Cameron House (Care Home) Care Home Service Culduthel Road Inverness IV2 4YG Telephone: 01463 243241 Type of inspection: Unannounced Inspection completed on: 19 December 2016 Service provided by: Church of Scotland Trading as Crossreach Service provider number: SP2004005785 Care service number: CS2003008463
About the service The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at www.careinspectorate.com. The Care Inspectorate will award grades for services based on findings of inspections. Grades for this service may change after this inspection if we have to take enforcement action to make the service improve, or if we uphold a complaint that we investigate. Cameron House Care Home was registered with the Care Inspectorate on 1 April 2011 to provide a care home service to a maximum of 30 older people. The care home provides long term care as well as short breaks and respite placements. At the time of the inspection 28 people were using the service. Cameron House Care Home is a purpose built care home situated in a quiet residential area approximately two miles from the centre of Inverness. The two storey building is situated in extensive well maintained grounds. The Care Home provides 26 single and two double bedrooms, all with ensuite facilities. There are several communal seating areas; a main sitting room, TV lounge and a quiet sitting room used for people using the service to meet with visitors. There is also a dining room and other seating areas near the entrance of the building. Upstairs there is a seating area and a small kitchen used for making tea and coffee. The lift is suitable for use by people with disabilities. There is an open courtyard and extensive grounds, with a seating area at the front, a summerhouse and greenhouse. The grounds are enclosed and allow people using the service to access this area in comparative safety. The service is provided by Crossreach, which is part of the Church of Scotland. Cameron House Care Home's aims are:- 'To provide a happy and caring environment; enabling residents to live as independently as possible. To provide residents with individually designed care plans to meet their needs, being always mindful of their rights and choices. To positively encourage open and good relationships with relatives, advocates, professional agencies and other professionals in the wider community.' These aims can be summed up by Crossreach's mission statement:- 'In Christ's name we seek to retain and regain the highest quality of life that each individual is capable of experiencing at any given time.' What people told us For this inspection we heard the views from several people who use this service and spoke with 10 relatives of people who use this service. People who used the service said that they liked living there and spoke highly about the service and the staff who supported them. page 2 of 15
Some told us that staff knew their likes and dislikes and made every effort to ensure that they were catered for. One person who had only just come to the home said that the care was "first class". Throughout the inspection we saw that staff had very good relationships with people and cared and supported them in a way that met their individual needs. Overall, relatives told us that they were very happy with the "very good" service provided by Cameron House. They told us that staff were "very supportive" and met individual needs for people very well. One relative felt that their mother had "come on in leaps and bounds" since they had started to live there and that they were "brighter" and "more interested" in things. Everyone was very complimentary about the activity organiser who they said provided good opportunities for activity and stimulation. Some relatives who had experience of other care settings felt that the staff had "picked up on things" that others had not and this had helped them to feel positive about the care. Relatives felt like the home and staff were part of "a family" and that they felt safe in the knowledge that their relatives were being "cared for" when they went home. Some joined the relatives' meetings and felt that this was a very good way to keep people informed about what was happening in the home. Within the questionnaires some relatives commented that they felt the staff were "compassionate", "caring" and "extremely helpful". Some stated that the staff also supported them through difficult times, which they were extremely grateful for. One relative commented that they did not agree with the grades that were awarded at the last inspection. This was because they felt that this was an excellent service and had nothing but praise for the service, manager and staff. Self assessment The Care Inspectorate received a fully completed self-assessment document from the provider. We were satisfied with the way the provider completed this and with the relevant information included for each heading that we grade services under. The provider identified what it thought the service did well, some areas for development and any changes it had planned. The provider told us how the people who used the care service had taken part in the self assessment process. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership Quality of care and support page 3 of 15
Findings from the inspection Cameron House provides good care and support. The service is well managed and benefits from a staff team who have worked hard toward improving the quality of life and experiences for the people who live there. People have opportunities to enjoy a range of activities inhouse and events in the local community that reflected their personal interests and choice. The activity staff member was very committed to making a positive contribution to people's daily lives. Some of the relatives felt that, because of this commitment, their relative was more gainfully included thereby, more interested in their surroundings. Staff worked closely with other healthcare professionals to ensure that people's overall health and wellbeing was monitored and addressed. A variety of assessments were used to influence the development of individual care plans and these covered a range of healthcare needs. Relatives told us that they were aware of the care plans and that their key worker had involved them with the development of these. Formal reviews of the care and support offered were held and people who use the service were involved with these. Relatives and key staff's views formed part of the review. Action plans were used to inform any changes that needed to be made to the agreed care. (See recommendation 1). We looked at the overall management of medication and could see that the systems and processes had been reviewed. Those staff who were responsible had also taken part in training. These actions had led to better management of individual people's medication needs. However, the service was to further look at and improve how they managed the use of 'as and when needed' medication and ensure that this linked with individual care plans. A review of the mealtime experiences had taken part and people who use the service and staff, had been involved with this. Changes had been introduced and then reviewed after a period of time, to see how people felt about these. (See recommendation 2). People who use the service had a financial care plan in place. Work had taken place to ensure that there was relevant documentation and certificates of authority in place, with regard to legal status. The service was to ensure that this information was easily available for staff's information when assisting people to make decisions regarding their care and support. Requirements Number of requirements: 0 Recommendations Number of recommendations: 2 1. The provider should ensure that care plans are further developed. These should contain personal and unique information, which influences how they support people in their day to day life and makes a positive difference. This should include reference to appropriate strategies to use when supporting people in times of stress and distress. Care plans were to be effectively reviewed, evaluated and updated, to ensure that the information is a current reflection of people's needs. National Care Standards Care Homes for Older People Standard 6: Support arrangements. page 4 of 15
2. The provider should ensure they carry out a further review of the mealtime experiences. This review was to include people who use the service and their views, staff's knowledge and understanding of good practice, the environment and the information about menu choice. The service should then use this information to ensure that mealtimes met their own standards and that all people were afforded the same positive experiences. National Care Standards Care Homes for Older People Standard 6: Support arrangements Standard 8: Making choices Standard 13: Eating well. Grade: 4 - good Quality of environment Findings from the inspection A secure entry system was in place and staff responded promptly to the doorbell. The home had a nice atmosphere and was pleasant and welcoming. There was a board displaying staff photos and names and this had received positive comments from visitors. The service had good housekeeping arrangements and the home was clean, hygienic and free from odours. The service had also fully addressed the requirement from the last inspection, which was about overall tidiness, the refurbishment of a bathroom and new carpeting for the activity room. In addition, the staff used an infection control audit to make sure they were regularly assessing the environment, to make sure it was of a good standard for the people who lived there. The grounds and gardens were now being well maintained and some relatives told us that the gardener had done "an amazing job over the summer and the gardens looked great". The service had suitable arrangements for repairs, checks and servicing of equipment used in the home. Maintenance staff dealt with internal day-to-day repairs promptly. A suitable call bell system was in place. Staff responded promptly when people using the service used this to summon for assistance. Staff promoted people's sense of wellbeing, belonging and identity through supporting them to personalise their rooms with pictures, photographs and personal belongings. The Kings Fund tool was being used to assess the environment in relation to it being dementia friendly. This meant that staff were aware of how the environment had an impact on the people living there and how changes could be made to make this more user friendly. Action plans were being used to ensure areas were taken forward and put into place. The service was to ensure that they used this tool in its entirety, as stated in the guidance, so that they could fully plan for improvement. The service had developed the overall monitoring of falls, accidents and incidents. Staff were using care plans and risk assessments to ensure that peoples safety needs were being addressed. (See recommendation 1). Some relatives told us that they had been involved with this work and that this made them feel confident that their relative's safety was being taken into account. page 5 of 15
Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. The provider was to further review the overall management of falls. This was so that people using the service were confident that their health and safety needs were being addressed. In order to do this the service was to: a. Ensure that specific care plans were put into place for those who were assessed as being at a high risk of falls and that these were reviewed regularly b. That the documentation used for monitoring individual trends and occurrences were fully completed and showed what actions (if any) were to be taken to protect the safety of people using the service, and c. That where the monthly review showed a spike in falls there was evidence of what actions (if any) had been taken by staff in relation to individual safety needs and also that the environment had been taken into account. National Care Standards, Care homes for older people Standard 4: Your environment Standard 6: Support arrangements Standard 9: Feeling safe and secure. Grade: 4 - good Quality of staffing Findings from the inspection People who used the service told us, where able, that the staff were very kind and that they supported them with their day to day living. We saw some good interaction from staff during the inspection. Relatives were very complimentary about the staff and management. They all knew who their key worker was and told us how they had been involved with the development of the support plans. They said that they were kept informed of healthcare needs and some said that their relatives had greatly improved since being admitted to the home. The service used supervision and appraisal as a way of monitoring and improving staff practice and to identify training needs. There had been an improvement in the planning and carrying out of supervision and appraisals. The service was to ensure that all staff took part. A variety of training was provided for staff, which was statutory and based on the healthcare needs of the older person. This also included Scottish Vocational Qualification training in levels 2, 3 and some senior staff to a level 4. The service had started to encourage staff to complete reflective accounts following training. Staff stated what they had learnt and how this would then be used to influence positive outcomes for the people using the service. page 6 of 15
We spoke with staff and they said that there were good opportunities for learning and development. Relatives told us that they felt staff were well trained and had the relevant experience to carry out their roles. Staff meetings were held for all grades of staff. How these were managed had been further developed. Agendas were now being used to inform the meetings and action plans were used to identify areas for improvement and who and by when, these were to be addressed. The service was to ensure that all actions that were identified were addressed. The importance of staff's views, opinions and participation in the effective running of the home were noted in the minutes. We could now see that staff were being informed about the outcome from inspections and what needed to be done to address any areas for improvement. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 4 - good Quality of management and leadership Findings from the inspection The service had made good progress in meeting the requirements and recommendations from the last inspection. Staff were now more involved in what needed to be achieved. This had resulted in some positive changes to the environment and support that was offered. The service had started to use action plans more effectively so that they could identify what needed to be achieved. These were used for meetings, audits and following inspections. However, the service was to ensure that they contained more information about what specific actions needed to be taken and by whom, in order that the service could then clearly move forward with making improvements. The service had used "Promoting positive outcomes for people with dementia" as a way to assess the level of care and support that was offered. This provided information against each standard as to how they were meeting the preferred outcomes. We found that some of the elicited responses did not necessarily match with our findings as part of the inspection. Therefore, the service could revisit this using the outcome from this report to provide a true reflection, so that clear actions could be highlighted and taken forward. Various audits on the provision of the service continued to be used to inform improvements and action plans had been drawn up so that this could be achieved. We could see that some of the actions had been taken, however, this was not the case for all. The service could review the content of the care plan audit to include the need for a more person centred approach when planning the care. In addition some of the language used by staff could be challenged to ensure that this was more appropriate. The service could look toward involving people in some of the newly introduced audit tools. By doing this they page 7 of 15
would be able to gain their perspective rather than just their own. This would further promote participation and involvement in the life of the service. All of the 10 relatives that we spoke with were extremely positive about their and their loved one's experiences in the home. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 4 - good What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The provider must ensure they make proper provision for the administration, dispensing, recording and storage of medication. This is in order to comply with:- Regulations 4(1)(a), 5(1)(2)(a)(b)(i)(ii)(iii) of the Social Care and Social Work Improvement Scotland (Requirements of Care Services) Regulations 2011 Scottish Statutory Instrument 2011/210. Timescale for this requirement: 8 August 2016. This requirement was made on 15 March 2016. Action taken on previous requirement The review of audits and how they were managed had led to improved practice and the service had addressed the areas of improvements that were highlighted at the last inspection. Met - within timescales Requirement 2 The provider must ensure they review the overall management of accidents/incidents/falls to ensure that residents' safety was addressed. Once reviewed they were to ensure that appropriate records and care plans page 8 of 15
were generated and reviewed so that service users were not left at continued risk. This is in order to comply with:- Regulations 4(1)(a), 10(1)(2)(a) of the Social Care and Social Work Improvement Scotland (Requirements of Care Services) Regulations 2011 Scottish Statutory Instrument 2011/210. Timescale for this requirement : 8 August 2016. This requirement was made on 15 March 2016. Action taken on previous requirement The service had reviewed the overall management of accidents and incidents and this had led to a decrease in falls. Staff were using tools to help them to assess and plan for the care and support that was needed and were asking for support from allied healthcare professionals. Some relatives told us that they had been involved with this area of care and that they were pleased with the outcome. Met - within timescales Requirement 3 The provider must ensure they make proper provision for the health, welfare and safety of service users. This is specifically in relation to the provider having appropriate procedures for the control of infection. This is in order to comply with:- Regulation 4(1)(a)(d) and 10(2)(a) of The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 Scottish Statutory Instrument 2011/210) Timescale for this requirement: 8 August 2016. This requirement was made on 15 March 2016. Action taken on previous requirement The service had taken action on the specific areas of infection control that were highlighted at the last inspection. Met - within timescales page 9 of 15
What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The provider should ensure they further develop the ways in which they involved the residents and relatives in their overall care and support and life in the care home. This was so that participation was meaningful and effective and showed how they were improving the service on behalf of others. National Care Standards Care homes for Older People. Standard 5 - Management and staffing arrangements. The service had fully addressed the recommendation and there was clear evidence that the way they managed participation had a positive outcome on the lives of the people living there. Recommendation 2 The provider should ensure that all care plans and associated documentation is reviewed and updated to reflect the individual care needs of each resident. National Care Standards - Care Homes for Older People. Standard 5: Management and staffing arrangements Standard 6: Support arrangements. While we could see that some work had been carried out on the support plans so that they were more person centred, this was not the case for all. Therefore, this recommendation remains in place. Recommendation 3 The provider should ensure that all information with regard to the legal status of residents and that of their relatives and/or representatives. In addition, this information was to be made accessible to staff so that informed choices could be made when needed. National Care Standards - Care Homes for Older People. Standard 5: Management and staffing arrangements Standard 6: Support arrangements Standard 8: Making choices. The service had fully addressed the recommendation as there was now information about people's legal status and who their appointed representative was, alongside certificates of authorisation. However, this was scattered page 10 of 15
throughout the support plan folders and we would encourage that these were all contained in one area for staff's ease of access. Recommendation 4 The provider should ensure they carry out a further review of the mealtime experiences. This review was to include the residents and their views, staff's knowledge and understanding of good practice, the environment and the information about menu choice. National Care Standards - Care Homes for Older People. Standard 6: Support arrangements Standard 8: Making choices Standard 13: Eating well. While we could see that the overall management of mealtimes had improved there were still areas that could be addressed. Therefore, this recommendation remains in place. Recommendation 5 The provider should ensure they review the indoor, outdoor and garden areas. This was so that they were pleasant places for residents to spend time in or to look at. National Care Standards Care Homes for Older People. Standard 4: Your environment. This recommendation had been fully addressed. Work had taken place on all garden areas to ensure that they were pleasant places to sit and to view. Recommendation 6 The provider should ensure that all staff took part in regular appraisal and supervision sessions. Identified training needs were to be transferred to the training plan and staff were given the opportunity to attend these training sessions. National Care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements. This recommendation had been fully addressed. We could see that the service had worked toward ensuring staff were provided with opportunities for supervision and appraisal and that their training needs were identified and planned for. Recommendation 7 The provider should ensure they further develop the overall management of staff meetings. This was in order that there was a focused approach to the development and improvement of the service as a whole and that the staff group were involved with this. page 11 of 15
National Care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements. This recommendation had been fully addressed. There was now a clear agenda for meetings for all grades of staff. Action plans were being used to ensure that areas for improvement or development were being used to good effect. Recommendation 8 The provider should ensure there were robust and effective quality assurance systems and processes in place and that all stakeholders were given the opportunity to take part in this. The action plans that were used to drive forward improvements were to be very clear about what needed to be done and they should be revisited in order that the service was able to assess and improve the overall quality of service they provided. National Care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements. This recommendation had been fully addressed. We could see that the service had worked hard on addressing the requirements and recommendations. Action plans were used to show how they were planning for and addressing shortfalls. Other audits had been used as a way to assess the quality of provision and we could see that these had a positive outcome for the people using the service. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 10 Feb 2016 Unannounced Care and support 3 - Adequate 3 - Adequate page 12 of 15
Date Type Gradings Management and leadership 3 - Adequate 3 - Adequate 12 Feb 2015 Unannounced Care and support Management and leadership 16 Oct 2013 Unannounced Care and support Management and leadership 24 Jul 2012 Unannounced Care and support 6 - Excellent Management and leadership 6 - Excellent 22 Nov 2011 Unannounced Care and support 6 - Excellent Not assessed Management and leadership Not assessed 30 Nov 2010 Unannounced Care and support Not assessed Not assessed Management and leadership Not assessed 19 Jul 2010 Announced Care and support Management and leadership 8 Jan 2010 Unannounced Care and support Not assessed Management and leadership Not assessed 2 Jul 2009 Announced Care and support page 13 of 15
Date Type Gradings Management and leadership 19 Dec 2008 Unannounced Care and support Management and leadership 11 Sep 2008 Announced Care and support Management and leadership page 14 of 15
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. page 15 of 15