Inspection on 26/09/07 for Clairleigh Nursing Home

This inspection was carried out on 26th September 2007.

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 20/07/06

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 26th September 2007 09:30 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.V344193.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. Clairleigh Nursing Home DS0000010131.V344193.R01.S.doc Version 5.2 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 clairleigh@britishlibrary.net 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.V344193.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing Notice issued 15 June 1993 Date of last inspection 20th July 2006 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. The fees for this home range from £580 to £870 each week (this information given to the CSCI in September 2007). Clairleigh Nursing Home DS0000010131.V344193.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection included an unannounced visit to Clairleigh, carried out by an inspector who was accompanied by one of the commission’s ‘Experts by Experience’. Responses to surveys carried out by the commission have also been taken into account. During the visit, we toured the premises, observed experiences of residents and spoke with residents, visitors, staff members and the home’s manager. The inspector sampled documentation such as care plans, staff recruitment files and medication charts. What the service does well: What has improved since the last inspection? Since the previous inspection, the home’s manager has completed the Registered Manager’s Award. The home has completed adoption of a nutritional screening tool – Malnutrition Universal Screening Tool (MUST). This is good practice, in line with the relevant National Service Framework. Clairleigh Nursing Home DS0000010131.V344193.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Clairleigh Nursing Home DS0000010131.V344193.R01.S.doc Version 5.2 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.V344193.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Before prospective residents are offered a place in the home, their needs are assessed to ensure the home can meet those needs. Prospective residents and/or their representatives normally have enough information to enable them to choose whether the home is right for them. Residents can be assured they will be provided with a contract/statement of terms and conditions. EVIDENCE: Eighty-nine per cent of the residents who returned survey questionnaires to the commission stated they had received enough information about the home before moving in so they could decide if it was the right place for them. One resident commented s/he had received a list from social services of homes in the Bromley area but this was not enough information. The home’s statement Clairleigh Nursing Home DS0000010131.V344193.R01.S.doc Version 5.2 Page 9 of purpose and its service user guide were readily accessible to residents, relatives and other visitors to the home. Discussions with residents and staff, and care documentation seen during the visit confirmed that assessments of individual residents’ needs had been carried out. Residents receive confirmation that the home is suitable for meeting these needs. Residents have a contract, which covers arrangements for fees, the terms and conditions of residency and both parties’ rights and responsibilities. Eighty-six per cent of the residents who returned questionnaires stated they had received a contract. Three residents’ files were sampled and two contained contracts/statements of terms and conditions. The third resident’s contract was with her representative. Clairleigh does not offer intermediate care thus standard 6 does not apply in this instance. Clairleigh Nursing Home DS0000010131.V344193.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each resident has a care plan, based on assessment of their needs. Their health care needs are met and they have good access to local health care services. Staff treat residents with respect and make sure their privacy is upheld. EVIDENCE: Care documentation sampled showed that care plans are based on assessment of the person’s needs and are kept under review. The Activities of Daily Living (Roper et al) are used as a framework for care delivery. Risk assessments for falls, mobility, continence, tissue viability and nutrition were in place for the care documentation sampled. A carer said she looks at care plans because “they tell me how to care for people, like how to help them move about”. Clairleigh Nursing Home DS0000010131.V344193.R01.S.doc Version 5.2 Page 11 Since the previous inspection, the home has adopted a nutritional screening tool (MUST), in line with the relevant National Service Framework. Nursing staff have received training in the use of this tool. The care of three residents was case tracked. It was evident that each of these residents was receiving care as outlined in their care plans. For example, one of the residents had a pressure ulcer for which staff were giving nursing treatment according to guidance set out in the care plan, and the progress of the ulcer was being kept under continual review. Input from local specialist health care services, such as tissue viability and diabetic podiatry services, had been provided as the resident’s needs required. A local GP practice provides medical support to the home. Residents confirmed that access to the doctor was available to them when they needed it. Of the residents who returned completed questionnaires to the commission, all stated they always receive the medical support they needed. Residents were well groomed and dressed appropriately for the time of year. One resident had had a manicure that morning which she was very pleased with when she showed the results to our Expert. Staff were treating residents with respect and residents said staff respect their privacy and dignity when helping with personal care. Of the residents who returned completed questionnaires to the commission, 33 stated they always receive the care and support they need and 67 that this is usually the case. I saw medicines being given to some of the residents and administration was carried out safely, in accordance with procedure. Nursing staff give medicines in this home. I looked at a sample of medication administration records (MAR) and found the records to be accurate and up to date. There were photographs of each resident and there were no unexplained gaps in administration records. The storage of drugs was generally satisfactory, though staff should make sure they always record the opening dates of perishable medications (recommendation 1). No residents were being prescribed controlled drugs at the time of this inspection. Clairleigh Nursing Home DS0000010131.V344193.R01.S.doc Version 5.2 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. 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. Residents choose how they spend their time and are supported to maintain contact with their families and friends. Residents can choose to take part in various planned activities. A balanced and nutritious diet is provided. EVIDENCE: The relaxed atmosphere in this home impressed our Expert, who had not visited Clairleigh before. Residents were sitting in groups, usually of around 46 people, in different areas of the home or people could choose to relax in their rooms. Residents are given choices and flexibility in daily routines, choice of food, bedtimes and getting up times. The activities coordinator was working with residents during the day of our visit. Residents can choose whether to take part in various planned activities, such as cooking, armchair aerobics, bingo and musical events. The coordinator works with resident groups and also visits residents in their rooms if they prefer her to meet with them individually. The activities file has entries for Clairleigh Nursing Home DS0000010131.V344193.R01.S.doc Version 5.2 Page 13 each resident in the home. The three residents being case tracked each had activities recorded for recent weeks, two having taken part in various group sessions and one who preferred the coordinator to work with her one-to-one. Residents offered positive comments about the activities offered. Of the residents who returned completed questionnaires to the commission, 44 stated the home always arranges activities that they could take part in and 56 that this is usually the case. One resident with restricted mobility and vision said she liked the food and the activities but because of her visual problem she could no longer read. This upset her, as she had been an avid reader, and our Expert suggested the home consider whether “talking books” would be appropriate. Residents said they were able to have visitors at any time. Relatives who were visiting said they were always made to feel welcome at the home. One resident being case tracked was visited by his priest during the day of the inspection. This is a regular visit, which is important to the resident and which the home supports. Of the residents who returned completed questionnaires, 33 stated they always like the meals at the home and 56 that they usually like them. Eleven per cent stated they sometimes like the meals. All the residents that our Expert spoke to said they enjoyed the food. One said she had had a birthday the previous week when a cake was made by the chef, and she also received cards from all the staff. Residents 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 Residents said the lunch was nice. I asked the chef for a small portion to try and I found it tasty and well cooked. Residents were being offered plenty of drinks and being encouraged to take fluids. The chef was making time to talk with residents to make sure they were happy with their meals. A resident told me the chef does this every day, which she thinks is a very good service. The menus showed that the diet is balanced and nutritious. I visited the kitchen and found it to be clean, tidy and well organised, with all its equipment in good working order. The home has received a local authority Clean Food Award, valid until May 2008. Clairleigh Nursing Home DS0000010131.V344193.R01.S.doc Version 5.2 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. 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. Residents know how to make a complaint, and may be confident that any complaints they or their representatives raise will be properly addressed. Residents are protected from abuse. EVIDENCE: Eighty-nine per cent of the residents who returned completed questionnaires to the commission stated they always know who to speak to if they are not happy. Eleven per cent stated this is usually the case. All the residents stated they knew how to make a complaint. The home’s complaints book was examined during the inspection visit. It contained records of specific complaints and gave a monthly summary of complaints received. There had been eleven entries since the previous inspection, including one complaint that the commission had referred to the provider for response. Details of actions taken were recorded. Members of staff showed understanding about protecting residents from abuse, what procedures to follow and whom they should inform if they suspected or witnessed abuse occurring. Adult protection procedures are in place and arrangements made so that staff receive relevant training. The commission is Clairleigh Nursing Home DS0000010131.V344193.R01.S.doc Version 5.2 Page 15 aware of one allegation made since the previous inspection. This was managed by Bromley social services, in consultation with the placing authority, and was not upheld. Clairleigh Nursing Home DS0000010131.V344193.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, clean and hygienic environment. Residents enjoy the facilities, such as the well-kept gardens. EVIDENCE: On the day of our visit, the home was clean, tidy and free from unpleasant odours. The home was well decorated and furnished. Seventy-eight per cent of the residents who returned completed questionnaires to the commission stated the home is always fresh and clean, and 22 stated this is usually the case. There is a large, well-kept garden with seating areas for residents, and there was also a sunny conservatory where several of the residents had their lunch later in the day. Residents said how much they had enjoyed being outside Clairleigh Nursing Home DS0000010131.V344193.R01.S.doc Version 5.2 Page 17 during the nice weather, and how they also like being able to see the gardens from inside the home. Bedrooms had the resident’s name on the door. The rooms were well decorated and there were photographs of families, soft toys, televisions and radios. At the time of our arrival, many of the residents were in their rooms. In the bedrooms there was a jug of juice and a jug of water for each resident, and these were replenished regularly. 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. Good infection control strategies were in place, with disposable aprons and gloves accessible to staff. The laundry assistant had an appropriate working knowledge of basic infection control practice. The laundry equipment was in good working order. The manager keeps a record of all infections, to enable monitoring of any trends. The information recorded includes the date, name of the resident, the type of infection, and a summary of any treatment given. Clairleigh Nursing Home DS0000010131.V344193.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents may be assured that the number and competence of staff members will meet their needs. The home’s recruitment procedures support and protect residents but can be improved further. EVIDENCE: The number and skill mix of staff working in the home on the day of our inspection visit was appropriate to meet the needs of the 27 people in residence. All of the residents who returned completed questionnaires to the commission stated that staff listened and acted on what they [the residents] said. Fortyfour per cent of these respondents stated staff are always available when they needed them, and 56 stated this is usually the case. A staff member said “occasionally we’re a bit stretched but this is not usual, and there is always enough time to talk with the residents”. A resident our Expert was talking with seemed uncomfortable and wanted to sit up in a more upright position. Two members of staff responded immediately and helped the resident to sit more comfortably. Clairleigh Nursing Home DS0000010131.V344193.R01.S.doc Version 5.2 Page 19 We saw examples during our visit of positive, relaxed interactions between residents and staff. Residents told our Expert that the staff were very friendly and helpful. Staff told they thought there was good communication and that the staff members work well as a team. A nurse outlined her responsibilities for care planning and review of care. She spoke about training she had attended, and how she had been able to apply training in her work with residents. The training events had been both in-house and external study days. Staff said they receive statutory training regularly. From discussions, I understood the home is working on arrangements regarding Skills for Care, which staff see as a new development. Staff members spoken with said they had applied for their posts, and had undergone a selection process that included an interview. They had had to wait for recruitment checks to be completed before they had started work in the home. On taking up their posts, they had undergone a period of induction to their new role and function. The staff files sampled for inspection had most of the information required by legislation. It was evident that a previous requirement about CRB disclosures had been met. One of the files did not include any information about the person’s previous work history and this omission was raised as an issue for attention (requirement 1). Clairleigh Nursing Home DS0000010131.V344193.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents may be assured the manager is experienced and has the skills to run the home well. Quality assurance mechanisms monitor the care and service provided, and identify where improvements might be made. The health and safety of residents and staff is promoted. EVIDENCE: Since the previous inspection, the home’s manager has completed the Registered Manager’s Award. She has been the manager of Clairleigh for twelve years and is an experienced registered nurse. Our Expert spent time with the manager and found her to be “friendly, approachable and Clairleigh Nursing Home DS0000010131.V344193.R01.S.doc Version 5.2 Page 21 professional”. This is consistent with the positive comments we have received about the day-to-day management of the home. Staff said the manager gives them good support and is readily available to them if they need to speak with her. The commission has been supplied with monthly reports of visits to the home, carried out by the provider in compliance with regulation 26. The reports indicate that all main aspects of service provision are kept under review, and that the views of residents and staff are taken into account. The home’s manager 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 to examine practice development and its application in their care homes. Normally, the home pays for services such as hairdressing in advance and an invoice is then sent to the family or other representative of the resident asking for reimbursement. Residents either look after their money or, where preferred, their families provide residents with small amounts of money for expenditure on items such as newspapers or toiletries. I examined a sample of health and safety documentation and maintenance records and found they were up to date and within the appropriate timeframes. The sample included documentation about accidents, gas safety, lifting equipment, disposal of waste, and fire prevention. This documentation, together with a tour of the premises, discussions with the manager and with the home’s maintenance technician, provided evidence that the home promotes the health and safety of its residents, staff and visitors. The premises and equipment within the home were being well maintained. Clairleigh Nursing Home DS0000010131.V344193.R01.S.doc Version 5.2 Page 22 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 X 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 3 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.V344193.R01.S.doc Version 5.2 Page 23 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 Sch 2 Requirement The registered person must ensure that a full employment history, together with a satisfactory written explanation of any gaps in employment, is obtained for all staff members before they begin work in the home. Timescale for action 31/10/07 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 that the opening dates are always recorded of medicines to be discarded within a stipulated time after first use. Clairleigh Nursing Home DS0000010131.V344193.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Clairleigh Nursing Home DS0000010131.V344193.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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