Inspection on 27/09/06 for Clare Hall Nursing Home

This inspection was carried out on 27th September 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 02/03/06

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 Shelagh Laver Key Unannounced Inspection 27th September 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.V314091.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.V314091.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 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.V314091.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. 2nd March 2006 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.V314091.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection. The manager Janet Gough had submitted Annual Quality Assurance Assessment documentation as part of the pilot of this new self-assessment system. Information provided confirms that for example 45 of staff are trained to NVQ level 2 and above and maintenance of equipment is current. Two inspectors carried out the inspection visit to the home over one day. The inspection was completed on 6th October when 15 comment cards were returned. The Registered Manager was available throughout the inspection period and to receive feedback at the conclusion of 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 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. 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. The standard of cleanliness within the home is good. The home is well managed; the Manager is approachable and is an experienced professional nurse. There is a dedicated and stable staff team. Feedback from people living at the home was extremely positive. Service users felt they receive the care and support they need from staff. Seventeen comment cards were received from service users or their relatives. Fifteen were unreservedly positive in all areas. Comments from relatives included Clare Hall Nursing Home DS0000003250.V314091.R01.S.doc Version 5.2 Page 6 “……needs always appear to be met….since he has been here he seems physically better…” “Has “blossomed under the good care at Clare Hall.” “Care and nursing staff are always polite and helpful”. On service user said “I am quite happy here.” Another spoke of her enjoyment of the activities provided and her comfortable room. The provision of food is good and is served in attractively presented dining rooms. The activities programme is varied and the co-ordinator tries hard to ensure service users lives are enriched. There is a commitment in the home to continued improvement and new initiatives such as a customer service programme. Comment cards confirmed service users or their families received enough information prior to moving into the home and several mentioned the visit of the manager and the help she had provided. What has improved since the last inspection? What they could do better: Whilst there were many very positive comments about staff kindness and care two comment cards completed by relatives felt that care and response to requests varied “depending who is on duty”. The manager confirmed that the home is fully staffed however there were some comments about staffing levels at weekends and the time taken to answer bells. A review of the off-duty indicated that staffing was adequate. All service users must have access to their call bells at all times. Overall the home was clean and fresh however the sluices in the home would benefit from a “deep clean.” Two relatives commented on a problem with flies in part of the home this summer. There should be an audit of cleaning practices with regard to the cleaning of commodes and disposal of continence aids to ensure guidance is followed in all rooms. . Training of trained staff and audit of medication charts must continue to ensure all practice complies with best practice. Clare Hall Nursing Home DS0000003250.V314091.R01.S.doc Version 5.2 Page 7 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.V314091.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 Clare Hall Nursing Home DS0000003250.V314091.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1234 Quality in this outcome area is good. 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. Service users are admitted to the home only when their needs can be met. 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. Comment from people living at the home indicated that they felt that the home provided a good standard of care and support. Clare Hall Nursing Home DS0000003250.V314091.R01.S.doc Version 5.2 Page 10 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.V314091.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is good. All people who live at the service have a care plan which sets out their health and personal needs. People who live at the service have their privacy respected. Medication management has improved since the last inspection. 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 showed regular up-dates recording changes in service users needs. Discussions with staff 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. There was evidence that wounds were healing. The home is implementing the Gold Standards Framework in Palliative Care and further development and training is planned to support service users at the end of their lives. Clare Hall Nursing Home DS0000003250.V314091.R01.S.doc Version 5.2 Page 12 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 medication administration system has improved since the last inspection. There is a medication audit in place. Additional training had been provided for the nurses. A review of the MAR charts indicated that attention to detail was required. For example if a service user is prescribed any regular medication and refuses it because they feel it is not needed this must be shown in the records or the prescription should be changed to prn (when necessary). Any entries on a medication record must be signed and dated. All service users appeared well presented 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 helpful. During the inspection, the inspector observed staff interacting with service users in a professional, kindly and respectful manner. Staff were friendly, but professional in their approach. Clare Hall Nursing Home DS0000003250.V314091.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is good. 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. Activities are offered and are led by the activities coordinator. Activities for the week were on display in the hallway. The inspectors were able to observe the afternoon entertainment of the day which was a visit from an owl, hedgehog and dog. It was noted that the activities co-ordinator was encouraging and supporting frailer service users to maximise their enjoyment. Tea was served with home-made cakes to complete the enjoyment. Other activities included a weekly quiz, games bingo, Holy Communion; sing along, domino club and listening to classical music and flower arranging. There is an Evergreen Club. Some service users enjoy 1:1 visits if they cannot leave their room. Clare Hall Nursing Home DS0000003250.V314091.R01.S.doc Version 5.2 Page 14 Some service users enjoy trips out. One service user wrote of a trip to WestonSuper-Mare “it was one of the nicest days I have had for years. The weather was perfect, my escort for the day was a perfect companion. And I enjoyed my fish and chips!” 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. There is a monthly newsletter from the manager. Visitors were seen and all said that they felt welcomed. Lunch was observed in the dining rooms, the dining tables are well presented. Staff served meals with care. Potatoes and vegetables are served in dishes to the tables, which allows varying appetites to be catered for. The food served looked appetising. Wine is offered with some meals. Meals are available for people who have eating and swallowing difficulties. Consideration should be given to ensuring that snacks are available for those who with swallowing difficulties or need high protein e.g. yoghurts for those who have pressures sores as this will support healing. The menus demonstrated that a balanced diet made up of home cooked/prepared meals is provided. In addition to two main choices at lunch time e.g. chicken casserole and fish pie there is a range of “always available” alternatives including omelette, salad cheese and biscuits and light desserts. There was a range fresh vegetables and homemade cakes were served at tea time. Clare Hall Nursing Home DS0000003250.V314091.R01.S.doc Version 5.2 Page 15 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 17 18 Quality in this outcome area is good. 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.V314091.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. Clare Hall is well maintained and provides a comfortable well adapted and well maintained environment for service users. EVIDENCE: On the day of the inspection overall the home was attractive and clean. The home is partially double-glazed, remaining windows are due to be replaced in the near future. The conservatory has been replaced and is now furnished and in use. There is an ongoing programme of decoration and recarpeting. There is a new carpet in the first floor corridor. Bedrooms are decorated when they are vacated. Rooms are well furnished and spare chairs are available for visitors and are stored in the corridors. Additional chairs have been purchased to replace those that are worn. 50 of the beds are adjustable and suitable for people with nursing needs. Clare Hall Nursing Home DS0000003250.V314091.R01.S.doc Version 5.2 Page 17 One bathroom on the ground floor needs refurbishment. There has been a problem with flies this summer and one room had a well used fly paper hanging from the ceiling. There was an odour in two bedrooms. The inspector spoke to the housekeeper who identified the source of the odour and dealt with it. 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. New paving has been completed this year and additional garden furniture has been purchased. 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. 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 although three service users were left without access to them. Clare Hall Nursing Home DS0000003250.V314091.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is good. The home has sufficient staff employed in all departments and demonstrated a satisfactory number of staff on duty at this inspection. Relevant staff training is provided EVIDENCE: The majority of the people living at the home and their relatives 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 although two comment cards stated they had to wait sometimes. The staffing rotas were viewed and showed that there were adequate staff on duty. There is a range of ancillary staff available. Staff confirmed that they had undertaken a range of training including NVQ’S. In-house Fire training was being completed on the day of the inspection. The nurses in the home have received care planning and medication training. Staff are completing a new nutrition workbook. There is an in-house manual handling co-ordinator. 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.V314091.R01.S.doc Version 5.2 Page 19 Clare Hall Nursing Home DS0000003250.V314091.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is good. The home has a 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 methodical and ensures as far as reasonably possible the health and safety of the service user. EVIDENCE: Mrs Gough is managing the home well; she has a friendly open management style. The home is well managed. 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. All records sampled for staff and service users were seen to be well managed and appropriately and safely stored. Clare Hall Nursing Home DS0000003250.V314091.R01.S.doc Version 5.2 Page 21 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 current and accurate. Clare Hall Nursing Home DS0000003250.V314091.R01.S.doc Version 5.2 Page 22 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 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 3 18 3 3 3 3 2 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.V314091.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP22 Regulation 16 (2)(c) Requirement 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. Timescale for action 01/12/06 2. OP9 13 (2) The registered person shall make 01/11/06 arrangements for the recording and safe administration of all medicines received into the care home. The registered person must ensure that if a prescribed medicine is not given the reason must be stated. There must no gaps in the records. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Clare Hall Nursing Home DS0000003250.V314091.R01.S.doc Version 5.2 Page 24 No. 1. Refer to Standard OP9 Good Practice Recommendations An audit of practices should be undertaken with regard to the cleaning of commodes and disposal of continence products. 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 consideration is given to providing alternative to cakes and biscuits in between meals for example yoghurts. 2. OP9 3. OP15 Clare Hall Nursing Home DS0000003250.V314091.R01.S.doc Version 5.2 Page 25 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.V314091.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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