good is our staff team? This key question was not assessed. How good is our setting? This key question was not assessed. How well is our care and support planned? Residents benefited from electronic support plans which were promptly written following a comprehensive assessment, regularly reviewed, evaluated and updated and took account of best practice and residents individual preferences and wishes. Overall, support plans contained a very good level of detail to direct staff about people's needs and how they liked them to be met. This information was easily accessible to staff at the point of care, which meant that people could be confident that they would receive the right support and that care would be up to date and adapted as their needs and choices changed. With residents permission, nominated relatives or legal representatives, had access to a relatives portal within the care plan system. Relatives told us that this helped provide reassurance about the care their loved one was receiving and could help them time their visits to better suit their family member. From the content of care plans we could see that staff were good at communicating with health care professionals when they identify any changes to the health status of individuals. This meant that staff were proactive in helping to keep people as well as they can be. Six monthly reviews of care took place with residents and/or their representative. This gave individuals the opportunity to formally evaluate their care arrangements. Comments about the service, from people receiving care and their relatives, at the reviews were positive. for Cameron Park Nursing Home page 6 of 8
Staff knew residents well and were mindful that pain could be the cause of stress and distress. We saw that medicines were regularly reviewed with the G.P. and ineffective medicines were stopped. Staff were already good at picking up visual cues from those residents who found it difficult to answer direct questions about pain. We thought there could be additional benefits for residents if care staff had more guidance about the use of pain assessment tools. By recording how well pain relieving medicine was working more consistently, analgesia could be further tailored to increase comfort and reduce any side-effects. The management team planned to enhance staff training in this area. Staff were helped to carry out the planned care and support through a range of comprehensive training opportunities and individual learning and development plans. This helped staff to carry out care with knowledge, skills and confidence. A cohesive management team helped support staff to offer a consistently high standard of care. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Detailed evaluations How well do we support people's wellbeing? 1.1 People experience compassion, dignity and respect 6 - Excellent 1.2 People get the most out of life 1.3 People's health benefits from their care and support How well is our care and support planned? 5.1 Assessment and care planning reflects people's planning needs and wishes for Cameron Park Nursing Home page 7 of 8
To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. You can also read more about our work online at www.careinspectorate.com Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @careinspect Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. for Cameron Park Nursing Home page 8 of 8