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Inspection on 29/09/05 for Clare Hall Nursing Home

Also see our care home review for Clare Hall Nursing Home for more information

This inspection was carried out on 29th September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People living at Clare Hall stated that they liked the staff and appreciated the hard work that they did. All stated that they received good care and support. The majority stated that the food was of good standard and that they enjoyed the meals. A large percentage of the people who live at the home were frail and nursed in bed for periods throughout on the day. These people received appropriate care. The service has close links with the local hospice and have a gold standard award in palliative care.

What has improved since the last inspection?

Since the last inspection the upper floor corridor and a number of the bedrooms in the "wing" has been redecorated and a new carpet has been fitted. The staff room has also had a new carpet.

What the care home could do better:

Frail people who are nursed or receive care in bed for periods should be provided with an adjustable bed. This allows staff to support the individual whilst in bed and reduces the risk of back injury. Clare Hall currently has sixteen adjustable beds. This is below the number that would be expected of a home of this size. On the day of inspection there was a disparity in the standard of cleanliness of the environment between the "house" and the "wing". The manager stated that this was due to a shortfall in ancillary staff and that this would be rectified in the near future. The majority of the home is double-glazed. Some of the windows at the front of the house are in need of replacement as some are in a bad state of repair such that at least one will not close. The conservatory in the main house is also out of use as the roof is unsafe. This will also require attention. The medication recording and storage was reviewed during the inspection and a number of good practise guidelines were discussed with the home manager.

CARE HOMES FOR OLDER PEOPLE Clare Hall Nursing Home Ston Easton Bath Somerset BA3 4DE Lead Inspector Justine Button Unannounced Inspection 29th September 2005 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.V254234.R01.S.doc Version 5.0 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.V254234.R01.S.doc Version 5.0 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 BUPA Care Homes (CFC Homes) 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.V254234.R01.S.doc Version 5.0 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. 22nd March 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.V254234.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors conducted this unannounced inspection over the course of one day. The inspectors were able to speak with a large number of the residents as well as staff on duty. The manager Mrs Janet Gouch was available on the day of inspection. The inspectors would like to thank the residents and staff for their time and hospitality shown to the inspector during their visit. This is the first inspection using the new CSCI reporting format, which focuses on outcome statements for National Minimum Standards. The inspector’s aim on this inspection visit was to seek views on the quality of the service from as many service users as possible and to speak to staff. A number of requirements were made at the last inspection. The inspection also focused on the work completed in achieving these shortfalls. Records examined were care plans, medication records, staff training & recruitment files and some on going maintenance records. Other records will be examined at subsequent inspection visits. A tour of the building was carried out on this visit. What the service does well: What has improved since the last inspection? Since the last inspection the upper floor corridor and a number of the bedrooms in the “wing” has been redecorated and a new carpet has been fitted. The staff room has also had a new carpet. Clare Hall Nursing Home DS0000003250.V254234.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Clare Hall Nursing Home DS0000003250.V254234.R01.S.doc Version 5.0 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.V254234.R01.S.doc Version 5.0 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. Standard 6 is not applicable. People who move into the home receive adequate information and have contact with the service to discuss their needs prior to admission. EVIDENCE: The home has both a Service User Guide and a Statement of Purpose. These were seen on the day of inspection and contained all the necessary information. Discussion took place with a person who had recently moved into the home and his wife. Both confirmed that they had received information about the home prior to moving in. They confirmed that they found this information useful and it was used to reduce their anxiety. They also confirmed that they had been able to visit the home prior to moving in and that an assessment of the individual’s needs had been completed. A copy of the homes “Terms and Conditions of Residence” was seen at the inspection. These are issued to those people who are able to pay privately for their fees or for those people who “top up” the fees paid by Social Services. People whose fees are paid by Social Services in full do not receive a copy of terms and conditions from the home. There is a contract between the home Clare Hall Nursing Home DS0000003250.V254234.R01.S.doc Version 5.0 Page 9 and the Social Services, which are paying the fees. Following recent guidance from the Office of Fair Trading it is advised that people who fall in to this category are made aware of the services to be provided by the home and that they receive a clear and transparent contract. Clare Hall Nursing Home DS0000003250.V254234.R01.S.doc Version 5.0 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, 11. Care planning has improved; care must be taken to ensure clear guidance is given to staff on all occasions. The home must continue trying to achieve more service user involvement. Medications management was not in line with good practise guidance. Service users are treated thoughtfully, with respect and are well cared for if very frail or very ill. EVIDENCE: Six care plans were sampled, personal details and contacts were recorded. Service users had recorded care needs assessments and subsequent reviews of care. The plans of care related to the care given for people who live at the service (case tracking). There was evidence in the care plans of input by the community health care professionals such as the chiropodist, dentist, optician and continence advisor. Out patient appointments and GP visits were recorded. Staff need to avoid ambiguous statements in the care plans. Statements seen included “ensure adequate fluids or turn regularly”. The plans of care need to be specific e.g. how much fluid or how frequently the Clare Hall Nursing Home DS0000003250.V254234.R01.S.doc Version 5.0 Page 11 person needs support to change position. The registered nurses need to ensure that the use of medical terminology is avoided. Both of these measures will ensure that clear guidance is given to care staff. There was limited evidence that individuals living at the service have been involved in the development and review of the plans. This is seen as good practise and helps to ensure that people have care delivered in the way that they would wish. Pressure relieving equipment was seen in use and all manual handling was risk assessed for the individual service users in their care plans. The care of one individual was discussed with the manager and a recommendation made. The home uses the Gold Standard Framework for Care Homes, advanced care planning. This allows a service user’s wishes for treatment to be recorded in advance and therefore be available for consultation in the event of their health deteriorating. Service users who were spoken with confirmed that they felt well cared for and that they are treated with dignity. Staff were observed knocking on bedroom doors prior to entering. Medication administration records were examined, gaps on the administration sections were identified and not all hand transcribed entries had signatures to verify who made the entry and who checked the entry. Skin creams for individual service users did not have opened on, nor discard by, dates on them; this is recommended at this inspection. Oxygen cylinders were stored in the treatment room. These were not secured adequately. In addition it is recommended that the dosage of medication given is made clear on the medication records. Clare Hall Nursing Home DS0000003250.V254234.R01.S.doc Version 5.0 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. The inspectors observed good practice and visitors were made welcome. The home’s ethos supports choice, independence and values the individual. The catering was good. 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. One person reported that they sometimes feel bored. 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. 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. Satisfaction with the care of their relatives was expressed. Comments about the food from those who were asked included ‘food is good’ “there is always plenty of food available”. Lunch was observed and was seen nicely served at well-presented tables. The menu looked appetising, Clare Hall Nursing Home DS0000003250.V254234.R01.S.doc Version 5.0 Page 13 Lamb chops or beef cobbler served with potatoes and a choice of vegetables was served. A choice of desserts was then offered. Hot drinks are served between meals with biscuits; homemade cakes are served with afternoon tea. Choices of cheese pie or sandwiches were available in the evening. Clare Hall Nursing Home DS0000003250.V254234.R01.S.doc Version 5.0 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. The home has a complaints procedure which is made available to service users. People living at the service 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. One complaint had been recorded and investigated. Clare Hall Nursing Home DS0000003250.V254234.R01.S.doc Version 5.0 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 suitable for it’s stated purpose. Some areas require additional cleaning. There are some outstanding maintenance issues. Some of the toilets were cluttered with equipment and furniture and therefore unusable. Not all specialist equipment is provided. People are able to bring their own possessions to personalise their bedrooms. EVIDENCE: A tour of the building was conducted during the inspection. Some areas including the corridor and some bedrooms in the “wing” area have been redecorated and new carpet has been laid. This is welcomed. Some of the carpets in the main house are in need of replacement or deep cleaning. There appeared to be a disparity in the standard of the cleaning between the two areas. The wing was clean and tidy on the day of inspection with the upper floor of the house less so. Some high cleaning and attention to areas such as Clare Hall Nursing Home DS0000003250.V254234.R01.S.doc Version 5.0 Page 16 doorframes, paintwork and skirting boards is required in the main house. The manager stated that there had been a shortfall in domestic staff however the staff vacancy had been filled and so these shortfalls would be addressed in the near future. The service is partially double-glazed. The remaining windows are now in a poor state of repair such that at least one would not shut completely. These now require urgent attention especially as the winter months are now coming. Since the inspection it has been confirmed that this window is now closed. The windows at the front of the house are due for replacement in 2006. The conservatory area in the main house is currently inaccessible as the roof is unsafe. A number of people at the service stated that they missed using this area and that it had been out of use for a significant period of time. The manager stated that these areas were due for repair or removal but could not confirm a timescale. Specialist equipment is available with the exception of adjustable beds. This may compromise the flexibility for the service user and the safety for staff in terms of moving & handling practices especially for those people who require care and support whilst in bed. There is an ongoing programme to replace some of the existing beds. The manager stated that an additional eight beds were to be purchased next year. The manager needs to continue to review the completed risk assessments to ensure that the service provides adequate numbers of specialist beds. Clare Hall has in place a range of equipment and adaptations. A nurse call bell is available in all areas. Various hoists and moving and handling equipment are provided to meet the needs of service users. There are grab rails and specialist bathing hoists. Clare Hall provides aids used for pressure relief and the prevention and treatment of pressure ulcers, equipment was seen in use. A number of the toilets were inaccessible as they are currently used as storage. This needs to be reviewed to ensure that there are adequate facilities for the people living at the service. People living at the home are able to personalise their rooms with their own possessions. Clare Hall Nursing Home DS0000003250.V254234.R01.S.doc Version 5.0 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, 30. The home has a dedicated core staff team. There are sufficient numbers of staff on duty. It could not be confirmed if all staff have undertaken the necessary training in order to meet the needs of the people who live at the service. EVIDENCE: Rotas were examined for the 2 weeks worked prior to the inspection. This has been compared with the previous Somerset Health Authority staffing requirements. The rotas showed that Clare Hall currently provides an adequate amount of staff hours to meet the needs of the service user group. Staff stated that they felt that the dependency levels within the home were currently high. People living at the service confirmed that staff were often very busy but they received good care and support. The manager confirmed that additional domestic staff have recently been recruited. The management stated that only a small amount of agency staff have recently been used to supplement the existing staff group since staff have been recruited from overseas. The Staff training matrix was viewed on the day of inspection. This did not clearly demonstrate that all staff had received all mandatory training. It is advised that the matrix is developed in order that staff training can be clearly Clare Hall Nursing Home DS0000003250.V254234.R01.S.doc Version 5.0 Page 18 demonstrated. Staff spoken to however, during the inspection stated that they felt that they had received enough training to fulfil their roles. A number spoken to had undertaken NVQ qualifications. Clare Hall Nursing Home DS0000003250.V254234.R01.S.doc Version 5.0 Page 19 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, 37, 38. This home generally has good occupancy rates. Service users speak well of the care and service they receive. Records are well managed and are stored securely. The home is well managed. EVIDENCE: Staff and people who live at the service all stated that they thought the service was well managed. Staff stated that they were well supported. All parties stated that they would feel confident in taking any concerns to Mrs Gouch. A number of health and safety records were viewed during the inspection. These included fire safety records, electrical and water checks. These were in order and in line with good practise. On the day of inspection the sluice was unlocked. This area contains chemicals and is therefore advised that this area is kept locked. Clare Hall Nursing Home DS0000003250.V254234.R01.S.doc Version 5.0 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 3 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 X 2 3 2 2 3 3 3 1 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X X 3 2 Clare Hall Nursing Home DS0000003250.V254234.R01.S.doc Version 5.0 Page 21 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 OP26 Regulation 23 (2) (d) Requirement It is required that there is a programme of deep cleaning in the “house” That a programme of redecoration and refurbishment to the “house” is submitted to the CSCI Action plan to be submitted detailing an agreed timescale 30/10/05. It is required that the window in the identified room is repaired such that it will close. It is required that BUPA submit to the CSCI details of the action to be taken with regard to the repair or demolition of the “house conservatory” Action plan to be submitted detailing an agreed timescale 30/10/05. The Registered Person must review the risk assessment for the provision of adjustable beds and devise an action plan as to how these are to be provided. DS0000003250.V254234.R01.S.doc Timescale for action 30/11/05 2 OP19 23 (2) (b) 30/11/05 3 OP22 16 (2)(c) 30/11/05 Clare Hall Nursing Home Version 5.0 Page 22 4 OP9 13 (2) The following requirements need 30/11/05 to be implemented following this inspection • The dose given of variable medication needs to be recorded. • Two people should sign all hand transcribed entries on the Medication Administration Records. • That medication is given as near to the prescribed time as possible. • All medication given should be signed for on the Medication Administration Record. If the medication has not been given then the reason for this omission must be recorded. • Skin creams for individual service users should have the opened on, nor discard by, dates on them. • Oxygen should be stored in line with good practise guidelines. 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 OP21 OP7 Good Practice Recommendations It is recommended that the number of toilets that are accessible be reviewed to ensure that there are adequate numbers available for use. It is recommended 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. DS0000003250.V254234.R01.S.doc Version 5.0 Page 23 Clare Hall Nursing Home 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. 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