Inspection on 20/07/06 for Clairleigh Nursing Home

This inspection was carried out on 20th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Clairleigh Nursing Home 26/09/07

Clairleigh Nursing Home 06/12/05

Clairleigh Nursing Home 26/11/04

Clairleigh Nursing Home 08/06/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Clairleigh Nursing Home 104 Plaistow Lane Bromley Kent BR1 3AS Lead Inspector David Lacey Unannounced Inspection 20th July 2006 10:00 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 Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 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. Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Clairleigh Nursing Home Address 104 Plaistow Lane Bromley Kent BR1 3AS 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) 020 8460 1527 020 8313 3815 Palmgrange Limited Mrs Mercian Courtney Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Terminally ill (30), Terminally ill over 65 of places years of age (30) Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing Notice issued 15 June 1993 Date of last inspection 6th December 2005 Brief Description of the Service: Clairleigh is a care home that provides nursing care for up to 30 older people including those requiring palliative care. It is a detached property with accommodation provided on two floors. There is parking space to the front and an attractive, well maintained garden to the rear of the home. There are eighteen single and six shared bedrooms, all having en-suite facilities. The home is near local amenities, public transport links and Bromley town centre. Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. What the service does well: What has improved since the last inspection? Any complaint or concern brought to the manager’s attention is recorded, including the details and the action(s) taken. Records are now kept of any alternatives to the main menu that are provided to service users. The laundry staffing levels have been increased. Reports of the providers’ monthly visits to the home are sent to CSCI. Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 Page 6 What they could do better: 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. Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 Page 7 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 Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users’ needs are assessed before they are offered a place in the home. The statement of purpose enables prospective service users and/or their representatives to make an informed choice about moving into the home. Service users are provided with a contract. The home does not offer intermediate care, thus standard 6 does not apply in this instance. EVIDENCE: Service users whose care was tracked said they had received an assessment by the home’s staff, usually the manager, before moving in to the home. The sample of care documentation seen during the visit confirmed that assessments of individual service users’ needs had been carried out, which had determined that the home was suitable for meeting these needs. The manager confirms in writing to service users that the home is able to meet their needs at the point of the assessment being completed, before admission to the home. Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 Page 9 The home’s statement of purpose and service user guide have been provided to the CSCI and were readily accessible to service users, relatives and other visitors to the home. Service users sign and receive a contract, which covers arrangements for fees, the terms and conditions of residency and both parties’ rights and responsibilities. Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. All service users have a care plan, based on assessment of their needs. Service users may be assured that their health care needs will be met. Service users are treated with respect and their privacy is upheld. EVIDENCE: Examination of a sample of care documentation showed that care plans are based on assessment of the individual service user’s needs. Care plans gave guidance to staff about meeting personal, social and health needs. It was evident that care delivery was kept under review but in one care plan seen the evaluation sheet did not accurately reflect the review dates listed. For example, it was stated that a review had taken place in June 2006 but the evaluation sheet did not contain anything for that month. It would be helpful to record the actual date of the review, rather than just the month. The manager advised that the home was in the process of adopting a new nutritional screening tool – Malnutrition Universal Screening Tool (MUST). All Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 Page 11 service users’ documentation will include the MUST by the end of July 2006. This is good practice, in line with the relevant National Service Framework. It was evident from service users’ files seen that they included the MUST but that not all were being used as yet. A local GP practice provides medical support to the home. The GP holds monthly ‘surgeries’ in the home, with additional visits as needed. Service users confirmed that access to the doctor was available to them when they needed it. Medication administration was observed and was satisfactory. Medication charts for service users being case-tracked were examined. These were satisfactory, though it is recommended that clear guidance is given with regard to ‘as required’ medications, which can be followed by staff when reaching decisions whether to administer. This should include creams, as it was not always clear why a cream had either been applied or omitted. It was evident from discussions with service users and relatives that they are treated with respect and their right to privacy maintained. Staff were seen to knock on doors before entering, and to address service users respectfully and by their preferred names. Service users spoken with said staff respected their privacy and dignity when helping with personal care. Privacy screening is provided in shared bedrooms. Staff were observed providing help to service users in a calm manner. Relatives said they had seen staff respond promptly to service users calling for assistance. Service users’ wishes about action(s) to be taken following their death are recorded in their care plans whenever possible. This was evident from a care plan examined during the inspection visit. Clairleigh offers palliative care and has been registered since 2004 to provide this to up to two service users with terminal illness. The Commission has confirmed recently that this specific registration category is to be withdrawn from 31/07/2006. This is because Government policy on palliative and end of life care recommends that all care homes should be able to provide this type of care for service users. The Department of Health [DH] has confirmed that the TI category is not essential before a care home can admit or keep service users with palliative and end of life care needs. The manager confirmed the home had received a letter in this respect from the CSCI’s Chief Inspector. Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. A range of appropriate activities is available to service users, to engage in as they choose. Service users choose how they spend their time and are supported to maintain contact with their families and friends. Service users receive a balanced and nutritious diet. EVIDENCE: There was a calm, relaxed atmosphere in the home when the inspector arrived in the morning. Service users were either in the lounges or their rooms. Service users said they get up when they choose. The manager said, “we don’t rush them, they can do as they please”. Service users are encouraged and supported to make their bedrooms as personal as possible, by bringing their own personal items, family photographs and small pieces of furniture. The home offers a programme of planned activities. During the afternoon of the inspection visit, a group of service users were enjoying listening to ‘oldtime’ music. From discussion, it was apparent that there are group activities, such as bingo and light exercises, and other activities provided for individuals Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 Page 13 such as a stock of large print books. Service users choose whether to take part in formal activities. Service users said they were able to have visitors at any time. Some relatives who were visiting during the inspection said they were always made to feel welcome at the home and are offered refreshments. It was a hot day when the inspector visited and service users were being offered plenty of drinks and being encouraged to take fluids. Service users took lunch either in their rooms or in the dining room, as they chose. Sensitive, unhurried assistance with feeding was provided by staff as needed. The chef was out and about, talking with service users and making sure they were happy with their meals. The inspector visited the kitchen and found it to be clean, tidy and well organised, with all its equipment in good working order. A previous requirement about food records had been met. Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users and their representatives may be assured that any complaints they raise will be properly addressed. Service users are protected from abuse. EVIDENCE: It was evident that a previous requirement to keep a record of all complaints made had been met. The home’s complaints book was seen and showed that four complaints had been received since the previous inspection. Details had been recorded about each complaint, the action(s) taken and the outcome. There was a monthly audit of complaints on file. Service users and visitors said they knew how to raise any concerns. One said, “I talk to Mrs Courtney (the manager) and she always sorts it out”. The inspector saw examples throughout the day of positive, relaxed interactions between service users and staff. Adult protection procedures are in place and arrangements made so that staff receive relevant training. Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users live in a safe, clean and homely environment. Procedures are in place to prevent infection. The home has appropriate equipment to meet its service users’ needs. EVIDENCE: A tour of the home showed that it was clean and tidy, with no evidence of unpleasant odours. Service users and visitors said the home is always like this, and was an important factor in choosing the home. The grounds were well kept, with grass cut and flower beds tended. In addition to the permanent garden building, there was a marquee with seating erected for the summer where service users and their visitors could sit in the shade while enjoying the gardens. Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 Page 16 The home has a passenger lift to access upper floors. Grab rails are fitted in all corridors and toilets. An emergency call system operates throughout the home and is readily accessible to service users. One of the shared rooms has a door leading to a roof terrace. The door had been left ajar, as it was a hot day. It was understood from the manager that this door was normally kept shut. By the end of the inspection visit, the manager had drawn up a risk assessment/protocol for the door. The water flow from the taps in an upper floor bathroom was restricted. The manager agreed to ask the maintenance technician to attend to this. A previous recommendation about laundry staffing had been addressed (see Staffing section below). The inspector visited the laundry and spoke with the assistant. The assistant had been in post for about three months, had received an induction and had an appropriate working knowledge of basic infection control practice. The laundry equipment was in good working order. Good infection control strategies were in place, with disposable aprons and gloves accessible to staff. Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Suitably qualified and competent staff members work in the home in sufficient numbers to enable good care delivery to service users. The home’s recruitment procedures provide protection for service users but can be improved further. EVIDENCE: There were sufficient staff working in the home on the day of the inspection visit, and the skill mix of the staff members was appropriate to meet the needs of the service users in residence. Comments from service users, relatives and staff members, and examination of the rota confirmed that appropriate levels of staffing were being maintained. A previous recommendation to increase staffing of the laundry at weekends had been addressed. It was understood an additional laundry assistant was to begin working for two days each week. A qualified staff member said she was happy working at the home. She said there were enough staff and that, “we are a good team and we help each other”. She had applied for her post, and had undergone a selection process that included an interview. Examination of her personnel file showed that the information and documentation required by legislation had been obtained. An enhanced CRB disclosure had been obtained through the provider when the nurse had applied for the post. Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 Page 18 A carer the inspector spoke with had been recruited from another European country, via a recruitment agency. Examination of her file showed that most of the necessary information had been obtained, with the exception of a CRB disclosure. She had provided a similar disclosure from her own country but this is not sufficient to meet UK legislation. It was understood the staff member was working under supervision but she had been in post since 2005. The provider must ensure that CRB disclosures are obtained for all staff members before they begin work in the home. Staff said they receive statutory training regularly. One of the senior nurses is the home’s designated moving and handling trainer, following her completion of an appropriate preparation course. She teaches carers and assesses their competence. The most recent session had been held the day before the inspection visit. The outcome was positive, with staff feeling they had developed their practice in this respect. Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The manager is fit to run the home. Quality assurance mechanisms are in place to monitor and improve the care and service provided. Copies of the provider’s monthly audit are again being sent to the CSCI, after a two-month gap. The health and safety of service users and staff is promoted. EVIDENCE: The home’s manager is experienced and has been assessed by the Commission as fit to run the home. She undertakes audits to monitor the quality of service, including the quality of nursing being provided. She is a member of a local nursing home managers’ group, which meets regularly to discuss practice development and its application in their homes. The inspector saw draft nutrition guidance, which the manager is working on as her current contribution to the group’s work. Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 Page 20 The home’s owners have recently delegated the operation of the home to a management company. However, the owners continue to spend regular periods of time each week in the home. Following a previous requirement, the CSCI had been receiving copies of the provider’s monthly audit until April 2006, but none had been received since that date until this inspection. It was understood that the home’s owners had now delegated this task to the management company. Following this inspection, the CSCI received the first regulation 26 report from the management company, on behalf of the provider. Thus, the previous requirement has been removed. Relatives provide service users with small amounts of money, which they keep on their person. Normally, the home pays for services such as hairdressing in advance and an invoice is then sent to the family asking for reimbursement. A selection of health and safety documentation was examined and found to be up to date and within the appropriate timeframes. There were floor-standing fans being used in the home during the hot weather. Given the frailty of some service users, it is recommended that risk assessments be put in place for the locations and operation of these fans. Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 Page 21 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 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 4 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 Page 22 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 OP29 Regulation 19 Requirement The registered person must ensure that CRB disclosures are obtained for all staff members before they begin work in the home. Timescale for action 31/08/06 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 Refer to Standard OP9 Good Practice Recommendations The registered person should ensure clear, written guidance is given with regard to ‘as required’ medications, including creams, which can be followed by staff when reaching decisions whether to administer. The registered person should ensure that risk assessments are put in place for floor-standing fans. 2 OP38 Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 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 Clairleigh Nursing Home DS0000010131.V290701.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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