Inspection on 02/03/06 for Clare Hall Nursing Home

This inspection was carried out on 2nd March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Clare Hall Nursing Home 21/01/09

Clare Hall Nursing Home 14/01/08

Clare Hall Nursing Home 31/08/07

Clare Hall Nursing Home 27/09/06

Clare Hall Nursing Home 29/09/05

Clare Hall Nursing Home 22/03/05

Clare Hall Nursing Home 08/09/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Clare Hall Nursing Home Ston Easton Bath Somerset BA3 4DE Lead Inspector Justine Button Unannounced Inspection 2nd March 2006 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.V285163.R01.S.doc Version 5.1 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.V285163.R01.S.doc Version 5.1 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 www.bupa.co.uk BUPA Care Homes (CFCHomes) Limited Mrs Janet Mary Gough 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.V285163.R01.S.doc Version 5.1 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. 29th September 2005 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 and the nearest shopping centre would be Wells or Shepton Mallet, both several miles away. 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.V285163.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors for the CSCI carried out this unannounced inspection over one day. One of the inspectors was the CSCI pharmacist. The Registered Manager was available throughout the inspection period and to receive feedback at the conclusion of the inspection periods. 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 clean, tidy and well maintained. The home had forty seven people living at the home on the day of inspection. Lunchtime was observed in the dining areas of the home. Records were sampled, these included, staff training, staff recruitment, personal finances, maintenance records care planning and medication. In addition the aim of this inspection was to review the progress made towards shortfall identified in the last inspection. What the service does well: What has improved since the last inspection? A number of areas were identified in the last inspection. The majority of these have been or are to be addressed in the near future. Clare Hall Nursing Home DS0000003250.V285163.R01.S.doc Version 5.1 Page 6 The conservatory, which is currently unsafe for use, is due to be replaced in April 2006. The remainder of the windows, which are not double-glazed, are due to be replaced some time in 2006. There is an ongoing programme of decoration and recarpeting. A quote has been obtained for the replacement of one carpet in the corridor. Five bedroom carpets have been replaced. Eight adjustable beds have been purchased. Four of these are in use, the remaining are awaiting the delivery of mattresses. 50 of the beds are now suitable for people with nursing needs. The standard of cleanliness of the “house” has now improved and is now of a good standard. 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. Clare Hall Nursing Home DS0000003250.V285163.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Clare Hall Nursing Home DS0000003250.V285163.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5. NMS 6 does not apply. The home provides a good level of information for prospective service users to make an informed choice of care home. Visits to view the home are welcomed. EVIDENCE: The CSCI Registration certificate is displayed. Clare Hall has a Statement of Purpose and offers information to prospective service users and their families/carers. Visits to the home are welcomed and the home offers respite care. Information is displayed in a file in the foyer at the home. The home uses the visitor’s log at reception, this is good practice. Clare Hall Nursing Home DS0000003250.V285163.R01.S.doc Version 5.1 Page 9 Comment from people living at the home indicated that they felt that the home provided a good standard of care and support. Care plans contained the information gathered for pre-admission assessment and care plans had been written to meet the needs of service users. Clare Hall Nursing Home DS0000003250.V285163.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. All people who live at the service have a care plan which sets out their health and personal needs. These need to be developed. The health needs of the people who live at the service are met in part. People who live at the service have their privacy respected. Medication is not well managed in all areas. EVIDENCE: All people who live at the service have a plan of care. six of these were viewed on the day of inspection. The plans need to be developed in order to give clear guidance to the staff on the specific needs of the people living at the service. Ambiguous statements such as “encourage fluids” need to be avoided. The plan should state how much fluid should be encouraged. Discussions with staff however showed that they had a clear knowledge of individual’s needs and requirements. There were risk assessments where necessary, including a manual handling and nutritional assessment. In three of the plans seen the Clare Hall Nursing Home DS0000003250.V285163.R01.S.doc Version 5.1 Page 11 assessments contained conflicting information to that contained in the care plans. When the inspector visited the individuals it again could not be confirmed if the information in either the plan or the assessment was relevant. For one individual the moving and handling assessment stated that the individual was mobile. The care plan stated that staff assistance and a handling belt was required. However on visiting the individual it was very apparent that a hoist would be required. One individual who had lost weight. This had not been reflected in the plan of care and there were no clear guidelines to instruct staff on the action to be taken to address this need. There was only some evidence of service user involvement documented in the plan, although the inspector assessed that a number of the service users could have been fully involved. This aspect requires further development to ensure service users are involved to the best of their capabilities and wishes. All Service Users are able to remain with their own GP, where possible. An arrangement has been established with the local GP providing regular support and weekly visits to those registered with the practice. All service users have a GP review in addition to community nursing reviews. A number of health professionals visit the home, both privately and through the NHS. The manager has access to a range of local health services and professionals as required via GP referral. The home has a large number of pressure relieving devices. Service user plans inspected showed evidence of community health care input. The date of receipt of medication into the home is not recorded on all occasions. The temperature control of the medication fridge was seen to be poor leading to inappropriate storage of medicines requiring refrigeration. Hand written entries on the Medication Administration Record (MAR) charts were not always dated and did not always have two signatures. For some variable doses of medication the amount actually administered was not recorded. Some out of date sterile products were found. The security and fixing of some of the medicine storage cupboards did not meet the current regulations. All service users appeared well kempt and those who were asked said that they are helped with their personal care as much as they need. People spoken to stated that staff were very kind and that they always “knocked on your door before coming in”. During the inspection, the inspector observed staff interacting with service users in a professional, kindly and respectful manner. Staff are friendly, but professional in their approach. Clare Hall Nursing Home DS0000003250.V285163.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Activities are well advertised and well managed. There is a good range of social events and for the less able there are opportunities for one to one social contact. Families were seen to be welcomed and to be part of the home life. The menu is varied and looked appetising EVIDENCE: People who live at the service spoke highly of their freedom and choices in daily life however input into the plan of care may increase the ability to make active choices. Activities are offered and are led by the activities coordinator. Activities for the week were on display in the hallway. These included games bingo, Holy Communion; sing along, domino club and listening to classical music, flower arranging. There are regular residents meetings at which people who live at the service have an opportunity to input into the running of the service. Minutes of the last meeting were seen during the inspection. Visitors were seen and all said that they felt welcomed. Clare Hall Nursing Home DS0000003250.V285163.R01.S.doc Version 5.1 Page 13 Lunch was observed in the dining rooms, the dining tables are well presented and meals are nicely presented by the staff. Potatoes and vegetables are served in dishes to the tables which allows varying appetites to be catered for. The food looked served looked appetising. Wine is offered with some meals. Meals are available for people who have eating and swallowing difficulties. The soft meal is served in separate portions. This is good practise as it allows the individual to differentiate the separate tastes. Staff were however then observed mixing the component parts together. Consideration should be given to ensuring that snacks are available for those who with swallowing difficulties or high protein e.g. yoghurts for those who have pressures sores as this will support healing. The kitchen was viewed during the inspection. This was clean and tidy. The menus demonstrated that a balanced diet made up of home cooked/prepared meals is provided. There was a range fresh vegetables and home made cakes in the storeroom. A number of people spoken to prior to the meal could not remember what was going to be served. This may be improved by displaying the daily menu on the tables. Clare Hall Nursing Home DS0000003250.V285163.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. The home has a complaints procedure which is made available to service users. Service users are protected from abuse with the homes policies and procedures and practice. EVIDENCE: The home has a corporate adult protection and Whistle blowing policies. The home has a complaints policy and procedure. All complaints are investigated and a record is kept. No complaints have been received since the last inspection. Clare Hall Nursing Home DS0000003250.V285163.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26. Clare Hall is well maintained and provides a comfortable well adapted and well maintained environment for service users. EVIDENCE: Since the last inspection some work has been completed to improve the standard of cleanliness in parts of the home. On the day of the inspection the home was clean and odour free. The home is partially double glazed. The remaining windows are due to be replaced in the next financial year. The conservatory, which is currently unsafe for use, is due to be replaced in April 2006. There is an ongoing programme of decoration and recarpeting. A quote has been obtained for the replacement of one carpet in the corridor. Five bedroom carpets have been replaced. Clare Hall Nursing Home DS0000003250.V285163.R01.S.doc Version 5.1 Page 16 Rooms are well furnished and spare chairs are available for visitors and are stored in the corridors. Eight adjustable beds have been purchased. Four of these are in use, the remaining are awaiting the delivery of mattresses. 50 of the beds are now suitable for people with nursing needs. 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 and aids to assist service users. There is an adequate call bell system. Clare Hall has in place a control of infection policy. All staff seen adhered to this policy and there were adequate facilities and equipment in place to control the spread of infection including hand-washing facilities. All laundry is washed in house and the laundry facilities were adequate for the numbers and needs of the service user group. Clare Hall Nursing Home DS0000003250.V285163.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. The home has sufficient staff employed in all departments and demonstrated a satisfactory number of staff on duty at this inspection. Staff training is provided. EVIDENCE: Testimony from the people living at the home and staff confirmed that there are adequate numbers of staff on duty at all times. People living at the service stated that they did not have to wait long if they required assistance or support. The staffing rota’s were viewed which confirmed this. There is a range of ancillary staff available. Staff confirmed that they had undertaken a range of training including NVQ’S. Moving and handling training had been arranged in the week following the inspection. Staff recruitment files were viewed. These were in line with good practise and all necessary checks had been made for all new employees. Clare Hall Nursing Home DS0000003250.V285163.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37 & 38. The home has a CSCI Registered Manager and the home is well managed. Records are appropriately stored and systems are in place to protect the best interests of service users. Maintenance is well managed EVIDENCE: Mrs Gough is managing the home well; she has a friendly open management style. The Manager is supported by a deputy manager, an administrator and by the corporate management teams input. Regulation 26 monthly management visits are made and are recorded. Clare Hall Nursing Home DS0000003250.V285163.R01.S.doc Version 5.1 Page 19 All records sampled for staff and service users were seen to be well managed and appropriately and safely stored. Financial accounts were seen where small amounts of money are held on behalf of service users. This was well managed and is held in one bank account for named individuals each with their own personal account details and each being individually interest bearing. This was satisfactory. Records are held on the homes accounts computer system that has restricted access. Maintenance of the homes equipment and servicing was well managed. Clare Hall Nursing Home DS0000003250.V285163.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 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 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Clare Hall Nursing Home DS0000003250.V285163.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement It is required that people living at the service are involved in the development and review of their plan of care. The plans should give clear guidance to the staff caring and supporting the individual. Timescale for action 30/05/06 2 OP9 13 (2) The registered person shall make 30/04/06 arrangements for the safe keeping of medicines in the care home The registered person must ensure that all medicines are stored within the temperature range specified by the manufacturer. The registered person must ensure that all medicines are stored in cupboards complying with current regulations The registered person shall make 30/04/06 arrangements for the recording and safe administration of all medicines received into the care home. The registered person must 3 OP9 13 (2) Clare Hall Nursing Home DS0000003250.V285163.R01.S.doc Version 5.1 Page 22 ensure that the date of receipt of all medicines into the care home is recorded. The registered person must ensure that the dose actually administered is recorded for medicines prescribed with a variable dose. The Registered Person must continue to review the risk assessment for the provision of adjustable beds and ensure that beds are provided in line with the completed risk assessments. 4 OP22 16 (2)(c) 30/06/06 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 OP9 Good Practice Recommendations It is recommended that the home develop a system to regularly check and monitor the expiry dates of all sterile products stored in the home. It is recommended that when an entry is hand written onto the Medicines Administration Record chart that this is signed and dated by the person making the entry and it is then checked and countersigned by a second person. It is recommended that staff are reminded not to mix the component parts of any “soft” diet provided. It is recommended that consideration is given to providing alternative to cakes and biscuits in between meals for example yoghurts. 3 OP15 Clare Hall Nursing Home DS0000003250.V285163.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Clare Hall Nursing Home DS0000003250.V285163.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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