CARE HOMES FOR OLDER PEOPLE
Clare Hall Nursing Home Ston Easton Bath Somerset BA3 4DE Lead Inspector
Justine Button Unannounced Inspection 14th January 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Clare Hall Nursing Home DS0000003250.V357801.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. Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Clare Hall Nursing Home Address Ston Easton Bath Somerset BA3 4DE 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) 01761 241626 01761 241727 robins@bupa.com www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd ****Post Vacant**** Care Home 57 Category(ies) of Old age, not falling within any other category registration, with number (57) of places Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Up to five persons of either sex in the age range 50-60 years, who require general nursing care One named person under 50 years of age currently accommodated in the home. 31st August 2007 Date of last inspection Brief Description of the Service: Clare Hall is registered to provide general nursing and personal care. The home is formed from an older house and a more recent extension. Both areas have been adapted for the client group. It is situated in the village of Ston Easton, 3 miles from Midsomer Norton and 12miles from Bristol and Bath. The home is set in large, well-maintained gardens, which provide different areas for sitting and walking. The majority of the bedrooms are for single occupancy although there are a small number of double rooms. There are several large areas on the lower floors used as dining and sitting rooms. The office space, kitchens and laundry are also found on the lower floor. The home is owned by Care First Homes, a direct subsidiary of BUPA. Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key unannounced inspection was carried out over one by two inspectors. An additional visit was made by one of the inspectors a week following the inspection. The manager Ms. Gale Smith was on duty on the day of the inspection. The inspector would like to thank Ms. Smith and the duty staff for their time and hospitality shown to the inspector during their visit. This is the second key inspection this year and so surveys and pre-inspection information was not requested from the home. This information was completed and received prior to the last key inspection which was conducted in August 2007. The purpose of this inspection was to assess the progress the home has made in reaching the requirements made at the last inspection. Due to this not all the standards have been assessed on this occasion and interested parties may like to refer to the August 2007 inspection report for additional information. Prior to the August 2007 inspection concerns had been raised to us (the CSCI) with regard to the care and support afforded to people living at the home. This was particularly with regard to the care and treatment of pressure ulcers. Due to these concerns we have been liaising closely with the management team of Claire Hall the local Primary Care Trust and social services. Staff at Claire Hall have worked hard to address the issues over the last few months and the previous issues have now on the whole been resolved. Since the last inspection a new manager, Ms Gale Smith has been recruited to the home. Ms Smith is committed to continuing the improvements at the home. During the inspection a tour of the premises was made and service users were seen and spoken with both in private and in the communal areas of the home. The home was tidy and well maintained. Lunchtime was observed in the dining areas of the home. Records were sampled, these included, staff training, staff recruitment, , maintenance records care planning and medication. Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 6 The current fee levels are £670- £730 per week depending on need and the room to be occupied. Fees do not include visitors meals, private treatments including chiropody and physiotherapy, hairdressing and any personal purchases including newspapers, toiletries, books magazines and gifts. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well:
Clare Hall is in a very pleasant rural setting and the grounds are well managed providing a very pleasant outlook for service users and level access for those service users wishing to go outside. Feedback from people living at the home was positive from some people. Some people living at the home felt they receive the care and support they need from staff. Comments included “it is lovely here, the staff are really nice and the food is excellent”. The management and staff at Clare Hall listen to complaints and act in line with the homes complaints procedure. The meal time experience is good. Tables are set with linen cloths and napkins. Vegetables are served to the table so that people can help themselves if appropriate. Staff support was completed in a dignified and unhurried manner. Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection?
Since the last inspection information available to people thinking of moving into the home has been improved and updated. The information available is now current, up to date and reflects the services provided. All people living at the home now have a copy of the terms and conditions of their stay. The terms and conditions issued met the Office of fair trading guidelines. Since the last inspection a new activities organiser has been employed. This has increased the opportunities for people living at the home to undertake social and recreational activities. The care and support plans have been developed and improved since the last inspection. The plans on the whole are now individualised and person centred. Some additional development of the plans is required in some areas. It was identified at the last inspection that some areas of the home required ongoing maintenance. This included a leaking roof in the conservatory, replacement of some windows and pot holes in the main driveway. These issues have been resolved and repairs have been made. The manager also stated that the home is due for a major refurbishment including the decoration and replacement of all furniture and carpets. This refurbishment will commence in February 2008. It is expected that all people in care homes who have nursing needs will be provided with an adjustable bed. This reduces the risk of back injury to staff and improves the quality of lives of the people living at the home. Not all people at Claire hall with nursing needs have been provided with these beds. Since the last inspection however BUPA have purchased an additional six height adjustable beds. In addition the management have conducted an assessment to ensure those people with the highest needs have the equipment they require. BUPA must ensure that the remaining people with nursing needs are provided with an adjustable bed as soon as possible. At the last inspection it was also noted that some beds were situated against the wall. This was noted to be for some people who required staff assistance while in bed. This again presented a risk to health as safety as staff had to pull the beds away from the wall. This issue has been addressed with all people to whom this was applicable now having beds with wheels, which are easily movable. Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 8 What they could do better:
As previously stated the staff at the home have improved the care and support plans. These however were not consistent in all cases and sometimes provided conflicting guidance to staff on the care needs of individuals living at the home. The plans therefore require additional development. One person at the home has a pressure ulcer on the day of the inspection. Issue with regard to infection control and inconsistent treatment of this wound were identified during the inspection and raised with the manager at the end of the inspection process. Medication was viewed during the inspection. It was noted that one of the rooms in which the medication is stored was too hot. In addition two of the fridges used to store some medication were found to be too cold. Storing medication at the incorrect temperature may reduce the medications effectiveness. Oxygen for use in the event of an emergency is stored at the home. This oxygen was not secured to the wall in line with good practise guidance. The management also need to consider having this stock within the home. Oxygen therapy is usually prescribed by a GP. Emergency oxygen would usually be given by the emergency services. The oxygen cylinder tubing and mask had not been used for a considerable time and as such were very dusty. This may pose an infection control risk. The oxygen mask and cylinder will require cleaning prior to being used for any person living at the home to reduce the risk of infection. On viewing the drug storage room a number of out of date blood needles were seen. These were given to the manager at the end of the inspection who agreed to dispose of them. Medication Administration Records (MAR) are pre printed by the pharmacy or chemist on a monthly basis. For drugs or medication prescribed in between this by the GP staff at the home have to hand write the medication onto the MAR. It is usual practise for the person who has written the entry onto the chart to have this checked by a second person to ensure that the correct medication and dosage has been recorded. This is required to reduce the risk of medication errors. Both people /staff are then expected to sign the MAR to demonstrate that this has been completed. On the day of the inspection some hand transcribed medication was not seen to have the necessary tow signatures. Staff recruitment was viewed during the inspection. One person recently employed by the home was a registered nurse. It is expected that when Registered Nurses are employed that the management at the home check that the individual is registered to practise with the Nursing and Midwifery Council.
Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 9 It could not be confirmed during the inspection that this had taken place for the individual recently employed. This was completed by the home manager on the day of the inspection and found to be satisfactory. The home however need to ensure that this is completed on all occasions. All staff recruited to work with in a care home are required to undertake a Criminal Record Bureau and POVA check. These had been completed for staff at Claire Hall. A copy of the certificate was seen at the home. It is good practise that once these have been received by the home that the certificate is destroyed to ensure the confidentiality of the individual. The home has experienced a several changes in the management over the last few months. Due to this staff have not received formal supervision over the last few months. This was discussed with the new manager who agreed to reintroduce this. Although the majority of comments from people living at the home were positive we received two comments from people which detailed some staff as being abrupt and occasionally rude to people living at the home. The comments also included issues around communication between staff and people living at the home. This was particularly an issue from staff whose first language is not English. This was discussed with the manager who agreed to look into the concerns raised 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. Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 10 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 Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 11 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): 1,3,4,5, NMS 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 home has a Statement of Purpose and Service User Guide to assist prospective service users to make an informed choice. The personalised needs assessment means that people’s diverse needs are identified and planned for before they move to the home. Visits to view the home are welcomed. EVIDENCE: Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 12 The home has a statement of purpose and service users guide to provide information to prospective people thinking about moving into the home or to provide information to interested parties including those already at the home. This has recently been updated to reflect the change in manager. The documents now reflect the care and support provided. The home receives the single assessment process paperwork for these service users and all new admissions to the home. The homes Manager would assess potential service users for their suitability for the home to ensure that care needs can be met. Examples of community care reviews were seen on the care plans sampled. Prospective service users are given the opportunity to spend in time in the home however all the service users spoken to at this visit were unable to visit due to them being in hospital. All said their relatives chose the home for them. The written contract and terms and conditions of residence are now in place for all people living at the home. The newest service users had a copy. The current fees were included and clearly laid out. This means that service users have the information they need about the service they will receive and how much it will cost them although no service users spoken to could remember signing the contract. In the main contracts are signed by relatives. Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 13 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 Adequate. This judgement has been made using available evidence including a visit to this service. The standard of care and support afforded to people living at the home has improved particularly with regard to the prevention of pressure ulcers. The treatment of existing pressure ulcers requires additional attention. The care plans require additional development to ensure that they are completed consistently and provide clear guidance to staff although some improvements have been seen. People living at the home are treated on the whole with respect and dignity is maintained. Medication is not well managed and this may place people at risk. EVIDENCE:
Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 14 The care and support plans for three people living at the home were viewed during the inspection. These showed that some improvements in the plans have taken place and they now give clearer guidance to staff on the care needs of the individual. Some issues however still remain. For one individual a Waterlow assessment (used to assess the risk for pressure ulcers) had been completed. The individual had been assessed as being at high risk of developing pressure ulcers. The care plan stated that a pressure mattress suitable for this risk was in place. On viewing the bedroom a mattress suitable for a person assessed as being at lower risk was in place. For a second individual a nutritional assessment had been completed. This stated that the individual had a body mass index of 20. Due to this a care plan had been developed to provide staff with information on how to support the individual with their nutritional needs. The plan was clear and recorded the person’s likes and dislikes. The plan, however, stated that on occasions the individual had a poor appetite. The plans did not specify what staff should do if meals were not eaten. An additional care and support plan was viewed for an individual who had pressure damage. The care and support plan for maintaining personal hygiene was very clear and person centred. Personal hygiene is important to help maintain the integrity of the skin. Good nutrition is important in the prevention and healing of any wounds and pressure ulcers. A nutritional assessment had been completed for this individual. The outcome of the nutritional assessment was a score of 2. BUPA guidelines state that for any person with this score a food and fluid diary should be completed. In addition the individual should be weighed on a monthly basis. There was no evidence on the day of the inspection that this was occurring. The care plans stated that due to the pressure damage and other health issues that the individual had a diet consisting of 2000 calories a day was required. Without the use of a diet sheets it is difficult to understand how this is monitored and appropriate care given by staff. A waterlow assessment had been completed. A score of 22 had been reached following this assessment. On the moving and handling assessment this score had been recorded as 17. The rest of the care and support plans seen for this individual were up to date and reflected the care needs of the person as an individual (person centred) The staff had developed a care plan and wound chart with regard to the ongoing and long standing pressure ulcers. Photographs are a tool used to assess the progress or deterioration of any wounds. BUPA guidelines state that these should be completed on a monthly basis. The photographs for November were not available in the file. Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 15 Due to the progress of the wound reaching a static state in December 2007 the care plan was reviewed and the an alternative dressing was used. This new dressing was first used on the 20/12/07. When the wound was redressed on the 21/12/07 the person completing the dressing reverted back to the “old” dressing. This swapping of dressings went on for several days. This leads the inspector to believe that some staff are not using the care plan as a working tool as if they had referred to the care plan they would have realised that the decision had been made to change the dressing type. This also calls in to question the competencies and skill of some of the registered nurses as they should have recognised that the dressing they had removed was not of a similar type on which they were planning to use. This should of led them to refer to the plan of care to ascertain that they were taking the right course of treatment. On the day of the inspection the bedroom of the individual was seen. In the bedroom open half used packets of dressings were seen. In order to reduce the risk of infection all dressing used in the treatment of pressure ulcers should be sterile and freshly opened when completing the dressing. In addition stainless steel tweezers and scissors were with the dressings. Again clean and sterile implements should be used to reduce the risk of infection when dressing the majority of wounds and ulcers. There was evidence in two of the care plans seen that the individual and/or their representative had been involved in the development and review of the plan of care. This was not seen in the other care plan. If people living at the home do not wish to be involved in this process then this should be clearly documented. The majority of people using the service who spoke to the inspector were very complementary about the care they receive and about the kindness and caring attitude of the staff. Staff were observed to treat people with dignity and respect and interacted in a personal and professional manner. It was observed that staff appeared to have a good knowledge of peoples needs. People using the service who spoke with the inspector, were able to confirm that they were able to make choices about their routine, meals and how they spent their day. Comments received included; ‘Staff are approachable and friendly ‘Care plan is good” ‘Atmosphere in the home is good’. Two comments were received by the inspectors that caused some concerns these are discussed in more detail in the section “complaints and protection.” The home has written protocols in place on the Medication Administration Records for the administration of most medications. There were no gaps evident in the Medication Administration Records There was evidence of variable doses being recorded. Some hand transcribed entries were observed not to have bee signed by 2 staff. This increases the risk of medication errors. The manager explained that Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 16 she plans to implement an auditing system in the near future to keep this under review. The rooms where medication is stored were seen during the inspection. One of these treatment rooms was found to be 27 degrees and the other 24 degrees. This is too warm for the storage of medication. In addition two of the fridges were found to be at the incorrect temperature (-1 degree) in that they were too cold. Storing medication at the incorrect temperature may reduce the medications effectiveness. The maintenance man stated that two air conditioning units were on order and that this will help to reduce the temperatures of the rooms. In addition he agreed to defrost the fridges and check that they were in safe temperature limits. During the inspection it was noted that a number of items were pasted their expiry date. These items included Blue vacutainers (08/2006 expiry) and subcutaneous fluid giving sets. These were given to the manager at the end of the inspection who agreed to dispose of them. Oxygen for use in the event of an emergency is stored at the home. This oxygen was not secured to the wall in line with good practise guidance. The management also need to consider having this stock within the home. Oxygen therapy is usually prescribed by a GP. Emergency oxygen would usually be given by the emergency services. The oxygen cylinder tubing and mask had not been used for a considerable time and as such were very dusty. This may pose an infection control risk. The oxygen mask and cylinder will require cleaning prior to being used for any person living at the home to reduce the risk of infection. People using the service have the option to self medicate should they want to. Risk assessments are recommended to be in place to ensure safe practice is maintained. Lockable storage is available as required. A homely remedy policy is in place with signed consent on agreed protocols by the relevant GP’s. All medications were stored safely and securely. There are systems in place for ordering of medication. The box used for the disposal of medication was very heavy suggesting that this had not been empty for some time. The manager needs to ensure that there are regular systems in place for the disposal of medication. Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 17 Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 18 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 provision of activities has improved with the employment of a new activities organizer. People living at the home are now able to make choices with regard to their daily routines and meals Meals and mealtimes arrangements are good EVIDENCE: The provision of activities has improved since the last inspection with the employment of activities organiser. The activities organiser is working 36 hours per week 10-4 Monday to Friday. People who have lived at the home for
Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 19 a period of time stated that they welcomed the reintroduction of activities and social opportunities. Comments included “the Activities organiser is excellent” 1:1 session are completed in the mornings for people who are unable or choose not to join the group sessions. Group sessions are in the afternoon in the afternoon. On the day of the inspection people were doing exercises in lounge. We were informed that on the day following the inspection that a dog from the “pat a pet” would be visiting. This is now a regular activity and people stated that they particularly enjoyed this. The recording of activities requires further development to promote a more person centred approach to activity provision. Not all activities and interaction are currently recorded within the care plan and so the peoples response and participation could not be gauged. One visitor to the home confirmed that they were always made welcome to the home and found staff to be helpful and they felt that there was ongoing communication regarding changing care needs. There were visitors to the home throughout the day and it was noted that staff offered visitors the opportunity to see their relative in private. People using the service’s rooms were decorated in a manner, which reflected their tastes and lifestyles. Evidence was seen in some cases of people’s own furniture and personal items in their bedrooms. Lunch observed was appetising and plentiful and a choices related to personal preferences were provided. Kitchen staff spoken to, had a good understanding of peoples dietary needs. The menu offers a choice and people using the service were complementary and satisfied with the meals provided. Special diets were available and pureed diets were served separately. Meals were served both in the dining room and in people’s bedrooms if preferred. Lunch on the day of the inspection was observed. Lunch was served at 12:45. Tables nicely set with linen tablecloths, napkins and condiments. Choices of drinks, apple or blackcurrant were available. The choice of lunch included Beef and vegetable stew or cod. The food looked and smelt appetising. The Vegetable are served separately to the table allowing people a choice of vegetables and portion size. The vegetables were however removed by staff prior to the meal finishing. It is suggested that the vegetables are not removed until meal has finished as people may like the opportunity have more. Staff assistance was given to those who required it in a dignified manner. The dining areas had a calm atmosphere with the TV’s being switched off and background music playing. Tea and coffee (with biscuits) are served at intervals throughout the day. Staff sated that alternative snacks are available for those people who due to dietary or swallowing restriction are unable to have biscuits. The alternative snacks
Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 20 are not readily available on the drinks trolleys. The staff need to ensure that these are actively offered as some people sated that “they did not like to bother the staff by asking”. Snacks such as cereal, toast, beans on toast yoghurt, fruit and biscuits are available at all times including during the night. The majority of people living at the home were aware of the availability of these items. Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 21 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Staff and people using the service are confident that the homes management team would appropriately deal with any complaints or concerns. Policies, procedures and training are available to staff to ensure they have the knowledge to prevent people from the risk of abuse. Recruitment procedures on the whole protect people using the service from the risk of abuse. EVIDENCE: The home has a complaints policy which was display at the home and also available within the Statement of Purpose/Service User Guide The home has received no complaints since the last inspection. The home has access to an advocacy service for people who may require an independent advocate.
Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 22 All staff who were spoken to during the inspection confirmed that they were aware of policies about protecting vulnerable adults and how you report any concerns about poor care practice or allegations of abuse. The recruitment procedures followed by the home are on the whole robust and are in place to protect people using the service from the risk of abuse. One employment history had an unexplained gap, which the manager was aware of but had not documented. All staff spoken to confirmed that they had received a Criminal Record Bureau Check and examination of recruitment files confirms that these check were undertaken before staff commenced employment. During the inspection two people living at the home raised concerns with the inspectors with regard to a perceived lack of respect from some staff. The two individual concerned stated that staff had been rude to them and had not accommodated their wishes with regard to going to bed or respecting their personal possessions. Both people stated that staff communication remained an issue for those staff whose first language is not English. Both the people stated that they did not wish to make a formal complaint. These issues were raised, maintaining the individuals confidentiality, with the manager. The manager agreed to review the culture within the home. Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 23 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, 20,22,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some maintenance issues identified at the last inspection have been rectified. The home is well maintained Not all people at the home have the specialist equipment they require. Some issues with regard to infection control were identified during the inspection. The home was clean and tidy in all other areas. EVIDENCE:
Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 24 The grounds are well maintained and there is a ‘sensory garden’, which provides a colourful area in the main front garden. Garden areas are mainly accessible for independent wheelchair users and there are tables and chairs in different paved areas. There are three main lounge/dining areas and smaller seating areas. They provide a good range of sitting areas for residents and visitors. All are well furnished, well lit and ventilated. There are two through-floor lifts, one for the ‘house’ and one for the ‘wing’. All areas are accessible for wheelchair users, and there are ramps in some places. There is adequate provision of hoists, which have been serviced regularly. It was found that a number of people living at the home had been assessed as requiring specialist equipment such as pressure mats and adjustable beds. These have been provided by the home. Not all people at the home with nursing needs have been provided with adjustable beds. This was raised at the last inspection and since this time an additional six adjustable beds have been provided. At the last inspection it was found that the lack of adjustable beds put staff and people living at the home at risk. It would appear following this inspection that those people who have been assessed as most in need have been provided with the beds. The management however need to keep this issue under review until all the existing divan type beds have been replaced. During the inspection some areas of the home were found to require additional cleaning. These areas therefore did not meet the standards required to maintain cross infection and infection control. The areas included dirty medical equipment as discussed under medication, a dirty bowl and toothbrush in two bedrooms, tables in some of the bedrooms were found to be dirty, the open dressings and dressing equipment previously discussed and in one of the clinical room there was not a bin in good working order. The remainder of the home including the communal areas were in an excellent standard of cleanliness. The manager stated that she would review these areas and complete some additional infection control training. All laundry is washed in house and the laundry facilities were adequate for the numbers and needs of the service user group. At the last inspection some issues were identified including a leaking roof in the conservatory, potholes in the driveway and replacement of some windows. These issues have now been resolved. In addition the manager stated that home is due for a major refurbishment in February 2008. Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 25 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. Staffing levels at the home appear adequate to meet the assessed needs of people using the service and staff training is promoted, comprehensive and well recorded. The recruitment process is on the whole robust and protects people using the service from the risk of harm. EVIDENCE: At the last inspection people living at the home and relatives discussed a perceived lack of staff at the home. No person raised these concerns on this occasion. The staff duty rota’s were seen. These showed that there are two Registered Nurses on duty at all times. In addition there are 8 care staff on duty in the mornings, 5 in the afternoon 7 in the evenings and 3 care staff on duty overnight. There were 40 people living at the home on the day of the inspection.
Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 26 In addition there are a range of ancillary staff including activities organiser, kitchen staff, cleaners, laundry staff and a handy man on duty. The staff training matrix was viewed during the inspection this demonstrated that all but 7 staff have undertaken fire training in 2007 and that all but 3 staff have done moving and handling training. Some of these staff however a newly employed at the home and would have therefore covered these areas during the induction training. new and this will have been covered in induction. Other courses attended by staff include training in bed rails, stroke rehabilitation, diabetes, dementia care and nutrition. The training matrix demonstrated that 3 staff have gained an NVQ 3 and 4 staff have an NVQ2. This is below the number that would be expected in a home of this size. Four staff recruitment files were viewed during the inspection. These showed that on the whole a robust procedure is followed. All staff recruited to work with in a care home are required to undertake a Criminal Record Bureau and POVA check. These had been completed for staff at Claire Hall. A copy of the certificate was seen at the home. It is good practise that once these have been received by the home that the certificate is destroyed to ensure the confidentiality of the individual. One person recently employed by the home was a registered nurse. It is expected that when Registered Nurses are employed that the management at the home check that the individual is registered to practise with the Nursing and Midwifery Council. It could not be confirmed during the inspection that this had taken place for the individual recently employed. This was completed by the home manager on the day of the inspection and found to be satisfactory. The home however need to ensure that this is completed on all occasions. Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 27 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, 36, 38, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Managerial arrangement s at the home are satisfactory although the manager is not yet registered for this service with the CSCI. Supervision arrangements are not currently satisfactory Maintenance and servicing are well managed. EVIDENCE:
Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 28 The home has been without a registered manager for a significant period ot time. During this time BUPA have supported the home with the placement of interim managers. A new permanent full time manager has recently transferred to the home from another local BUPA home. The new manager Ms Gale Smith has 16 years experience in the field of older people. Ms Smith also holds a D32 and D33 qualification (NVQ assessor), ENB941 (certificate in elderly care) and an RMA (registered managers award) Ms Smith had been working at the home for approximately a week prior to the inspection and was therefore in the process of becoming familiar with the remaining issues at the home. Ms Smith will provide the stable manager the home requires and it is hoped that any issues identified during the inspection will be quickly rectified and that the improvements that have already been made will continue. A number of meeting have taken place over the last few months. These meetings have taken place to keep both the staff and people living at the home informed of the managerial arrangements and continued developments. The meeting have included Head of department meeting 25/10/7,trained staff meeting 23/10/07, Care staff meeting on the 12/09/07, House keeping on the 15/02/06 and residents meeting on the 11/01/08. Staff supervision has not been conducted over the last few months. Supervision is a system where staff have 1:1 time with a senior member of staff to discuss any issue either party may have. This should be conducted six times annually for each staff member. Records demonstrated that Staff supervision had taken place for May-June 07, July- August 07, SeptemberOctober 2007, since October no supervision has been recorded. This needs to be re-introduced. Maintenance and servicing records were viewed during the inspection. These were found to be in good order. Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 29 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 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 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 2 3 3 X 2 X X X 1 STAFFING Standard No Score 27 3 28 1 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X 1 X 3 Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES 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 It is required that the care plans are reviewed to ensure that they care completed consistently and provide clear guidance to staff on the care needs of the individual. It is required that medication is stored at a temperature in line with the manufactures guidelines. This requirement is outstanding from the last inspection. Previous timescale 17/10/07 3. OP9 13 (2) It is required that all hand 15/03/08 transcribed entries on the Medication Administration Record have two signatures It is required that an audit 15/03/08 system is implemented that ensure that all out of date medical equipment and medicines are removed form the home. The Registered Person must 01/04/08 continue to review the risk
DS0000003250.V357801.R01.S.doc Version 5.2 Page 31 Timescale for action 30/03/08 2. OP9 13(2) 15/03/08 4. OP8 OP9 13 (2) 5. OP24 16 (2)(c) Clare Hall Nursing Home assessment for the provision of adjustable beds and ensure that beds are provided in line with the completed risk assessments. 6. OP8 OP26 13 (3) 7. OP29 Schedule 2 It is required that the system in place for infection control is reviewed to ensure it is in line with best practise. This relates to wound dressings and equipment, oxygen masks and tubing and dirty items such as bowls. It is required that the provider checks the Nursing and Midwifery Council register for all newly recruited Registered Nurses prior to them commencing employment. 15/03/08 15/03/08 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 OP7 OP18 Good Practice Recommendations It is recommended that the staff consult with those people who have not yet had the opportunity to input into the development and review of their plan of care. It is recommended that the management ensure that staff have competent communication skills and opportunity to meet the needs of people living at the home. (this relates to the comments received during the inspection from two people living at the home.) It is recommended that the storage of oxygen is reviewed. In addition the use of oxygen in an emergency without a prescription should be considered. It is recommended that BUPA review the number of people
DS0000003250.V357801.R01.S.doc Version 5.2 Page 32 3. 4. OP9 OP28 Clare Hall Nursing Home who have an NVQ and ensure that the opportunity is available for staff to undertake this qualification. 5. OP36 It is recommended that the system of staff supervision is re-introduced. Clare Hall Nursing Home DS0000003250.V357801.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Regional Contact Team 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
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