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Inspection on 06/12/05 for Clairleigh Nursing Home

Also see our care home review for Clairleigh Nursing Home for more information

This inspection was carried out on 6th December 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home ensures service users health needs are met by the staff working in the home and when necessary liaising with relevant health care specialists. Staff working in the home were able to demonstrate the manner in which they support service users to make choices about their day to day lives and activities. The home ensures service users are provided with details of the complaints procedure; this information is also display in the home. Appropriate training is provided to meet the health, safety and care needs of service users and staff working in the home. There are a sufficient number of suitably qualified and competent staff employed to provide care to service users. Robust recruitment procedures are in place and provide protection for service users living in the home.

What has improved since the last inspection?

No requirements or recommendations were made following the previous inspection.

What the care home could do better:

Although service users are provided with a choice of menu for each meal and an alternative is offered if a service user does not like the planned meals, a more detailed record needs to be kept of changes and variation from the menu provided to service users. The home needs to keep a record of any complaint or concern brought to their attention and the action taken to address the matter. The home needs to develop the system of processing service users laundry to address complaints that the manager has received regarding clothing going missing. The providers need to ensure a copy of the report they produce following their monthly audit of care and service in the home is forwarded to the CSCI.

CARE HOMES FOR OLDER PEOPLE Clairleigh Nursing Home 104 Plaistow Lane Bromley Kent BR1 3AS Lead Inspector Lorraine Pumford Unannounced Inspection 6th December 2005 14.00 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.V258339.R01.S.doc Version 5.0 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.V258339.R01.S.doc Version 5.0 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 over 65 years of age (30) of places Clairleigh Nursing Home DS0000010131.V258339.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Staffing Notice issued 15 June 1993 No more than 30 service users to be accommodated at any time. Date of last inspection 7th July 2005 Brief Description of the Service: Clairleigh is a care home which 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 have ensuite facilities. They are an adequate number of assisted bathing facilities provided. The home is located near local amenities and public transport, and is within walking distance of Bromley town centre for those with and restricted mobility. Clairleigh Nursing Home DS0000010131.V258339.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken by one inspector who spent part of the afternoon and early evening in the home. The primary focus of this inspection centred on the policies and procedures regarding the safety and well being of service users and staff working in the home. During the course of the inspection the manager, some members of care staff and the chef were spoken with at length. Parts of the premises were inspected. All Registered Care Homes receive a minimum of two inspections within a 12 months period, the previous inspection concentrated primarily on the service users and their opinions of the service provided, as this inspection may not have covered all the “National Minimum Standard” in sufficient depth, should further information be required it is recommended that a copy of the last inspection report also be obtained. What the service does well: The home ensures service users health needs are met by the staff working in the home and when necessary liaising with relevant health care specialists. Staff working in the home were able to demonstrate the manner in which they support service users to make choices about their day to day lives and activities. The home ensures service users are provided with details of the complaints procedure; this information is also display in the home. Appropriate training is provided to meet the health, safety and care needs of service users and staff working in the home. There are a sufficient number of suitably qualified and competent staff employed to provide care to service users. Robust recruitment procedures are in place and provide protection for service users living in the home. Clairleigh Nursing Home DS0000010131.V258339.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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.V258339.R01.S.doc Version 5.0 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.V258339.R01.S.doc Version 5.0 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): Standards one to five were inspected during the course of the previous inspection. Standard six is not applicable in that Clairleigh does not provide intermediate care. EVIDENCE: Clairleigh Nursing Home DS0000010131.V258339.R01.S.doc Version 5.0 Page 9 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): 8,11 Service users can be assured that their health care needs will be met. EVIDENCE: The manager has made arrangements with a local GP practice who undertake regular monthly surgeries in the home; further visits are made by the GP as and when required. The manager stated that service users are given the opportunity of retaining their own GP prior to admission, if their previous GP is prepared to retain this responsibility. A health service chiropodist attends service users in the home, however the manager stated that due to the infrequency of the service a number of residents see a chiropodists privately. The manager stated that in the event of any service user developing a pressure area the tissue viability nurse works with nursing staff to resolve the issue as soon as possible. In addition the care plan format requires nursing staff to regularly monitor any changes to service users pressure areas Clairleigh Nursing Home DS0000010131.V258339.R01.S.doc Version 5.0 Page 10 to keep abreast of any potential risk of sore areas developing thus enabling staff to take preventative action. The home is registered to provide nursing care to two service users who have been assessed as requiring palliative care. The manager and staff spoken with stated they have received appropriate training to enable them to provide appropriate nursing care and support. The manager stated that wherever possible service users wishes in respect of action to be taken following death are included in their care plan. Clairleigh Nursing Home DS0000010131.V258339.R01.S.doc Version 5.0 Page 11 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): 14,15 Menus inspected were found to be balanced and nutritious. Records must be kept if an alternative meal is provided to a service user. EVIDENCE: A member of staff spoken with was able to demonstrate ways in which she enables service users to make choices about their day-to-day lives by assisting service users to make choices regarding clothing, meals and activities. It was evident that service users are able to bring in personal possessions to personalise their own room. During the course of the inspection conversation took place with the chef, who stated that he meets with new service users on a one-to-one basis to ascertain their likes and dislikes, evidence was seen that service users are provided with a choice of menu at each meal time and an alternative is provided if a service user does not like the planned menu. Whilst it is imperative that a menu is prepared in advance to enable the chef to plan meals and service users to see the forthcoming meals, if an alternative from the main menu is provided to a service user a record of this alternative meal must be kept. Clairleigh Nursing Home DS0000010131.V258339.R01.S.doc Version 5.0 Page 12 At present a four-week menu rota is in operation. General discussion took place regarding the frequency of reviewing and rotating menus to include seasonal change of fruit and vegetables etc. Clairleigh Nursing Home DS0000010131.V258339.R01.S.doc Version 5.0 Page 13 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 Service users and relatives are provided with the information they need to be able to make a complaint if they are unhappy with the care or service they receive. Staff have received appropriate training regarding the homes vulnerable adults procedure to ensure a proper response is made to any suspicion or allegation of abuse. EVIDENCE: A copy of the homes complaints procedure is displayed in the home and a copy is also provided in the Service User Guide, which is given to each of the residents. The book used to record complaints made to the manager was examined and general discussion took place regarding if information brought to her attention orally constituted a complaint, or a concern. The manager agreed that to avoid confusion all information would be fully documented in future including the issue brought to her attention and the action taken by herself or the homeowner to address the matter. Generally complaints received centred around clothing becoming lost in the laundry process, this issue was discussed in detail between the manager and the inspector who examined the issue in relation to staffing and the laundry process. Clairleigh Nursing Home DS0000010131.V258339.R01.S.doc Version 5.0 Page 14 A care assistant spoken with stated she was aware of the term whistle blowing and stated if she had any concerns regarding the practice of colleagues she would discuss the matter with the manager. Whistle blowing was also discussed with one of the nurses, who is responsible for the initial induction and monitoring practice of non UK nurses working in the home whilst undertaking their nurse adaptation training. The nurse stated the issue is addressed in detail with nurses commencing their placement in the home. The manager stated the home liaises with Bromley Social Services department and the Health Authority enabling staff to attend adult protection training on a regular basis. Clairleigh Nursing Home DS0000010131.V258339.R01.S.doc Version 5.0 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): Standards 19 to 26 were inspected during the course of the previous inspection and were not inspected again on this occasion. EVIDENCE: Clairleigh Nursing Home DS0000010131.V258339.R01.S.doc Version 5.0 Page 16 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 There are a sufficient number of suitably qualified and competent staff employed to provide care to service users. Robust recruitment procedures provide protection for service users living in the home. EVIDENCE: The manager stated that there is always a minimum of one Registered General Nurse in charge of each shift over a 24-hour period of time. Over 50 of care assistants working in the home have now attained an NVQ two qualification in care. Discussion took place in relation to care staff undertaking laundry duties at weekends; this practise reduces the overall number of care hours being provided. The inspector voiced the view that the addition of a member of staff at weekends to undertake laundry would ensure that care staff could focus on meeting the nursing and care needs of service users. Further would reduce the risk of the possible spread of any infection and over all this additional post would help to ensure that effective processing of laundry takes place over a seven-day period reducing the risk of clothing becoming lost in the system. Record seen by the inspector indicated that sound recruitment procedures are in place with staff providing details for written references and POVA/CRB checks being taken up. Record seen in relation to recruitment complied with the minimum requirement detailed in schedule 2 of the CSA Act 2000. Clairleigh Nursing Home DS0000010131.V258339.R01.S.doc Version 5.0 Page 17 Staff spoken with stated they had been provided with a job description and contract detailing their terms and conditions of employment. The manager has formulated a staffing matrix regarding staff training needs; staff stated they are routinely provided with statutory training. Clairleigh Nursing Home DS0000010131.V258339.R01.S.doc Version 5.0 Page 18 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 There are relevant policies and procedures in place to safeguard service users and staff working in the home. The quality assurance mechanisms must be developed to include a copy of the owners monthly audit being forwarded to the CSCI. EVIDENCE: The manager is a qualified nurse and will be undertaking additional training in the near future to obtain The Registered Manager Award. Records seen indicate that regular staff meetings are held to discuss with staff issues around practice, policies and procedures. Although records seen indicate the homeowners undertake an audit on a monthly basis to ensure that the building, care and services provided are all Clairleigh Nursing Home DS0000010131.V258339.R01.S.doc Version 5.0 Page 19 well maintained and appropriate to the service user group, to date a copy has not been forwarded to the CSCI as required, this issue must be addressed. Discussion took place regarding service users finances. The manager stated that relatives provide service users with small amounts of money which they keep on their person, however generally the home pays for services such as hairdressing in advance and an invoice is then sent to the relatives requesting the money is reimbursed. Discussion took place regarding safe working practices in the home, staff spoken with stated they had attended manual handling courses, the manager stated that both herself and another member of senior staff were accredited assessors to enable this training to take place in house. From records seen and discussion with staff it is apparent that they have received regular training regarding fire safety precautions in the home. Records seen indicate that the fire alarm system is tested on a regular basis. Clairleigh Nursing Home DS0000010131.V258339.R01.S.doc Version 5.0 Page 20 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 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 X 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Clairleigh Nursing Home DS0000010131.V258339.R01.S.doc Version 5.0 Page 21 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 OP15 Regulation Schedule 4.13 Requirement Records of the food provided to service users is in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise and of any special diets prepared for individual service users. Keep a record of all complaints made by service users or representatives or relatives of the service users or by persons working at the care home about the operation of the care home, and the action taken by the registered person in respect of any such complaint. A copy of the providers monthly audit is sent to the CSCI. Timescale for action 30/01/06 2 OP16 Schedule 4.11 30/01/06 3 OP33 26.5 30/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Clairleigh Nursing Home DS0000010131.V258339.R01.S.doc Version 5.0 Page 22 No. 1 Refer to Standard 27 Good Practice Recommendations Staffing is reviewed with a view to recruiting a member of staff to undertake laundry duties at weekends, in order to improving the overall laundry process. Clairleigh Nursing Home DS0000010131.V258339.R01.S.doc Version 5.0 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.V258339.R01.S.doc Version 5.0 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. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!