Inspection on 20/06/08 for Clavering Nursing Home

This is the latest available inspection report for this service, carried out on 20th June 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Clavering Nursing Home 15/02/07

Clavering Nursing Home 27/02/06

Clavering Nursing Home 06/09/05

Clavering Nursing Home 01/03/05

Clavering Nursing Home 21/09/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Clavering Nursing Home Royston Grove Hatch End Pinner Middlesex HA5 4HE Lead Inspector Julie Schofield Key Unannounced Inspection 09:50 20th June, 1 and 11th July 2008 st X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clavering Nursing Home Address Royston Grove Hatch End Pinner Middlesex HA5 4HE 020 8421 5819 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) clavering@elitecarehomes.co.uk Clavering Care Ltd Mrs Milithra Wickramarachchi Care Home 49 Category(ies) of Dementia - over 65 years of age (0), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (0) Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia over 65 years of age - Code MD(E) 2. Dementia over 65 years of age - Code DE(E) The maximum number of service users who can be accommodated is: 49 9th July 2007 Date of last inspection Brief Description of the Service: Clavering Nursing Home is a registered care home providing nursing care and accommodation for a maximum of 49 older people aged over 65 years who have dementia or enduring mental disorder. The registered provider is Clavering Care Ltd. The Registered Manager is Mrs Milithra Wickramarachchi. The home is located in a quiet residential road in Hatch End about five minutes walk from the main Uxbridge road. It is therefore situated at some distance to local shops, pubs, transport and leisure facilities in Hatch End. There are parking areas for more that six cars in the grounds of the home as well as street parking around the home. The home has a large garden to the rear that is well maintained and accessible to residents through the building. The building consists of three floors. There is a passenger lift, which serves the first and the ground floors where residents are accommodated. The second floor/attic area consists of 2 offices, a training room and a staff room. The home has 29 single and 10 shared bedrooms. There are four bedrooms, which are en-suite, but there are bathroom/shower toilet facilities on each of the floors where residents are accommodated. There are now three lounges and a Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 5 conservatory with a seating area on the ground floor and a lounge on the first floor. On the first day of the inspection there were no vacancies. Details of the fees for the service are included in the Service User Guide and, as of June 2008, are from £650 to £850 per week for the “standard charge”. However, the Service User Guide points out that the home provides personcentred care, specifically tailored for the needs of the service user, so the fee charged may vary from the “standard” on completion of the pre-placement assessment. Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection took place over 3 days. It began on the 20th June. The visit started at 9.50 am and finished at 4.30 pm. We called back to the home on the 1st July and the visit started at 9.00 am and finished at 1.20 pm. A final visit was made to the home on the 11th July and the visit started at 8.25 am and finished at 1.30 pm. During the inspection we spoke with the manager, who was on duty on the 1st July and the 11th July. We also spoke with members of staff and residents. Records were examined and the care of a number of residents was case tracked, a tour of the building took place and compliance with the statutory requirements identified during the previous key inspection in July 2007 was checked. We also saw some of the activities taking place in the home and observed a mealtime. As a significant number of the residents in the home were unable to give direct feedback on the quality of care received we spent time there on the third day observing the care practice and the interaction between residents and members of staff and looked at the residents for signs of well being. Survey forms were sent to members of staff and at the time of writing the inspection 9 forms had been returned. We also received survey forms from 2 health care professionals. We would like to thank everyone for their assistance and for their comments during the inspection. We have also received the Annual Quality Assurance Assessment (AQAA) that was completed by the home and have used this in the inspection. What the service does well: When asked what it was like to live in Clavering a resident said that it was “absolutely marvellous, like living in a hotel”. Another resident said that it was very nice and that she liked it at Clavering. A third resident said that she was pleased to be here. Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 7 Members of staff on duty said that the home is clean and that there is a calm atmosphere. Residents are treated with politeness and respect and their dignity is maintained. Members of staff that completed a survey form said that the training opportunities were good, teamwork was positive and that the home provided good quality care. The manager of the home provides good leadership and there are letters of thanks from the relatives of current and past residents on display. When we sat in the lounge and observed the residents during the morning of the third visit we saw signs of well being, engagement with other people and saw residents taking part in an activity. Members of staff sat and spoke with residents on an individual basis. What has improved since the last inspection? What they could do better: During the assessment and care planning process forms need to be completed (and dated) so that the service provided is in accordance with the needs and preferences of the resident. The assessment of need must fully consider the Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 8 social care needs of the resident in addition to their health and personal care needs. Care must be taken when handling medication so that other blisters are not damaged when medication is administered. The person responsible for administering must check that all tablets have been given. A review of staffing levels in the afternoon is needed to ensure that there are sufficient staff on duty to respond to residents’ requests in a timely manner. The programme of refurbishment of the bedrooms must continue so that some items of worn furniture are replaced. A valid insurance certificate for the Employer’s Liability must be displayed in the home so that everyone is able to see that their welfare is protected. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although an assessment of need is carried out before admission the completion of a service user’s choices form would assure a resident of a service tailored to their individual needs. Standard 6 was not inspected, as Clavering Nursing Home does not offer an intermediate care service. EVIDENCE: Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 11 The pre-admission assessment form has now been amended to include information about the mental health needs and dementia care needs of the prospective resident. We discussed this with the manager, using the case file of a resident that had recently been admitted to the home, as an example. We also looked at the case files of 4 other recent admissions to the home. We saw that on each file the needs assessment tool had been completed but on 1 file the form had not been dated. The needs assessment included the areas of communication, eating and drinking, personal care, mobilising, socialising, expressing sexuality, orientation and psychological needs. There were guidance notes on the new form regarding the assessment of the cognitive needs of residents in addition to a behavioural assessment. Each of the files also contained a service user’s choice form. We saw that on 1 file the form had been crossed through with the words “bed bound and peg feed” written on the form. One of the remaining forms was completed but not dated and another form had not been completed. The home does not provide an intermediate care service. Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A thorough assessment of the social care needs of residents would assure them that all their individual needs are identified and can be addressed. The health and well being of residents is promoted through regular health care checks and appointments. Generally the management of medicines in the home promotes and protects the safety and well being of residents although taking care when opening blister packs will prevent the backing of other blisters being damaged and tablets falling out. Discreet and caring support is given to residents by staff so that the privacy and dignity of the resident is respected. EVIDENCE: Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 13 The care records of four residents were inspected. Each contained an assessment of need document and a service user’s choices form. Each file contained a care plan and the needs identified varied from resident to resident. However, the identification of social care needs was still brief on some case files as the manager said that the detail was still to be developed. For those already completed we noted that cultural needs had been considered for each resident and we saw examples of the cultural needs of Irish, African Caribbean and English residents. We also saw that the care plans and the needs assessments were subject to monthly evaluations and these were up to date. After completing her Mental Capacity Act training the manager has considered the implications for the assessment process and is starting to use a form at the six monthly review of the care plan, which is completed with the help of the resident or their family/representative. Case files contained a general risk assessment, which addressed wandering, self-harm, suicide, falls and inappropriate sexual behaviour. We also saw individual risk assessments, where appropriate. A carer that we spoke with said that they had access to the care plans and that looking at this was, “the main thing with a new resident”. One member of staff ticked on the survey form that they were “usually” given up to date information about the needs of the people they supported although the others ticked “always”. The daily handover session was mentioned several times as one of the means of communication within the home. We spoke with the manager about health care needs and she confirmed that there is a training programme in place to ensure that members of staff receive an annual update in respect of manual handling. We saw that manual handling risk assessments included details of the type of hoist, when used, but not the size of sling to be used when required. Plans to manage the prevention of pressure ulcers for residents identified as high or very high risk included details of the equipment to use for prevention and we saw during the inspection that pressure relieving equipment was in use. At the time of the inspection 1 resident had a pressure ulcer. The resident’s care plan included pressure care and the file contained a wound assessment chart. We noted when examining case files that photographs are also taken of pressure sores. There was a record of a number of visits made by the tissue viability nurse and a copy of a letter from the GP referring the resident to the hospital. On the third visit to the home a new resident had been admitted to the home from hospital and they had arrived with a pressure sore. The manager demonstrated how this was fully documented. We saw that case files contained weight charts and we spoke with the manager regarding a case file where there was a significant weight loss over a short space of time. This issue had been identified in the care plan. The manager confirmed that the resident was receiving palliative care. However, although nutritional review forms have been drawn up we noted that the form was blank Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 14 on one of the new admissions to the home and only the weight at the time of admission had been entered on a second form. Case files included evidence of access to health care services e.g. dentist, chiropodist and optician. There was evidence that specialist support is sought when necessary e.g. the speech and language therapist, the dietician, the tissue viability nurse, the diabetes nurse and the continence advisor. Residents had opportunities for exercise and we saw that when the weather was fine they were encouraged to take short walks in the garden with a member of staff or to go for a walk outside the home. Residents can also do chair exercises to music. An aroma therapist comes to the home and offers massage sessions. We discussed the support given to diabetic residents. Since the last inspection the type of lancing device for the testing of blood sugar levels and the use of insulin pens has been reviewed, in line with guidance from the MHRA. We looked at the storage of medication and it was safe and secure. Records were seen and were up to date and complete. The home uses a blister pack system for the administration of medication and these were examined. We saw that 2 tablets were missing from packs, as the blisters were open although the day for doing this had not yet arrived. After an investigation the manager concluded that the backing to the blisters was thin and fragile and could tear on a blister even when the member of staff was not opening this particular blister. She has since spoken about this with the pharmacist. Members of staff administering medication have been reminded to be careful when handling the blister packs to avoid the backing tearing before blisters are opened. We also saw that one tablet remained in the blister pack and the word “omitted” had been written on the record sheet. The member of staff had forgotten to give this tablet and when they realised this at the time of the next medication round they marked the records appropriately, and took advice. The temperature in the fridge was monitored but the temperature in the clinical room was noted to be around 28 degrees centigrade, above the recommended guideline of 25 degrees centigrade for most medication. We discussed the resident’s right to privacy and dignity with the carers and a carer said that it was important to make sure that doors and curtains were closed and that only the people that needed to be in the room were present. A carer also stressed the need to promote independence by encouraging residents to do as much as they could for themselves. One of the residents that occupied a shared room told us that there were screens and that they were used in the room to give the residents privacy. During the inspection we saw that residents were clean and tidy and smartly dressed and noted that assistance with personal care was offered discreetly. Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Taking part in activities and using community resources gives residents the opportunity to enjoy an interesting and stimulating lifestyle. With staff support, residents are encouraged to maintain contact with their families and to enjoy fulfilling relationships. Residents are offered a varied and wholesome diet to maintain their well being. EVIDENCE: The home employs an activities co-ordinator for either a morning or an afternoon session, five days per week. The programme of activities includes outside entertainers visiting the home on a monthly basis. Cultural events are celebrated in the home. A notice was on display about the home’s anniversary party that was being held in July. (Relatives are encouraged to attend). Within the home music sessions take place, both those including listening to Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 16 music and singing and those including playing musical instruments. The programme on display also listed aromatherapy sessions and reminiscence sessions. We saw ball games being organised. The company also pays for 2 people to offer craft sessions in the home. A resident’s case file contained details of a resident going out for a pub lunch and attending parties held in the home e.g. for Easter Sunday, St Patrick’s day, St George’s Day etc. We saw that a number of residents enjoyed reading the paper and one of the residents told us that she was provided with a paper each day, free of charge. A resident confirmed that they took part in the activities organised in the home and pointed to some of the paintings they had done that were displayed on their bedroom wall. One of the residents said that she had enjoyed the Irish music because her father was Irish and she recognised the songs. A resident had recently celebrated her birthday and said that she had a birthday cake and that they “do it very nice for you”. We saw that there was a crucifix on the wall in the main lounge/dining area and a religious painting and statue. The manager said that there were a number of residents that were Catholic and one of them told us that the priest came to the home to celebrate mass. Residents confirmed that they were able to entertain their visitors in their bedroom or in the lounge areas. Visitors are welcome at all reasonable times although the nurses confirmed that the resident has the right to choose not to see a visitor and this is respected. We asked what choice or control residents had over their lives. Residents confirmed that they were able to choose where they entertained visitors, when they get up and go to bed, what clothes to wear, whether to spend time in their room rather than using the lounge and whether to take part in activities. The nurses also said that where residents were able to clearly make their wishes known they were asked whether the intended meal was acceptable or whether they would prefer an alternative. They also said that some residents are in the habit of getting up at night if they wake up and that this is respected. On arrival at Clavering we noted that the home has been awarded a 5 star (excellent) “score on the door” by the environmental health officer for food safety standards in the home. We spoke with the chef and looked at the 4 week rolling menu plans for lunch. Alternatives are listed on the menus and if the resident does not want either of the choices they are able to have a sandwich, or an omelette etc. Evening meals offer residents the choice of soup or a light cooked meal etc. Meals are prepared that are suitable for the dietary needs of 2 diabetic residents and that meet the cultural needs of AfricanCaribbean residents. Menus have been amended in the light of comments or suggestions made during residents or relatives meetings and the manager gave an example. She said that a suggestion had been made for jam to be included in the choice of fillings for sandwiches and that this had proved to be Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 17 very popular with residents. Snacks are available during the day and night, if required. Residents said that they were satisfied with the meals served in the home. They were described as nice and one resident said that the food was good and that it was well cooked. Another resident said that the meals were fine with edible home cooking. She had enjoyed a “nice piece of Cornish haddock” for lunch. One resident agreed that the meals were good and had also enjoyed the lunch of fried fish and the dessert of fruit salad. We saw the serving of the midday meal and noticed that a significant number of residents needed assistance with feeding. The manager said that each carer on duty was responsible for assisting named residents and we saw that when the assistance was given it was carried out in a friendly but professional manner. We also saw that a resident refused the main meal and the alternative and several other suggestions before they accepted one of the choices given. A number of residents with swallowing difficulties had a pureed meal and we noted that each different food item had been pureed separately and that the mashed potato was piped on the plate in the form of a rosette to provide an attractive appearance to the meal. Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure in place to protect and safeguard the rights of residents. Protection of vulnerable adults training for staff and familiarity with the home’s procedure and the interagency guidelines contribute towards the safety of residents. EVIDENCE: The home has a complaints procedure in place and it includes the stages and timescales for the process. A copy is on display in the entrance hall and it includes contact details for the local office of the CSCI. A copy of the complaints procedure is left in a pocket on the door of each resident’s bedroom. Parts of the revised Service User Guide were emailed to the CSCI and we saw that it contains information regarding the complaints procedure and contact details for the CSCI, the local Primary Care Trust and the local Social Services department. Records were available for inspection although no complaints from residents or from relatives acting on their behalf have been recorded by the home since the last inspection in July 2007. When asked Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 19 whether they would know what to do if someone had concerns about the home 8 of the 9 members of staff ticked “yes”. We spoke with the nurses and carers on duty and they confirmed that they had received training in adult protection procedures. They were able to link this with whistle blowing and to explain to us what they would do in the event of an allegation or incident of abuse occurring in the home. The nurses were clear about reporting lines, if the manager was off duty, when a disclosure was made or incident occurred. The home has a protection of vulnerable adults procedure in place, which includes a link to the home’s whistle blowing procedures and contains information regarding the CSCI. The manager said that there have been no incidents or allegations of abuse since the last key inspection. She confirmed that the home has a copy of the local authority interagency guidelines in the event of abuse. The manager said that the home also had a copy of the guidelines for each authority that had a contract with the home. The administrator confirmed that members of staff receive training in house regarding protection of vulnerable adults and the home has a video, which is used when giving refresher training. They also attend external courses for protection of vulnerable adults training and safeguarding adults training. We saw that induction training for new staff included an awareness of protection of vulnerable adults procedures. Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents enjoy comfortable surroundings that are maintained to a good standard. The numbers of bathing and toilet facilities in the home are sufficient to meet the needs of the residents. Residents are assured of hygienic surroundings as good standards of cleanliness prevail. EVIDENCE: Residents said that they were satisfied with their rooms. They were described as nice and a resident said that they had one of the best as it had a pleasant outlook and that sitting in a chair she could watch the trees and this lifted her Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 21 spirit. One of the residents had recently changed bedrooms and had moved from a first floor shared room to a ground floor single room with an en-suite toilet. Due to health reasons the new room was more appropriate and the resident was very pleased with their new accommodation, especially as it overlooked the garden. A site inspection took place during the first visit to the home. There is level access to the home at the front of the building and into the garden area and the provision of a passenger lift linking ground and first floors ensures accessibility within the building. It was noted that the home was clean and was maintained to a good standard although some bedroom furniture is in need of replacement and the manager said that they are working through a programme of replacement. The home was furnished and decorated in a homely manner with personalised touches to the communal areas and the bedrooms. Bedroom doors had a picture of and the name of the client(s) occupying the room to promote orientation. The new lounge area on the ground floor is now used by residents and used as a visitors’ room. It has a dining table and comfortable seating for 8 persons. Residents said that the home was kept clean and tidy and that the rooms were kept clean. Since the last inspection additional grab rails have been fitted in some of the bathing and toilet facilities so that residents find them easier to use. The toilet that was out of use at the time of the last inspection has been repaired and reopened. A new toilet has been installed that incorporates a bidet function and where the height of the seat can be adjusted at the press of a button. The new parker bath has been installed. We discussed the suitability of some of the en-suite facilities and the manager said that due to the frailty of many of the residents and the size of the room the en-suite facilities were seldom used. Communal facilities are situated on each floor containing residents’ bedrooms and close to lounge/dining areas. Bathroom and toilet doors had a picture of the bath or toilet to promote orientation. We noted that all parts of the home were free from offensive odours. Members of staff confirmed that they had received training about infection control procedures. A resident said that bedding and clothing was changed on a regular basis and praised the very quick turnaround for laundering clothes. Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are assured of sufficient staff on duty to meet their needs. Residents benefit from a service provided by carers that have demonstrated their skills and understanding through NVQ training. Thorough recruitment practices protect the safety and welfare of residents. A comprehensive programme of training for staff encourages good working practices. EVIDENCE: We discussed staffing levels with the 2 nurses on duty during our first visit to the home. A copy of the rota was available. There are 3 qualified nurses and 8 carers on duty during the early shift and 2 qualified nurses and 8 carers on duty during the late shift. At night there is 1 qualified nurse and 4 carers on duty. Although most of the carers are female there are 4 male carers working in the home. Carers that we spoke with confirmed that the staff on duty worked well together as a team and said that their colleagues were helpful. A newer member of staff said that she could ask questions and that her colleagues also asked her if she needed any help. When asked whether there Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 23 are enough staff on duty to meet the individual needs of service users 5 members of staff ticked “yes” and 4 members of staff ticked “usually”. One of the 4 members of staff went on to comment that it would be helpful if an extra carer could be provided for the afternoon shift so that there is enough time to respond to residents requests. The home also employs catering and domestic staff. There is a laundry person, a handy person responsible for maintenance in the home, a housekeeper, an administrator and an activities co-ordinator working in the home. Residents described the staff as “helpful and kind”, “kind and caring” and “friendly”. We spoke with the administrator regarding NVQ training. She has successfully completed an NVQ level 3 in management qualification. On studying the rota she said that 3 carers have completed their NVQ level 3 training and 8 carers have completed their level 2 training. A further 14 carers are currently undertaking NVQ level 2 or 3 training. In addition the housekeeper and domestic and catering staff are also undertaking NVQ training. The home has met the target of 50 of carers having achieved an NVQ level 2 in care qualification. We spoke with 2 carers working in the home during the inspection. One carer had completed her NVQ level 3 training and the other carer was currently studying for her level 3 qualification. Five staff files were examined. We saw that files contained application forms, job description, contract, enhanced CRB disclosures, pova first checks (as required), proof of identity (passport details), and 2 references. The right to reside and to work in the UK had been established. Where the applicant was a qualified nurse the pin number had been checked and verified. The nurses that we spoke with confirmed that they were given opportunities to undertake the training necessary to maintain their PIN status. They confirmed that they had also undertaken mentoring and undertaken equalities and diversity training within the last 12 months. Carers confirmed that they received training. This included both training sessions and the use of DVD’s and videos. They confirmed that they had received training in safe working practice topics and training that was specific to the needs of the residents e.g. dementia care, diet and nutritional needs etc. The activities co-ordinator has completed a “Therapeutic Activities in Dementia Care” training course. Ten members of staff are studying English as a Second Language at a local college. The administrator showed us a copy of the record of forthcoming training events with the confirmation of delegates from the home that would be attending. Staff files contained individual staff profiles and copies of attendance certificates for training attended were kept. A comprehensive package of training is arranged for new members of staff, which includes the Skills for Care Common Induction Standards and the Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 24 home’s own “Learn to Care” programme which includes a series of videos. (The series includes the topics of food hygiene, infection control, protection of vulnerable adults procedures and dementia care). Records are kept in respect of both elements of training. In addition new employees also receive a copy of “Each Day is Different”, a booklet produced by the Alzheimer’s Society for carers of residents that have dementia. A new member of staff confirmed that she had received induction training. Monthly training plans were available for inspection and they demonstrated that a wide range of courses is offered. These were on display in the home. Five members of staff ticked that their induction covered everything they needed to know to do the job when they started “very well” and four members of staff ticked “mostly”. When asked whether the training given since then is relevant to their role and whether it kept them up to date with new ways of working all of the members of staff ticked “yes”. When asked whether the training provided helps them to understand the individual needs of service users (disability, gender, age, race and ethnicity, faith and sexual orientation) 8 of the 9 members of staff ticked “yes”. Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Continuing to undertake further training enables the manager to develop her knowledge, skills and understanding and to provide a service that is responsive to the needs of residents. Information gained through the quality assurance systems in place in the home is used to shape the future development of the service and ensure that the changing needs of residents are met. Systems are in place to protect the financial interests of the residents. Training for staff in safe working practice topics promotes the health and safety of residents, staff and visitors to the home. However, this is compromised due to the lack of a valid employer’s liability insurance certificate. Testing and servicing of equipment and systems in the home demonstrate that they continue to be safe to use. Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 26 EVIDENCE: The manger has been managing the home for more than 5 years and prior to this she worked as a manager for the company for 6 years. She is a registered nurse and has successfully completed the RMA. Since the last inspection she has undertaken training in relation to the Mental Capacity Act, leadership at the point of care, conflict management and mentoring. She has completed her Assessors’ certificate and has undertaken a management training course. Members of staff that we spoke with said that the manager was supportive and a carer said that there were regular meetings and that anything new was discussed. When asked on the survey forms whether the manager met with the member of staff to give them support and to discuss how they were working 5 members of staff ticked “regularly”, 2 members of staff ticked “often”, 1 member of staff ticked “sometimes” and 1 member of staff ticked “never”. A member of staff added on the survey form that, “the manager is present at the handover daily. She is very helpful towards all staff at all times”. A resident said that on arriving at the home the manager “had made me very welcome”. There were systems in place to monitor the quality of the service provided in the home. The manager carries out spot checks during the night shifts and calls to the home unannounced at various times of the day. The most recent report of a quarterly night visit was dated June 2008. A number of themed audits are undertaken e.g. care plans and medication management, housekeeping and the kitchen. Head office also carries out quality audit reviews by sending out an annual survey to relatives and stakeholders, with feedback to the home in September. Relatives receive feedback about the results of the survey in a newsletter. The home itself also sends out survey forms on an ad hoc basis to relatives and to staff. A copy of the form was seen. Relatives meetings are held and the minutes of the meeting are sent to all relatives, irrespective of whether they attended. The last meeting was held in June 2008. The home has Investors in People status, which is subject to external scrutiny and review. A resident said that she attended residents’ meetings. We discussed the home’s involvement with residents’ finances with the manager. No one working for the company is an appointee for any of the residents. Some residents receive assistance from a solicitor or from the Court of Protection. Records are kept of all transactions made on behalf of a resident and some relatives may leave a small amount of money with the home or send money directly to head office or arrange for a standing order to be made Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 27 payable to head office so that there is money available for their resident’s use. All receipts are sent to head office and invoices for some services e.g. massage or hairdressing are automatically sent there. Relatives receive individual statements so that they have a record of how the money is spent. Records were seen and were up to date and complete. We saw that interest is paid on the balance of money held at head office, on behalf of the resident. A discussion took place about systems and equipment in use in the home. All servicing/inspection records are kept in a file and there is a service inspection sheet at the front to help track when the next service/inspection is due. Records were inspected and we saw that servicing/inspection had been carried out at the required intervals and that there was confirmation that the fire precautionary systems and equipment in the home were in working order and safe to use. A copy of the employers’ liability insurance certificate was on display in the home in the entrance hall. This had expired. A number of nurses and carers have trained to be fire wardens. There was a record of weekly testing of the fire alarm system and regular fire drills being held. Fire notices were translated into Lithuanian as the home has a significant number of carers that were born in Lithuania. Fire exit signs were present in the home. There was a record of training carers in safe working practice topics. Since the last inspection keypads have been fitted on doors on the first floor leading to the internal staircase. Due to the height of the banisters on the landing and the gaps between the spindles on this staircase they could have posed a safety risk to residents. Similarly alarms have been fitted to fire doors so that if a resident managed to break the glass and leave the home the staff on duty would be alerted. Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1) Requirement To assure each resident that the service provided meets their individual needs and preferences a service user’s choices form must be completed, even where the resident’s choices may be limited by their physical circumstances. To assure residents that all of their individual needs are identified and can be addressed the care plan must include a thorough assessment of social care needs. To assure residents that their medication is protected during storage members of staff handling the blister packs must do so with care to avoid damaging the backing of the blisters. To assure residents that they receive their medication at the times of the day as directed by their GP the person administering medication must check that all tablets have been given. To assure residents of a pleasing DS0000057551.V366899.R01.S.doc Timescale for action 01/10/08 2 OP7 15(1) 01/10/08 3 OP9 13(2) 01/08/08 4 OP9 13(2) 01/08/08 5 OP19 16(2) 01/01/09 Page 30 Clavering Nursing Home Version 5.2 6 OP27 18(1) 7 OP38 25(2) and comfortable environment the home must complete its programme replacing worn bedroom furniture. To assure residents that there are sufficient staff on duty to respond to their needs in a timely manner a review of staffing levels in the afternoons must take place. To assure residents, members of staff and visitors to the home that their welfare is promoted at all times a valid certificate for Employer’s Liability insurance cover must be on display in the home. 18/08/08 01/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP3 OP8 OP9 OP16 OP30 Good Practice Recommendations That all forms used in the pre-admission procedure are dated. That nutritional risk assessment forms are complete and present on each case file. That consideration is given to ensure that medicines are kept below 25 degrees centigrade by using measures such as installing air conditioning. That during the next staff meeting all members of staff are reminded about what to do if someone has concerns about the home. That the home reviews the training given to members of staff that is to enable them to understand the individual needs of residents in terms of disability, gender, age, race and ethnicity, faith and sexual orientation. Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Clavering Nursing Home DS0000057551.V366899.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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