Inspection on 06/05/08 for Clann House Residential Home

This inspection was carried out on 6th May 2008.

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

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

Other inspections for this house

Clann House Residential Home 03/03/09

Clann House Residential Home 30/09/08

Clann House Residential Home 30/05/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Clann House Residential Home Clann House Residential Home Clann Lane Lanivet Cornwall PL30 5HD Lead Inspector Helen Tworkowski Key Unannounced Inspection 6th May 2008 08:20 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 Clann House Residential Home DS0000068997.V363901.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. Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clann House Residential Home Address Clann House Residential Home Clann Lane Lanivet Cornwall PL30 5HD 01208 831305 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) julie.frape@btconnect.com Susan Ann Clarkson John Reid Clarkson Julia Ann Frape Care Home 34 Category(ies) of Dementia (34), Mental disorder, excluding registration, with number learning disability or dementia (3), Old age, not of places falling within any other category (3) Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category- Code OP- maximum 3 places Dementia- Code DE- maximum 34 places Mental disorder, excluding learning disability or dementia- Code MDmaximum 3 places The maximum number of service users who can be accommodated is 34. 30th May 2007 2. Date of last inspection Brief Description of the Service: Clann House is situated in three acres of land and gardens, in a quiet rural setting a short distance from the village of Lanivet, near Bodmin. The home is registered to provide accommodation and personal care for up to twenty six older people with a dementia; it is also registered to care for named residents with mental healthcare needs (3), old age (3) and one resident with a learning disability over 65 years. The adapted farmhouse offers comfortable accommodation, with level access around most of the ground floor. The bedrooms offer views of the surrounding countryside. The home offers accommodation on both the ground and first floor, with stair lift provision for those who require it. An extension has been added to the home providing eleven en-suite bedrooms. Communal rooms comprise of three lounges, and a dining room. The dining room comfortably accommodates the residents. There is a central safe courtyard garden. The home has its own car parking with space for approximately 5 to 7 cars. A further extension has been built on to the side of the premises, and provides accommodation for a further 8 people. The accommodation in this new extension is not level access and is suited to people who are more mobile and more self sufficient. Information about the home (Statement of Purpose and Service User Guide) is available from the office, and information is provided in each bedroom. Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 5 The fees for the home are between £384 and £482; this does not include toiletries, chiropody, hairdressing, clothing or other personal items. Use of the vehicle is charged at 40p per mile. Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This inspection included two visits to Clann House by two inspectors. The first visit was on 6th May (8.20 am- 4.10 pm) the second on the 12th June (8.30 am –1.00 pm). The Registered Manager was present through out the first day of inspection, however was only present for a brief period during second day. During the visits to the home we looked around the building, interviewed four of the care staff and talked with the cook, spoke with a number of residents and visitors to the home including a district nurse. We looked at the medication system, health and safety records and the staff records. We also looked at care plans for four individuals who live at Clann House and where possible talked with them. As part of this inspection time was spent sitting and observing what happens in the home and how staff and the people who live at Clann House interact. In addition to this we sent surveys to all of the staff who work at Clann House, we received seven forms back. We sent forms to the people who live at Clann House, who are able to complete a form, where this was not possible we also sent them to their representative or to a relative. Four forms were returned by people who live at Clann House, and a further ten forms were returned by relatives. We also received a questionnaire completed by the Manager that gave details of any changes in the home over the previous year. What the service does well: All of the relatives who responded to the survey reported that the home always or usually gave the care that they expected or had agreed. People commented that they thought that the staff were excellent and caring, and appeared kind and patient. When we spoke with people who lived at Clann House they said that thought the home was “very pleasant”, other people commented that the home was difficult to better. The meals are well cooked and people commented that they enjoyed them. Residents are given a choice including a cooked breakfast. The main part of the house is well suited to the needs of people with dementia, and the layout means that people can walk around, if they are able, unhindered and are able to use the courtyard garden. People enjoy using this area of the home. The house is clean and many of the people who live in the Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 7 home have brought their own pictures and furniture to make their room their own. Staff are well trained and almost all of the staff have a qualification to show they are competent in care, or are working towards this qualification. 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. The summary of this inspection report can be made available in other formats on request. Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 8 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 Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 9 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, and 3 (standard 6 does not apply) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who are thinking about a move to Clann House are provided with good information to help inform them about their choice of home. EVIDENCE: We asked the Manager, Julie Frape, about what information the people who lived at Clann House had about the home. She confirmed that copies of the Statement of Purpose and Service User Guide, documents that tell a person about the home, are kept in a draw in each of the bedrooms, and are given to prospective people as part of their “welcome pack”. This pack also includes the Complaints Procedure. We asked to see copies of contracts or terms and conditions for people who are living in the home. We were told that this was not possible as they are at the head office, as they were being revised. Such documents should be available for inspection in the home. Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 10 As part of this inspection we looked at the assessments that were carried out prior to a person moving to Clann House. We found that for two people who had recently moved to the home there was very comprehensive information provided by the either the Social Worker or by the Community Psychiatric Nurse. The purpose of a pre-admission assessment is to help decide if a care home is able to meet a person’s needs and to form the basis of planning their care, should they move to the home. Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 11 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 poor. This judgement has been made using available evidence including a visit to this service. Many of the people who live at Clann House and their relatives feel that they are offered a good standard of care, however the home is not meeting the needs of people with more complex needs or difficult behaviours and so is placing them and others at risk. EVIDENCE: We talked to the people who lived at Clann House and some of their relatives during this visit. The feedback received was generally very positive. Comments included “I can’t fault the place and would give them full marks”, and the staff are very “kind”. During this inspection we spoke with one person who was distressed about the fact that one or two staff spoke to people in a demeaning manner. Surveys sent to relatives indicated that that people are happy with the service provided and people’s needs are met. This contrasted with what we found from the records of incidents that happened in the home, which will be looked at later in this section. As part of this inspection we spent time observing in the dining room, how Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 12 people were treated. There were 18 continuous periods of five-minute observations (1.5 hours). Eleven residents were observed at different times, though only five at any one time. There were twelve staff interactions with residents of which ten were seen to be inclusive, respectful and demonstrated warmth of feeling for the individual. One was seen to be impersonal, instructing the client rather than engaging with them, the other took no account of the residents wishes (the staff member handed the client a cushion she did not want and no assistance was offered in positioning the cushion on the seat. Residents were seen to have a positive state of being, interacting with their environment, and with each other. Staff were seen to be actively engaging with residents in recreational activities. Overall, staff explained things well and spoke appropriately with clients. One resident was served breakfast mid morning, demonstrating flexibility on the part of the staff to meet the residents needs. Many of the people at Clann House have dementia or mental health needs and are not able to always explain their needs or difficulties. It is therefore important that there are written care plans that detail how needs are to be met. This will ensure that staff know the nature of the care they are to provide. Clann House uses a computerised system for all records. We looked at the care plan documents for four people. We found that where there had been an assessment the information about the person’s needs did not appear to have been detailed in the care plan. For example, one person with a mental illness experiences delusions. This was not mentioned in the care plan, or how staff were to help and support the person. Another person moved to Clann House at the end of March 08. The daily notes stated that the individual had at times been very distressed, had been aggressive and had tried to leave the house. The Care Plan did not provide any guidance to staff on any of these issues. The Care Plan contained a section on keeping a safe environment; this included the use of hoists, slings, sliding sheets and turning discs. These areas of safety were not relevant to the individual. However the important issue of potential risk from attempting to climb out of windows and leaving the building was not included. We looked at the daily notes; there was no record of any analysis of these individuals’ behaviours or what actions staff could take. For example, it was noted that the individual, “got agitated last night about the noise the care assistant was making cleaning”, a few days later it was noted that the individual became aggressive towards a night care assistant when she was hovering the lounge and threw the vacuum cleaner at her. Incidents are poorly recorded in that there was no reference to any follow up actions or advice or guidance from the manager or other professionals. Another person was admitted for a short break early in 2008. This individual quickly became unwell and assaulted both staff and other people at Clann House. The risk assessment did not detail the degree of potential risk. The care Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 13 plan, written two days after the individual moved in, did not reflect the individual’s needs. Where an individual poses a threat to themselves and others we would expect to see actions taken to ensure the safety of the individual and other people. Whilst treatment was sought from the emergency GP, the level of supervision, as recorded in the notes, was poor- and this individual was able to assault other vulnerable people living at Clann House. There was no evidence from the records that residents or the people who were representing them were involved in planning the care provided. We were shown the medication system by the Deputy Manager. She explained that a monitored dose system, prepared by the pharmacist, is used at Clann House. We looked at the records of relating to the administration of medicines. The majority of the medicines had been signed and checked for on receipt, however we found that one lot of medication had not been checked in, as the person responsible was not on duty. The medication system must be able to work effectively, at all times. We noticed that creams were not being signed as administered. We discussed with the manager the importance of setting up a system to ensure that all prescribed medication, including creams, is recorded in some way. The home does have a system for keeping controlled drugs and has a controlled drug book. We were shown a system for checking medication, however this had not been done as frequently as the system required. It is important that all medication should be easily audited, so that it is possible to quickly check the quantity of medication is correct. Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 14 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. The people at Clann House are provided with a good standard of meals and are offered a range of activities to occupy their time. EVIDENCE: We visited Clann House twice whilst breakfast was being served, and this confirmed what we had been told: that residents are offered a choice, and that this includes a cooked breakfast. We asked staff about what time people got up and was told that 90 of the people are awake by 7.00 am, as most people eat their breakfast in the dining room. We talked with the cook and she explained that information about what was on the menu was usually put up on a board for residents to see. The cook confirmed that soft diets were offered, and care was taken to ensure that such meals were presented in a manner that was attractive, i.e. the whole meal was not pureed together. We talked to the people who live at Clann House about the meals and they said that the meals were “good”; two of the people responding to surveys said, “The meals are excellent” and “ If anyone does not like anything, they are usually offered an alternative”. Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 15 One of the very positive aspects of the design of Clann House is that the central courtyard provides a pleasant area to sit and many people seemed to enjoy sitting outside or walking around the courtyard. The people who lived at Clann House who responded to the surveys varied in their opinion as to whether there were always enough activities in the home. There is a list of activities on the notice board. The home has recently purchased vehicle so that the people who live at Clann House can have more opportunities to go out. When we talked to the people at Clann House about the things they had to do they mentioned activities like bingo and skittles, and that there was always something going on “. Nine out of the ten relatives responding to the surveys said that they were always or usually kept up to date with important issues affecting their relatives. We talked with some of the people about any rules, and views varied about whether there was a time to get up or not. It is the Commission’s expectation that the people who live at Clann House should be able to decide about their own daily routines, as far as they are able to. We discussed with the manager this discrepancy and the need for staff to be clear that people have a choice about such daily routines as the time they get up or go to bed. Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 16 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 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The people who live at Clann House cannot be assured that they will be protected from abuse. EVIDENCE: As part of this inspection we asked four of the staff on duty on 6th May 08 about what they would do if they had to deal with a complaint. Staff were aware that they should refer concerns to the manager or to senior staff. We also asked staff about what they would do if they thought someone was being abused. Most staff were aware that they should report such concerns about abuse to their manager, but were not aware of the role of external agencies such as Social Services in dealing with allegations of abuse. In the surveys sent to relatives half of those who responded did not know how to make a complaint, however all said that the home has always or usually responded appropriately when they have raised a concern. We looked at the record of complaints; one complaint had been received in the last year. One of the responsibilities a care home has is to protect people from abuse. When we looked at care records it was apparent that some individuals had engaged in very difficult behaviours, which had placed themselves or other people at risk. There were no records of actions being taken to ensure people were protected, and in some cases the actions taken appeared inappropriate. Examples of this included people hitting other people, or one person being Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 17 locked in his or her room. A number of concerns have been raised regarding the wellbeing and safety of people who live at Clann House. Social Services and the Registered Providers, Mr and Mrs Clarkson, are currently looking into these matters. Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 18 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, 21, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at Clann House benefit from accommodation that for the most part has been designed to meet their needs. The accommodation is clean and odour free. The system of locks in the older part of the house is unsafe and could mean that people get locked in their rooms. EVIDENCE: We looked around the home with the Manager, as part of this inspection. The rooms were all clean and generally in good order, there were no unpleasant odours. The cleaner had started work in one part of the home, and there was a clear routine for cleaning and airing the bedrooms. Some of the people had brought items of their own in to decorate their rooms, and a couple of people had tea-making facilities. Other people had no pictures and there appeared to have been little done to make the rooms more individual. The Manager explained that they were working with people to make them feel more at home and to put up pictures and ornaments, but that this took time. All of the rooms were of a good size and many had ensuite bathrooms or showers. We looked at the bedding and discussed with the Manager having mattress covers or Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 19 under blankets on the beds so that people did not sleep with nothing between the sheet and the plastic covering the mattress. The most recent extension to the home can provide accommodation for a further eight people. These rooms are down a corridor where there is a door with a keypad; there are a few steps even for rooms on the ground floor. We discussed with the Manager the type of people who could be accommodated in these rooms and she confirmed that they were people who were mobile and who were sufficiently independent to manage the key pad or use the call bell for assistance in the night. People who needed more care and support lived in other parts of the home. There is a central courtyard around which there are bedrooms the dining room and lounge. This means that people are free to wander freely in the rooms and corridors that surround the courtyard, or use the courtyard itself. On the day of inspection the courtyard was well used, and provide benches in the sun and in the shade. This part of the home provides safe accommodation for people who may have dementia or memory problems to walk safely and not to be enclosed. The garden area to the side of the house would benefit from further planting and seating facilities. We looked at the door locks in the older part of the house. These locks are Yale locks, and the Manager explained that in emergency there is a spare key for each room. At night doors are not locked, as the lock is held on a “snib”. When we looked at these locks we found that it was possible for anyone in a bedroom in a confused state to lock the door from the inside so that it could not be over ridden with a key. We also discussed with the Manager that there was no master key, so in an emergency such as a fire staff would need to go through a bunch of keys to find the right key for each door lock. The people who live at Clann House need to have door locks that suit their needs: that are easy to use, operate with a key on the outside and that they can be over ridden in an emergency. During the tour of the building it was noted that there was liquid soap in many of the bathrooms and toilets, this soap had been topped up, as distinct layers could be seen. We discussed with the Manager the need to ensure that “old” and new “soap” is not mixed, and that the dispensers are regularly cleaned. Following the first visit to the home we were informed that there had been an outbreak of diarrhoea and vomiting. Medical advice had been sought for individuals however the Manager did not, as required, inform the Health Protection Agency, who can provide advice on how to best manage such situations. Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 20 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. There are sufficient staff who are well trained and who have gone though a recruitment process to check their suitability for the work. EVIDENCE: Information provided by the Home to the Commission shows that of the 23 care staff at Clann House, twelve have a National Vocational Qualification Level II or above, and a further nine people are working towards this qualification. This is a high proportion of staff. As part of this inspection we interviewed four of the care staff on duty on 6th May 08. Staff who had worked at the home for some years had received training in relation to Basic Food Hygiene, First Aid, and Manual Handling. Staff who had recently started in the home had signed to say that they had completed their induction. Comments from staff included that there is sufficient staff, and that training is available. We looked at some of the staff files during the second day of the inspection and this showed that staff had received a range of training. The files we looked at related to people who had been in post for some time. It was noted one person had information on their Criminal Records Bureau Check. The Commission expects that in this situation the home make a risk assessment as to whether the person is suited to work with vulnerable people. No risk assessment was on the file. We tried to look at the file of a recent recruit, however this was not available at the time of the inspection. Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 21 We sent surveys to all of the staff who work at Clann House, seven were returned. All of the care staff said that they had sufficient training to do their work and that the manager met with them regularly to give them support and to discuss how they were working. However we were unable to find any record of these discussions since April 2007. Staff responding to the surveys said that there was always or usually enough staff on duty. When we looked around the house people were up, dressed and there was no evidence of a lack of care. Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 22 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, 32, 33, 37 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service to people who have complex or behaviours that challenge, who live at Clann House, is not well managed. There is no clear ethos that protects people’s rights and provides them with the support they need. EVIDENCE: The Manager said that she sent out Quality Assurance forms to find out about people’s views about the service, and that these forms are also on available in the entrance hall. The Manager said that this form did not contain any specific information about safeguarding from abuse, however she felt that by speaking to people she would find out if there were any problems. We talked to the Manager about her understanding of her role in both protecting people from abuse, and in ensuring people have the right to make Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 23 their own decisions. The Manager did not appear to understand the tension the can arise from protecting people from abuse whilst safeguarding their right to take decisions about their lives. She was unclear about the implications of the Mental Capacity Act, and we noted that this was not informing care planning decisions. The home accommodates a number of people with complex needs that includes behaviours that challenge the service. Some of the people present as a potential risk to others. When we spoke with the Manager and read records it was evident that there had been no assessment of risk or appropriate strategies put in place to deal with the issues. Events were reacted to rather than managed. We looked at the way information was managed in the home. The majority of the records are computerised. We asked the Manager about whether the system was “backed up” she was uncertain if this was the case. On the first day of the inspection the system was not working properly and it was not possible to look at Care Plans, on the second day of inspection we were able to look at Care Plans, however when we asked a member of staff to show us how they used the system, it was no longer working. We were told that a written handover is kept so that staff could up date each other. When we looked at this information it was in far more detailed than information that we had seen on the computerised system. However it was not possible to double- check this, as we could not access the computerised records, as the system was not working. We were told that these handwritten notes are destroyed every few days. The Manager told us about the system in place for daily health and safety checks and how these are recorded. We noticed that last health and safety check was recorded some weeks prior to the start of the inspection. We also saw a Fire Risk Assessment that included information on fire training for staff. We were told that an external trainer comes in every 6 months to train staff and that new staff are shown procedures on their first day and are given further guidance in their second week. The Manager explained that the home had recently been checked, by an electrician, for its five yearly electrical survey. It was therefore of concern that a socket in one of the bedrooms was broken and scorched. We checked the temperature of the hot water in some of the bathrooms and found that in three of these rooms the water was very hot. The Manager was not aware of how water temperatures are regulated. On the second day of the inspection plumbers were visiting the home to look at making the hot water system safe. Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 24 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 1 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 3 X 3 X X 2 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 1 1 3 X X X 2 2 Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 15 (1) Requirement All people using the service must have an up to date detailed Care Plan, based on an assessment of need. This will ensure that they receive person centred support that meets their needs. The individual or their representative must be consulted. People who present difficult or challenging behaviours must be provided with the support they need to keep themselves and others safe. There must be effective recording systems that monitor difficulties and provide staff with guidance about the support to be provided. Where appropriate there must be evidence of professional help being sought. The Manager must ensure that there are arrangements in place, by training staff or by other measures to prevent people being harmed or abused or suffering risk of harm or abuse. Where bedroom door locks are fitted these must be suit the needs of the occupant and DS0000068997.V363901.R01.S.doc Timescale for action 01/08/08 2 OP8 12 (1) 01/08/08 3 OP18 13(6) 01/08/08 4 OP24 13 (7) 01/08/08 Clann House Residential Home Version 5.2 Page 26 5 OP31 10 (3) 6 OP32 12(1) 7 OP37 15 8 OP38 13 (4) a should not allow any individual to be locked in a room, even by accident. Staff must have easy access to all rooms in an emergency. The Registered Manager must ensure that she has a clear understanding of the Mental Capacity Act to ensure that people who use the service are appropriately cared for. The Registered Manager must communicate a clear sense of direction and implement in practice a service that meets the needs of everyone who lives at Clann House, but particularly those with dementia or complex needs. The system for record keeping must be reviewed. Care records must be kept up to date, be readily accessible by those who need to use them and be suited to their purpose. Hot water must be assessed for the risk it presents to people who use the service, and action must be taken to minimize any identified risk. 01/08/08 01/08/08 01/09/08 01/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP26 Good Practice Recommendations There must be a record of all medications received into the home, along with a record of administration of medication, including creams. Control of Infection Procedures should be reviewed to include out breaks of diarrhoea and vomiting, this should detail the use of external agencies. DS0000068997.V363901.R01.S.doc Version 5.2 Page 27 Clann House Residential Home 3. OP29 Risk assessments should be carried out on prospective staff who have criminal records to determine if they are suited to work with vulnerable people. Clann House Residential Home DS0000068997.V363901.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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