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Inspection on 05/08/05 for Clairmont Residential Home

Also see our care home review for Clairmont Residential Home for more information

This inspection was carried out on 5th August 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 provides a homely environment in which to live. Families` spoke highly of the care provided and resident appeared mainly to enjoy living there. Staff were seen to be supportive and kind during the inspection and treated the residents with respect at all times. A lot of fresh vegetables and fruit were used in the preparation of the meals and residents said they enjoyed the food and that they had a choice.

What has improved since the last inspection?

One of the bedrooms had been decorated.

What the care home could do better:

The home has recently changed its registration to all dementia and part of the conditions was that Future DE(E) Service Users have single rooms, unless it can be evidenced through a multi disiplinary assessment the appropriateness to share a room with another DE(E) service user. One residents was complaining that she had to share with a resident who had dementia and that she was not happy with this. The home must seek to remendy this situation as soon as possible. More guidance into the care of residents with dementia and/or challenging behaviour needs to be incorporated into the care plans. There have been a high number of falls in the last month and the home is advised to instigate a falls prevention programme to try to reduce the number of accidents occurring. It is advised that help be sought from the Falls Coordinator as St Bartholomew`s Hospital, Rochester. Clean clothing needs to be distributed to the correct person to prevent residents wearing someone else`s clothing.

CARE HOMES FOR OLDER PEOPLE Clairmont Residential Home 89-91 Woodside Wigmore Gillingham ME8 0PN Lead Inspector Sue McGrath Unannounced 5 August 2005 9.30am 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 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. Clairmont Residential Home H56-H06 S28864 Clairmont V243115 050805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Clairmont Residential Home Address 89-91 Woodside Wigmore Gillingham Kent ME8 0PN 01634 361468 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Gwyneth Hayward Mr Godfrey Hayward Care Home 13 Category(ies) of DE Dementia (13) registration, with number of places Clairmont Residential Home H56-H06 S28864 Clairmont V243115 050805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Future DE(E) Service Users have single rooms, unless it can be evidenced through a multi disiplinary assessment the appropriateness to share a room with another DE(E) service user. Date of last inspection 14 December 2004 Brief Description of the Service: Clairmont Residential Home is a large detached property situated in a residential area close to a public park and within easy walking distance of a local convenience store and Post Office. The home is on a bus route and within easy reach of Hempstead Valley shopping centre. The nearest town and main line station is Rainham, which is about a mile away. The home has an attractive rear garden part of which is sectioned off for service users, the remaining garden has a swimming pool, service users only access this part of the garden when accompanied by staff.The home provides accommodation to 13 with a diagnosis of Dementia on two floors and offers 24-hour care. There is one waking night and one ‘on call’ at night. In addition to the team of care staff a cook and a cleaner are employed at the home. Clairmont Residential Home H56-H06 S28864 Clairmont V243115 050805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 05-08-05. Two inspectors were in the home and the main focus of the inspection was on the progress of the home in meeting with requirements made at the last inspection, the general environment and the well being of the residents. The owners of the home were on holiday and the assistant manager led the inspection on their behalf. During the inspection documentation and records were read, including care plans. A tour of the building was undertaken and many of the residents and some visiting family members/friends were spoken to. Time was also spent talking to staff. What the service does well: What has improved since the last inspection? One of the bedrooms had been decorated. Clairmont Residential Home H56-H06 S28864 Clairmont V243115 050805 Stage 4.doc Version 1.40 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. Clairmont Residential Home H56-H06 S28864 Clairmont V243115 050805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Clairmont Residential Home H56-H06 S28864 Clairmont V243115 050805 Stage 4.doc Version 1.40 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 standard(s) Not inspected but all standards were met at the last inspection. EVIDENCE: Clairmont Residential Home H56-H06 S28864 Clairmont V243115 050805 Stage 4.doc Version 1.40 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 standard(s) 7,8,10,11 Whilst residents benefited from detailed care plans some areas of the plans need to improve. The health needs of individual’s were mainly well met and residents benefited from good multidisciplinary working. The service users can be confident that the home has handles the issues of illness and ageing sensitively. EVIDENCE: Several care plans were viewed and were found to be giving some guidance to staff but little guidance on how to cope with challenging behaviour of some of the Residents. Little evidence could be found of any nutritional assessments taking place and advice was given on how to complete these assessments. Regular monthly reviews were not being recorded. Discussion with the assistant manager focussed on how best to improve the care plans to ensure all the relevant information and guidance to staff was incorporated. More information on how to deal with dementia and challenging behaviour needs to be included. Clairmont Residential Home H56-H06 S28864 Clairmont V243115 050805 Stage 4.doc Version 1.40 Page 10 Residents said that when being given any personal care they felt comfortable and well supported by staff. Relatives spoken to also stated that they were happy with the level of care and the kindness shown to their loved ones. One resident was being cared for in bed and evidence was seen that this was being handled well and that appropriate care of tissue viability was being undertaken. Resident’s healthcare needs were generally being well catered for. Records indicated that there had been a high levels of falls in the home particularly in the last month (approx 13). Not all of the falls were recorded in the accident book. The home is strongly advised to contact the Falls Coordinator at Saint Bartholomew’s Hospital to obtain advise on falls management. This service is now available to all residential homes. Staff stated that they always knocked on bedroom doors before entering and it was noted throughout the inspection the residents were treated with respect and dignity. One area of concern was the distribution of clean clothing. Clothes were replaced in the wrong rooms and some wardrobes were shared causing even more muddling of clothing. Closer monitoring of this issue is advised. The home had a comprehensive policy for handling the death of service users, including sudden death, which ensured their death was handled with dignity and propriety. The assistant manager confirmed that service users were able to spend their final days in their own room, surrounded by their personal belongings, unless there were strong medical reasons to prevent this. The home had developed good working relationships with the District Nurse team and felt they received good support from them. Clairmont Residential Home H56-H06 S28864 Clairmont V243115 050805 Stage 4.doc Version 1.40 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 standard(s) 13,15 Residents are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. The residents benefit from the appetising meals and balanced diet offered by the home and those service users requiring specialist diets are well catered for. EVIDENCE: Two family visitors confirmed that they could visit at any times and were always made welcomed. Residents can met with their visitors either in the lounge or in their own bedrooms. The home does have a conservatory that is used as the smokers’ room and visitors sometimes use this. Residents said that the food was nice and that they had a choice. The home uses fresh vegetables and fruit daily and the food was home cooked and served in a congenial setting. Hot or cold drinks were offered as required. Specialist meals such as diabetic and vegetarian meals were catered for. Clairmont Residential Home H56-H06 S28864 Clairmont V243115 050805 Stage 4.doc Version 1.40 Page 12 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 standard(s) 16,18 Residents are protected by a robust complaints system and service users and relatives feel their views are listened to and acted upon. The home has robust adult protection policies and procedures to ensure that residents are protected from abuse. EVIDENCE: The home had a written complaints procedure in place that both staff and the family members spoken to were aware of. Both family members spoken to stated that they had not needed to use the procedure and felt confident that any issues could be resolved with the manager before they got to that level. The home had adopted the Multi Agency Adult Protection Policy for Kent and Medway and staff spoken to were able to demonstrate an awareness and understanding of the policies. Clairmont Residential Home H56-H06 S28864 Clairmont V243115 050805 Stage 4.doc Version 1.40 Page 13 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 standard(s) 19,20,21,22,23,26 Residents benefit from living in a fairly clean, safe environment and have safe access to indoor and outdoor communal areas. Some of the areas are well maintained and in some are in need of re-decoration. Whilst service users’ rooms are fairly homely and reasonably comfortable not all service users benefit from living in single rooms that meet the requirements for space. EVIDENCE: It was advised that a programme of routine maintenance and renewal of the fabric and decoration of the premises be produced, as some areas were starting to show signs of general wear and tear. Some carpets in the hallway were starting to fray. One of the bedrooms have been recently decorated. The gardens were well maintained and accessible to residents. The home has sufficient communal space and a smoking area is provided. Lighting in the communal room was domestic in character and of good quality. Clairmont Residential Home H56-H06 S28864 Clairmont V243115 050805 Stage 4.doc Version 1.40 Page 14 The home had 5 toilets and 4 bathrooms and 1 en-suite room. Each bedroom had a hand basin. It was unclear whether the environmental risk assessments required from the last inspection had been carried out so this will be reassessed at the next inspection when the owners would be present. One area of concern raised was that two Residents were accessing the first floor on their bottoms as they were unable to manage the stairs. Urgent consideration must be given to installing either a chair lift or a passenger lift. The home must ensure it can meet the assessed needs of all the residents. One resident who shared a room was very unhappy with the person she shared with as she suffered from dementia and was disruptive and disturbed her. Part of the conditions of registration for dementia care stated clearly that DE(E) Service Users have single rooms, unless it can be evidenced through a multi disiplinary assessment the appropriateness to share a room with another DE(E) service user. This would also apply to resiends who do not have dementia. It is not apprpraite for resident to share if they are not happy to do so. It will be a requirement that a single room is offered as soon as one becomes available and that as stated in the condition of registration future DE(E) Service Users have single rooms, unless it can be evidenced through a multi disiplinary assessment the appropriateness to share a room with another DE(E) service user. The home would benefit from having more domestic hours. Clairmont Residential Home H56-H06 S28864 Clairmont V243115 050805 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not inspected EVIDENCE: Clairmont Residential Home H56-H06 S28864 Clairmont V243115 050805 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35,38 Residents are protected by sound accounting procedures within the home with personal finances safeguarded. Some current arrangements were not sufficient to fully protect the health, safety and welfare of residents and staff. EVIDENCE: The assistant manager was able to evidence that some quality assurance had taken place and that they were working towards compliance with this standard (33). The owner is reminded that the home should have an annual development plan for the home and that the internal audit regarding quality assurance should take place annually. Discussion took place as to how this Clairmont Residential Home H56-H06 S28864 Clairmont V243115 050805 Stage 4.doc Version 1.40 Page 17 information could be incorporated in to the homes Statement of Purpose and be a positive marketing tool. Evidence was seen that robust accounting procedures were in place that safeguarded residents’ monies. The procedures of storage and recording of these monies was seen and two accounts where sampled and found to balance exactly. The assistant manager confirmed that the owners were in the process of obtaining quotes regarding the installation of thermostatic valves and radiator covers as required from the last report. These requirements will remain until the work has been completed. The water remained very hot. It is advised that window restrictors are fitted to the upstairs windows. Clairmont Residential Home H56-H06 S28864 Clairmont V243115 050805 Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 3 2 2 x x 2 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 x x 2 Clairmont Residential Home H56-H06 S28864 Clairmont V243115 050805 Stage 4.doc Version 1.40 Page 19 Yes Are there any outstanding requirements from the last inspection? 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 OP22 Timescale for action 23(2)(n) The registered person shall Action plan having regard to the number and by 23rd needs of the service users September ensure that-(n) suitable 2005 adaptations are made, and such support, equipment and facilities, including passenger lifts, as may be required are provided, for service users who are old, infirm or physically disabled.In that environmental risk assessments are undertaken for all service users by a suitably qualified person. 13(4)(a)(c The register person shall ensure Action plan ) that-(a)all parts of the home to by 23rd which service users have access September are so far as reasonably 2005 practicable free from hazards to their safety;(c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated.In that pipe work and radiators are guarded or have guaranteed low temperature surfaces. (Standard 25.5)The rooms of service users that have a diagnosis of dementia to be prioritised 13(4)(a)( The register person shall ensure Action plan b) that-(b)all parts of the home to by 23rd H56-H06 S28864 Clairmont V243115 050805 Stage 4.doc Version 1.40 Page 20 Regulation Requirement 2. OP25 3. OP25 Clairmont Residential Home 4. OP19 23(2)(d) 5. OP23.6 23(1)(a) which service users have access are so far as reasonably practicable free from hazards to their safety;(c)unnecessary risks to the health or safety of service users are identified and so far as possible eliminated.In that preset valves of a type unaffected by changes in water pressure and which have fail safe devises are fitted locally to provide water close to 43 degrees centigrade. (Standard 25.8)The rooms of service users that have a diagnosis of dementia to be prioritised. The registered person shall having regard to the number and needs of the residents ensure that all parts of the home are kept clean and reasonably decorated. In that a programme of routine maintenance and renewal of the fabric and decoration of the premises is produced and implemented with records kept. Where rooms are shared they may be occupied only by residents who have made a positive choice to share September 2005 Action plan by 23rd September 2005 Action plan by 23rd September 2005 6. 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. Refer to Standard OP10 OP8.8 Good Practice Recommendations It is recommended that wear their own clothes at all times and that the system used for returning clean clothing is reviewed. It is recommended that information is obtained from the Falls Co-oordinator and a falls management programme is implemented to reduce the number of falls in the home. H56-H06 S28864 Clairmont V243115 050805 Stage 4.doc Version 1.40 Page 21 Clairmont Residential Home 3. 4. 5. OP38.3 OP7 OP26 It is recommended that window restrictors are fitted on all first floor windows. It is recommended that service users plans be reviewed to include more direction to staff into the care of residents with dementia and with challenging behaviour It is recommended that more domestic hours are provided as six hours a week appearsa to be insufficient to maintain the high standards previously set. Clairmont Residential Home H56-H06 S28864 Clairmont V243115 050805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent. ME16 9NT 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 Clairmont Residential Home H56-H06 S28864 Clairmont V243115 050805 Stage 4.doc Version 1.40 Page 23 - 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!