Inspection on 31/08/07 for Clare Hall Nursing Home

This inspection was carried out on 31st August 2007.

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.

Other inspections for this house

Clare Hall Nursing Home 21/01/09

Clare Hall Nursing Home 14/01/08

Clare Hall Nursing Home 27/09/06

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 Justine Button Unannounced Inspection 31st August 2007 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.V349309.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.V349309.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 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.V349309.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. 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.V349309.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 deputy manager and a member of the quality and compliance team were present throughout the inspection. BUPA had submitted Annual Quality Assurance Assessment documentation prior to the inspection. Feedback was given at the conclusion of the inspection. Two inspectors carried out the inspection visit to the home over one day. The inspection was completed on 31st August 2007 when a number of comment cards had been returned. Comment cards were sent to people living at the home, relatives, staff and professional individuals. The outcome of these comments cards has been reflected in the main body of the report. The comment cards for people living at the home request either a yes or no answer or alternatively give four choices. These choices are always, usually, sometimes or never. Overall the outcome of the feedback forms was positive although some issues were raised. On the 12th June 2007 concerns were raised with the CSCI with regard to pressure area care and wound management at the home. A Joint agency meeting was held on the 22nd June 2007 including a member of the local Primary Care Trust and social services. At the meeting representatives from Clare Hall agreed to review care practises at the home. Until this had been completed BUPA agreed to stop any new admissions to the home until the care and support to people living at the home had improved. Members of the Quality and Compliance team from BUPA have been supporting the home in this interim period. Additional meetings have been held and a random inspection was conducted by the CSCI in July 2007. It was agreed at the end of August 2007 that improvements had been made and admissions have now recommenced. Staff at Claire Hall have worked hard to address the issues over the last few months. 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 clean, tidy and well maintained. 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. Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 7 Despite the improvements made in some areas of the home a number of concerns were identified during the inspection that require the attention of the management team. A number of people living at the home have been assessed as requiring specialist equipment. Those identified during the inspection included pressure mats, pressure mattresses and adjustable beds. The management need to ensure that all assessed equipment is provided to ensure that the health, safety and well being of people living at the home and staff is not compromised. The home has not provided social activities for the last four months. This has had a significant impact on the life of people living at the home. This was raised as a significant issue in the feedback forms returned prior to the inspection. Staffing levels were also raised as an issue via the feedback forms. The duty rota’s were seen. These did not show any shortfalls in the minimum staffing levels required however staffing levels were not compared to the dependency needs of the people living at the home by the inspector. The management need to ensure that the staffing levels are such that all needs including social and recreational needs are met. Not all people living at the home have a copy of the terms and conditions of their stay. BUPA are aware of this shortfall and are currently addressing this issue. In addition the homes statement of purpose does not reflect the services provided. These impacts on the availability of prospective or current people living at the home having access to up to date information about the services they should expect to be provided in the fee. The management of medicines needs attention in some areas. This includes ensuring that the medication is stored at the correct temperatures and ensuring that the confidentiality of people living at the home is not compromised. The meals and mealtimes were overall a pleasant experience for people living at the home. Management need to ensure that there are a range of accessible snacks available for people on specialist diets. Some areas of the home are in poor repair. This includes a leaking roof and pot holes in the drive. Some of the bathrooms and sluices will require updating in the near future. Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 8 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.V349309.R01.S.doc Version 5.2 Page 9 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.V349309.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. Standard six is not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The statement of purpose and service user guide are currently not reflective of the care and support offered at the home or the managerial arrangements All prospective residents receive a pre admission assessment by the registered manager to ensure the home can meet the assessed needs identified. Not all people living at the home have a copy of the terms and conditions of their stay. EVIDENCE: Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 11 The Feedback forms asked people living at the home asked:Have you received a contract? 3 People stated yes, 3 people stated no. The remaining four forms were left blank. 1 stated funded by Social Services so presumes they have contract Did you receive enough information? 8 people replied yes and 2 stated that they did not. The home provides information to interested arties in the form of a statement of purpose and service user guide. Both the Statement of Purpose and Service User Guide available in the lobby of the home. The documents are in need of review. The Statement of Purpose referred to the previous manager and was dated 13/01/2006 and the organisational structure relates to 01/04/2002. There were 2 different service user guides available which were different. These also referred to a regular programme of activities that are not happening at present and have not happened since the previous activities coordinator left. Fee levels are available upon request to the home. Extra charges are met by service users for newspapers, hairdressing, trips/outings, personal toiletries/items and special requirements. In addition medical charges may be incurred if applicable for dentist, optician or chiropody. The homes statement of purpose states that either party requires four weeks notice. The CSCI is aware that contract/financial agreements have not been issued to people who are funded via the local authority. This is not in line with recent guidance issued by the Office of Fair Trading. The guidance states that all people however they are funded should be aware of the terms and conditions of their stay at the home. BUPA is currently developing a contract that reflects the services that they provide. People who are privately funded have a financial agreement with BUPA. The manager or her deputy visit the majority of prospective service user and carry out an assessment to ensure that the assessed needs and aspirations of the individual can be met by the home. The care plan for the individual who had recently moved into the home was viewed this showed that the manager had completed a full pre admission assessment. This assessment was in addition to the assessment undertaken through the care management arrangements. Assessments from other professionals were also seen in care records. Prospective service users and/or their representatives are invited to visit the home prior to making a decision. Service users move to the home initially on a 4 week trial period. This is to ensure that all parties are happy with the placement. Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 12 Clare Hall Nursing Home DS0000003250.V349309.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 poor. This judgement has been made using available evidence including a visit to this service. The care planning systems have improved in some areas particularly with regard to the documentation and management of wounds and pressure damage. Some additional improvements are needed. The care plans are not developed and used consistently as working documents and do not always reflect changing needs. The health care needs of people living at the home are not met in all areas particularly due to the lack of equipment, which may put some people at risk. The privacy and dignity of people living at the home is respected Medication overall appears well managed although some areas may potentially place service users at risk of harm. EVIDENCE: Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 14 The Feedback forms asked people living at the home • Do you receive the care and support you need? 5 stated always and 5 stated usually. • Do you receive the medical support you need ? 6 stated always and 4 stated usually Two comments on the forms stated that they were more than happy with the care and support received. Care plans were viewed during the random inspection which was conducted in July 2007. The care planning system for the management of wounds and pressure ulcers has improved following the concerns raised. Staff are now more proactive in identifying and documenting the care in this area. A range of tools are now used including photographs and measurements. Four people were case tracked during the inspection and their care plans reviewed. Case tracking involves identifying individuals at the beginning of the inspection and comparing the care and support they receive with the needs identified in the care plan. The care notes for an additional person living at the home were also viewed, as concerns were identified during the inspection. For one individual a Waterlow assessment (used to assess the risk for pressure ulcers) had been completed. This had been assessed as very high risk. On viewing the bedroom it was clear that appropriate pressure reliving equipment was in place. The individual had a pressure ulcer. Wound charts for pressure ulcer had been commenced and in addition a wound care plan and photo’s to assess the progress of the wound were in place and had been reviewed frequently by staff. The person concerned had MRSA. A Care plan for the MRSA was in place and gave clear guidance to the staff on the action to be taken. Appropriate equipment was in place in room and staff were observed to be using this. The family of the individual visit very frequently and were spoken to during the inspection. They stated that they were always kept informed of their relative’s condition. The individual had lost some weight over the previous months but was in a very frail condition. Fluid/ diet and positional change charts were being used and these reflected the care that the individual received throughout the day The second individual, who was part of the case tracking process, was in his room in his nightwear, asleep in the chair, at the start of the inspection. Staff assisted the individual during the morning to get washed and dressed. Apart from this the individual remained asleep in the chair for the duration of the inspection. He was awoken by staff for lunch which was also taken in the bedroom. The plan of care, however, stated that he should be encouraged to go to the dining room to avoid being socially isolated. It could not be Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 15 confirmed if the individual remained asleep through lack of stimulation or if he had chosen to remain in his room. Staff did state however that he was unwell on the day of the inspection. The care plan was viewed and stated that he should have a pressure mat in the bedroom as he was at risk of falling. This is mat that is placed in the room which alerts staff if the person starts to move around the room thus staff can respond quickly reducing the risk of falls. This equipment was not in place. The plan stated that this was ordered on the 15/05/07. There was no evidence available to suggest that staff had proactively followed up this order. This may put the person concerned at risk. In addition the individual had been had been assessed as requiring an adjustable bed however the risk assessment stated that one was not available. The person concerned was weighed on admission to the home and had gained weight initially. This weight gain had been lost again by the time of the inspection. There was evidence in the plan of care that this issue had been discussed with the GP and that appropriate action had been implemented by staff. The care plans for personal hygiene, mobility, elimination and nutrition were very clear. The plan detailed the gentleman’s daily routine including times of getting up and going to bed. There was evidence that the family were involved in the review of the plan of care. For the remaining two individuals who were case tracked the plans of care were good, giving staff clear guidance on the needs of the individual. One of the individuals had a pressure ulcer again there was a clear plan of care including wound charts and photographs in order that staff could assess the progress of the wound. One of the individuals had been assessed by staff as requiring an adjustable bed but the assessment stated that there is not one available. During the inspection it was identified that one person, who was nursed in bed, as they were very frail, did not have the appropriate equipment in place. A Waterlow assessment had been completed and had been assessed as being at very high risk. This individual had existing pressure ulcers. The care plan stated that the individual was on an appropriate pressure-reliving mattress. The plan stated that this equipment had been broken for a significant period of time, since June 2007. On visiting the bedroom, of the individual no pressure mattress was in place. This placed the individual at significant risk of additional pressure damage. There was no evidence that staff had been proactive in obtaining this equipment or seeking an alternative while the original mattress was being repaired. The care plans for people living at the home are now stored in the bedrooms. This allows the staff to access the records more easily and ascertain the needs of the individual. Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 16 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 medication arrangements at the home were inspected by Brian Brown, CSCI pharmacist. The Medicines fridge in the house area of the home was not working currently on the day of the inspection. This was raised with the maintenance person who told the inspector that he would defrost it and then see if it worked. if this was not successful then a new one would be obtained. On checking the temperature records only the current temp of the fridge had been recorded and the thermometer used has no facility to monitor maximum and minimum temperatures. Room temperature of the medicine room in the Wing was recorded regularly over 25C. June 17 days 25C July 24 days 25C August 24 days 25C A Medication Audit had been carried out by the home on 08/08/2007. A tick has been inserted to indicate that the medicines room temperature is recorded daily and is below 25C. This was not the case. If medicines are not stored within the manufacture guidelines this may affect their effectiveness. First floor medication trolley for the wing is stored in the stairwell with the Medicine Administration Record sheets kept freely available on top of the trolley. This may put the confidentiality of the people living at the home at risk. It was identified that one individual had a hand written entry on MAR (Medication Administration Record) for a liquid food supplement, usually given over a long period (several hours), to be given at a rate of 1000ml/hr. The prescription stated that 1300ml was to be given. Given at a rate of 1000ml/hr the supplement would have been completed in under an hour and a half. The correct rate that the supplement was to be given was 100ml/hr. This error would have caused the individual some discomfort and may have caused some nausea and vomiting. A number of people living at the home are prescribed creams and lotions by the GP. These had been entered onto the MAR although staff had not signed to confirm that these had been applied. For one individual a capsule was being opened to enable the individual to take the medication more readily. This practise should only be used in extreme Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 17 circumstances and only with the agreement of the GP and manufacture. The home had completed this and there was a clear audit trail about the opening of the capsules. For one individual medication was stored in the cupboard. This medication is used during an epileptic fit. This was not recorded on the MAR chart. On checking the care plan there is no comprehensive care plan or protocol on how this is to be used. The Controlled Drugs were reviewed during the inspection. Stock quantities checked and were in good order. In both of the cupboards were bottles of Oramorph that had been dispensed by the Pharmacist into bottles. Once opened this medication should only be used for 28 days. There was no record made of the original date of opening the larger bottle. This was raised as an issue to be followed up by the home urgently with the supplying pharmacy. One Food Supplement, Calogen, was not stored according to the manufacturers instructions once opened. Some food supplements were stored on the floor. This is not in line with good practise Clare Hall Nursing Home DS0000003250.V349309.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 poor. This judgement has been made using available evidence including a visit to this service. People living at the home do not have opportunities for their social and recreational interests to be met. People living at the home are able to meet friends and family. The opportunity to make choices is limited with regard to social and recreational opportunities and with regard to some aspects of personal care. Meals and mealtimes are on the whole a pleasant experience. EVIDENCE: Feedback forms from people living at the home asked • Do the staff listen and act on what you say ? 6 stated always. Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 19 The remaining forms made the following comments. 2 people stated, “Staff do not have enough time to listen.” An additional person stated, “Trained staff do not understand my medical condition. Language and culture differences can make things difficult” • Are there activities arranged by the home that you can take part in? 2 people stated usually, 4 stated sometimes. 4 comments were received which stated that there had been no activities person for 8 months. 3 Relative feedback stated that they felt lack of activities was an issue and that this detracted from a sense of wellbeing. Comments included “Mum spends too much time alone. Staff do not encourage her to leave her room.” and “Lack of activities an issue. No staff member appears concerned with mental wellbeing.” Information received from the home prior to the inspection stated that the home “provides a structure range of activities, open visiting and service users always say that the meals are good. Over the next 12 months the home want to introduce regular meetings with clients to see what they want to do and to listen to there points.” There were no social activities on the day of the inspection. This confirms the concerns expressed via the feedback from people living at the home and relatives. It was confirmed with the management during the inspection that there had been no activity organiser in the home for about 4 months. Additional care staff had not been provided to undertaken this role. Staff spoken to during the inspection stated that they tried to complete activities but the demand for them to meet the physical needs of the people living at the home did not always allow this to happen. There was limited documentation available which demonstrated activities that had been on offer at the home. People spoken to during the inspection stated that a cream tea had been recently organised and all who had attended had enjoyed that this. The management are currently actively seeking to recruit an activities organiser in order that social and recreational opportunities are re commenced at the home As previously stated one individual who was part of the case tracking process remained in the bedroom asleep for the majority for the day of the inspection. This person may have been less socially isolated if there were activities and events going on in the home. Visitors were seen at the home throughout the inspection. People stated that they were made to feel welcome by staff. People spoken to during the inspection stated that they were able to make choices and decisions with regard to their daily routine including getting up and going to bed. This was documented in some cases in the plan of care. It was Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 20 apparent during the inspection that the bathrooms were rarely used whereas the shower rooms were used frequently. It could not be confirmed during the inspection if people living at the home had chosen to shower rather than bathe or if staff offered this choice. This was not documented clearly in the plan of care. Lack of staffing is an issue raised by a number of people via the feed back forms. This included staff having the time to chat “perhaps someone popping into her room for a chat now and again would help her pass the time” and “The activities/ entertainment is as good as non existent. Therefore the days are long. Some time could be devoted to just talking to people at the home.” When asked via the feedback forms • Do you like the meals at the home? 4 People stated always and 6 stated sometimes. Comments included food is presentable and good choice is offered. Food sometimes spoiled by poor service due to staff shortages. 1 relative stated the lack of vegetarian option was an issue. Lunch was observed during the inspection. Food looked appetising and care was taken in presentation of the food. Those requiring assistance were aided thoughtfully and for one person who did not eat much of their lunch the care staff asked if she wished to have anything different. For another service user one of the care staff made an extra trip to the kitchen to obtain further carrots. It was observed however that one staff member asked people if they would like mash potatoes with their meal. Then proceeded to ask them if they would like chips. All people had said yes to the mash because they were not aware chips were also available. Some people therefore had chips and mash. The management need to ensure that people living at the home are aware of all the options before being served by staff. One suggestion has been that larger serving dishes are purchased to enable both options to be presented in the same dishes. The morning coffee trolley and afternoon tea trolley were observed during the inspection. These contained cakes in the afternoon and biscuits in the morning. There was no alternative, on the trolley, for those on specialist diets who may not be able to eat these items. One family did stated however that staff sometimes gave their mum yoghurt in the afternoon. The management at the home stated that alternatives are available for those on specialist diet or for those people who do not want cake or biscuits. The management team need to ensure that staff actively offer an alternative. Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 21 Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. Complaints are dealt with in line with the homes policy and procedures. People living at the home are aware and comfortable in expressing any concerns. People living at the home are protected by the homes policies and procedures EVIDENCE: Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 23 Feedback forms to people living at the home asked Do you know who to speak to if you are not happy ? 8 stated always and 3 replied sometimes. Comments received included I would speak to my daughter who would deal with it. Do you know how to make a complaint? 9 replied always and one stated 1 never. Comments from relatives included “Dad has been at the home for a number of years I have no reason to complain” The Home has a Complaints Procedure that is clearly written and contains the contact details for CSCI. The home has received. The complaints file was viewed during the inspection. Five complaints have been made since February 2007. These complaints included One complaint concerned that his relative had some weight loss. A complaint with regard to the lack of activities and reduced staffing numbers. One complaint was concerned with the environment of the home including the conservatory leaking and the buckets collecting rainwater. Pot holes in the road. All the complaints had been dealt with in line with the homes policy and procedure. 3 complimentary letters were also held on the file. In addition to these complaints the CSCI have received concerns via the local community nurses with regard to the care and support of people with wounds and pressure ulcers. These concerns resulted in a series of meetings with local Social Services departments, the Primary Care trust, BUPA and the CSCI. Following these concerns the CSCI conducted a random inspection on the 13th July 2007. This report is available on request. Information received by the home prior to the inspction that “BUPA Care Homes has appointed a Director of Quality and Compliance and has developed a national Quality and Compliance team of experts.”This team has been involved in reviewing the care and support offered at the home. BUPA have been proactive in addressing the issues raised and the staff at the home has worked hard to improve the care and support at the home. No additional meetings are now being held. Some issues raised in this report however confirm that some outcomes for people loving at the home remain poor and additional work is required to ensure that improvements continue. The policies and procedures regarding protection of residents are of a good standard, which include complaints,recognising signs of abuse and whistleblowing. Staff recruitment files were veiwed during the inspection. These contained all necessary checks. Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 24 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, 21, 22, 23, 24, 25, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all people at the home have the specialist equipment they require. Some on going maintenance is required to ensure that the service continues to meet the needs of the service users. The bedrooms seen were clean, tidy and personalised. EVIDENCE: The feedback form asked people, Is the home fresh and clean ? 5 people stated always and 5 stated sometimes. Comments included chairs in dining room wet with urine. These are not always cleaned Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 25 A tour of the building was conducted during the inspection. This included visiting all the communal areas and some bedrooms, including those bedrooms for the people who were part of the case tracking process. 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 mattresses, pressure mats and adjustable beds. These had not been provided by the home. This can place both service users and staff at risk. The management need to ensure that any assessed equipment is provided. There are an adequate number of bathrooms, which contain specialist equipment. Some of the bathroom décor is poor and in need of updating. 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. Although the home was clean and tidy on the day of the inspection comments from people during the inspection highlighted some concerns with regard to the fabric of the building. The conservatory area by the main lobby area is leaking and buckets are used to catch the rainwater. This looks unsightly and makes this area unusable in the wet weather. There are a number of potholes in the driveway, which require repair. Some upgrading of the building is taking place. Double-glazing was being fitted to the remaining area of the home on the day of the inspection. The bedrooms seen during the inspection were clean and tidy on the day of the inspection. People are able to personalise their bedrooms and this was seen on the day of the inspection. Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 26 Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 27 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 adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are appropriate to the numbers of current service users. These have not been compared to dependency levels. The perception of people living at the home and family/ friends is that there are not adequate numbers of staff particularly in the evenings and at weekends. The training opportunities available to staff are good. The home follows appropriate staff recruitment procedures. EVIDENCE: A number of comments from people living at the home, friends and family both in the feedback forms received and during the inspection stated that there were inadequate numbers of staff on duty to meet the needs of the needs of the people at the home. The staff duty rota’s were copied and reviewed Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 28 following the inspection. These showed that there are adequate numbers of people on duty. Some shortfalls were seen if staff had become sick at short notice. The home however has had some empty beds over recent months. The staffing numbers was not compared, by the inspector, to the dependency levels of people living at the home during the inspection. It was observed during the inspection that as there were no activities on offer the majority of people returned to their bedrooms after lunch. This means that staff are not highly visible as they are supporting people in non communal areas. The perception therefore may be that there are no staff in the building. This issue was discussed with the management at the end of the inspection. It is required following this inspection that BUPA compare the dependency of people at the home and compare this to the current numbers of staff available to ensure that there are adequate numbers of staff on duty at all times. Following the concerns expressed by the community nurses all staff have attended a range of updating training including care planning, wound management and aspects of providing care including food, diet and fluids and positional change. A member of the quality team has supported and assessed all the competencies of the registered nurses. Staff stated that they now feel more supported and have welcomed the training opportunities available to them. Despite this however some areas, including lack of equipment required to meet identified needs, was not in place and this had not been identified by the staff at the home. Eight of the 36 care staff have an NVQ qualification. This is below the expected 50 . The home has a system of regular staff meetings. Three staff recruitment files were examined. These contained all appropriate information as required in Schedule 2 of the Care Homes Regulations 2001. Enhanced CRB checks and POVA checks were in place. Staff induction was not viewed on this occasion. Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 29 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, 33, 35 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home does not currently have a registered manager BUPA have put in place adequate managerial arrangements in the interim period. The home is run in the best interests of service users. BUPA have been very proactive in addressing recent issues raised. Residents are protected by the systems adopted by the home to look after their personal finances. Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 30 The home was failing, in some areas, to ensure the health and safety of residents and staff. EVIDENCE: The home currently has no manager registered with the CSCI. BUPA have put in place interim managerial arrangements. In addtion the deputy manager who has been absent from the home has recently returned. As previously stated due to the concerns raised recently members of the Quality and Compliance team from BUPA have been visiting and supporting the home over recent months. The home conducts regular Health & Safety meetings with a standardised agenda giving staff the opportunity to communicate on Health and Safety issues. The minutes from these meetings go to the Regional Manager. Resident’s personal finances for two service users were checked. Clear audit trail and receipts for all expenditure were seen except information about the shop purchases. However the person responsible for the shop was not present at the inspection so these could not be confirmed. Servicing records were viewed during the inspection. These were in good order. Hot water outlet temperature records are checked and recorded every six months. Hoists observed with stickers indicating that they were serviced Oct 06 and next service due Apr 07. When asked the maintenance person confirmed that they carry out monthly LOLER checks and because of this the service interval for the hoists is yearly. During the tour of the building it was observed that a number of people who would require staff support to change position when in bed were seen to have divan type beds. In addition these beds were placed against the wall. The beds did not have wheels. Staff confirmed during the inspection that they pulled the bed away from the wall at night when care was required. When the care had been delivered the bed was pushed back towards the wall. This is a moving and handling issue and may compromise staff safety. In addition as previously stated not all people who had been assessed as requiring specialist equipment did not have this equipment provided. Again this may compromise the health and safety of both people living at the home and staff. Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 31 Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 32 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 2 2 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 3 3 1 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 1 Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 33 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 OP1 Regulation 4 (1) (a) Requirement It is required that the statement of purpose and service user guide are reviewed to ensure that they adequately reflect the services provided. It is required that staff ensure that the care plan clearly reflects the equipment in use for an individual. The plan should clearly document when equipment is not available and the action that staff have taken in response to this. It is required that medication is stored at a temperature in line with the manufactures guidelines. It is required that people living at the home have the opportunity to access social and leisure activities in line with their wants and wishes. It is required that the condition and fabric of the building and grounds does not adversely affect the life of the people living at the home. This includes the leaking roof and potholes in the DS0000003250.V349309.R01.S.doc Timescale for action 31/10/07 2. OP7 15 (b) 31/10/07 3. OP9 13(2) 17/10/07 4. OP12 16 (2) (m) (n) 31/10/07 5 OP19 23 (2) (b) 31/10/07 Clare Hall Nursing Home Version 5.2 Page 34 6 OP24 16 (2)(c) driveway. The Registered Person must review the risk assessment for the provision of adjustable beds and ensure that beds are provided in line with the completed risk assessments. 01/10/07 7 OP24 12 (1) (a) 8 OP27 18 (1) (a) 9 OP38 13 (5) It is required that specialist equipment is provided to individuals according to their assessed needs. This includes pressure mattresses and pressure mats. It is required that the management review the staffing levels at the home in line with the dependency levels to ensure that staffing is provided in sufficient numbers to meet all the needs of the people living at the home including social and recreational needs. It is required that the health and safety of staff is not compromised by the position of inappropriate equipment. This relates to the lack of inappropriate beds placed along bedroom walls. 17/10/07 31/10/07 17/10/07 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. Refer to Standard OP9 Good Practice Recommendations It is recommended that the storage of documentation including the Medication Administration Record does not compromise the confidentiality of people living at the DS0000003250.V349309.R01.S.doc Version 5.2 Page 35 Clare Hall Nursing Home 2. OP15 home. It is recommended that consideration is given to providing alternative to cakes and biscuits in between meals for example yoghurts, fruit, milky drinks. 3. 4. OP27 OP28 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. It is recommended that BUPA review the number of people who have an NVQ and ensure that the opportunity is available for staff to undertake this qualification. Clare Hall Nursing Home DS0000003250.V349309.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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