Inspection on 19/04/05 for Clare House

This inspection was carried out on 19th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 House 07/11/08

Clare House 29/10/07

Clare House 13/12/06

Clare House 19/04/06

Clare House 27/09/05

Clare House 30/11/04

Clare House 02/06/04

Clare House 01/03/04

Clare House 16/04/03

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Clare House Whittlebury Road Silverstone Northants NN12 8UD Lead Inspector Moira Mosley Unannounced 19 April 2005 10.00 th 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 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 House C51 S12744 Clare House V222046 190405.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Clare House Address Whittlebury Road Silverstone Northants NN12 8UD 01327 857202 01327 858976 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Clarex Limited Vacant Care Home 25 Category(ies) of PD(E) Physical Disability - Over 65 Years (25) registration, with number OP Old Age (25) of places DE(E) Dementia - Over 65 Years (5) Clare House C51 S12744 Clare House V222046 190405.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 named person may be accommodated over the age of 62 years No one in the category of DE (E) may be admitted to the home if there are already 5 service users in this category accommodated within the home. Date of last inspection 30th November 2004 Brief Description of the Service: Clare House is a detached property situated in the village of Silverstone to the south of Northampton and is set back from the road in pleasant gardens. The Home provides personal care for 25 residents over the age of 65 years, some of whom have an additional physical disability. They have recently been registered to take up to 5 residents who have dementia. There is an ongoing process of refurbishment to update and improve the facilities. There is a communal lounge, conservatory, library area and a large dining room for the use of all the residents. Bedrooms are over three floors with a passenger lift for access to the first floor. All bedrooms are single rooms with ensuite facilities. In addition there is a main kitchen catering for all the main meals and a laundry to cater for all the residents needs. Clare House C51 S12744 Clare House V222046 190405.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory unannounced inspection was in response to an anonymous complaint received by the Commission for Social Care Inspection. The complaint raised concerns about the following issues: • • • • • Recruitment practice – uptake of Criminal records Bureau clearance and references for staff not being done prior to employment. Unsecure storage of staff files. Unsecure storage of resident care plans. Manual handling needs identified for a named resident not being met. Insufficient staff training for the care of residents with Dementia. These were investigated as part of the inspection process and the findings are included within the complaints section of the report. The inspection took place over 3.75 hours. The care of two residents was examined and this involved looking at their care plans and records including medication. Discussions were held with those residents and a further three residents and three members of staff to find out about how they felt about this home. A tour of the communal areas, laundry and three resident bedrooms were seen as part of this inspection. The registered manager position has been vacant since September 2004 and the owner of the home is providing management cover until a new appointment is made. What the service does well: Residents spoken to were very positive about the staff team and felt they were provided with good care and support. There has been extensive refurbishment and redecoration to all areas of the home and the residents spoken to were very pleased with the outcomes and said it was a homely and pleasant environment to live in. Liaison with healthcare professionals for example the District Nurse, Community Psychiatric Nurse and GP are evident and this ensures that healthcare needs for the residents are identified and addressed. Clare House C51 S12744 Clare House V222046 190405.doc Version 1.30 Page 6 What has improved since the last inspection? 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 House C51 S12744 Clare House V222046 190405.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Clare House C51 S12744 Clare House V222046 190405.doc Version 1.30 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 standard(s) 3,4 and 5 Assessment procedures are inadequate to ensure needs of residents are fully assessed and needs can be met. EVIDENCE: Assessment documents for a recent new admission contained limited information and did not detail all the residents needs. Dementia care is fragmented with no specialised plans in place to manage the care, staff spoken to confirmed they have had limited training and there was some concern that they did not have the skills to deal with behaviours exhibited. A resident was displaying some agitation and confusion with no clearly documented plan for consistency in approach by the staff. A prospective resident and their relative were in the home to see if would suit them before agreeing to a placement and they were given information about the facilities and service. Clare House C51 S12744 Clare House V222046 190405.doc Version 1.30 Page 9 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 standard(s) 7,8,9 and 10 The care planning system does not provide clear and consistent information for staff to satisfactorily meet resident needs. Procedures for managing medication are inadequate and this places residents at risk of not getting what is prescribed for them. EVIDENCE: The care plans lacked specific details and instructions. One resident had identified incontinence and anxiety needs with no care plan evident to guide staff action. Some residents had been made aware of their care plans and staff confirmed this is continuing to be addressed with the residents and their relatives. There were no care plans for dementia care, one resident was anxious about her stay in the home and there was no consistent approach documented. There were no pressure ulcer risk assessments available although two residents had been provided with pressure relieving equipment via the District Nurse. Clare House C51 S12744 Clare House V222046 190405.doc Version 1.30 Page 10 Records and discussions with a resident demonstrated that the home is proactive in seeking specialist interventions including the GP, District Nurse, and Community Psychiatric Nurse. There was no clear evidence of the amounts of medication entering the home. A controlled drug book has been implemented however this also did not include the amounts of medication entering the home or a running total of what remains. A resident prescribed an antibiotic had two tablets remaining although the signatures for administration indicated that only one should be left. There were gaps in the Medication Administration Records for administration of creams, lotions, and eye drops prescribed. It was not possible to audit medication that had been destroyed. Refusal of medication was not always documented and there was no evidence of GP involvement when a resident had refused medication over a period. The residents spoken to said the staff treat them with respect and records showed that a resident had made a request about who attended to their personal care and this was addressed. Staff spoken to and observations made confirmed that residents are appropriately interacted with. Clare House C51 S12744 Clare House V222046 190405.doc Version 1.30 Page 11 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 standard(s) 12,13,14 and 15 Choice and options are available to residents and how they spend their day and includes social activity involvement. However residents with dementia have no specific activities or occupation. EVIDENCE: An activity programme has been developed and is advertised on the notice board in the home. One resident said they particularly enjoyed the ‘sing a longs’. The hairdresser was in the home and several residents said it was nice to have this regular service. Religious needs are met and included a planned communion service in the home. At present, there are no specific activities or occupation planned to meet the needs of the residents who have dementia. Residents were observed to make choices about how they spent their time, several went out with family and friends on a regular basis, and others chose to remain in their own rooms. There were records showing that residents had been asked about preferred daily activities for example when to get up and go to bed and other daily activities. The residents spoken to confirmed that they were offered choice in many aspects of the care provided and that their families and friends are welcomed in to the home. Clare House C51 S12744 Clare House V222046 190405.doc Version 1.30 Page 12 All the residents spoken to said the food was good and they were able to make choices about what they ate. The lunchtime meal was homemade and served to most of the residents in the dining room. It was a very relaxed and pleasant environment, residents and staff were interacting well, and all said they were happy with the dining provision. Some residents ate in their own rooms through personal choice. Clare House C51 S12744 Clare House V222046 190405.doc Version 1.30 Page 13 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 standard(s) 16 The complaints procedure is ineffective and the residents are not fully informed on how to raise any issues or concerns. EVIDENCE: The residents spoken to were unsure about how to make a complaint and whom they would speak to. Staff knew there was a procedure available and would direct any issues to the owner of the home. The complaints procedure on the notice board had not been updated to include the Commission for Social Care Inspection information; it did not refer to timescales or address how complaints would be dealt with. An anonymous complaint about this home was received by the Commission for Social Care Inspection and investigated as part of this inspection. Outcome: • Recruitment practice – that references and Criminal records Bureau clearance were not being done prior to staff employment. Staff spoken to said they had had references and Criminal records Bureau clearance, the staff files were unavailable and the registered person has been asked to supply further details. Unsecure storage of staff files – staff files were unavailable on the inspection as they were locked in the office. Staff confirmed that when the owner was not present the office was locked at all times. This part of the complaint was not upheld. C51 S12744 Clare House V222046 190405.doc Version 1.30 Page 14 • Clare House • Unsecure storage of resident care plans – resident care plans were stored in a lockable metal cabinet in the library area of the home and staff stated it was locked when not in use. This part of the complaint was not upheld. Manual handling needs identified for a named resident not being met – This resident was discussed with staff in the home, the care records seen and the resident spoken to. The home have taken advice from the GP and physiotherapy re manual handling problems and action taken. However this was not fully documented within the manual handling assesment or identified in a care plan in sufficient detail. Requirements have been made about these issues.This part of the complaint is partially upheld. Insufficient staff training for the care of residents with Dementia – as identified in the report there is concern about training and a requirement has been made about the training of staff in this area. This part of the complaint is upheld. • • Clare House C51 S12744 Clare House V222046 190405.doc Version 1.30 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 standard(s) 19, 20, 24, 26 Residents are provided with comfortable surroundings that meet their needs. The lack of fire safety records and the locks on bedroom doors are placing residents at risk in the event of a fire. EVIDENCE: The residents spoken to were all very positive about the facilities in the home and the level of decor and furnishings provided. The home was clean, tidy, and well maintained. The fire records did not show recent checks on equipment and systems. Staff stated that a new fire system had been recently installed but there was no evidence available to confirm current safety checks. The new bedrooms have suitable locks provided although staff do not have a master key to override the lock in the case of an emergency. The older rooms still have unsuitable locks that could mean a resident could be locked in a room or pose a problem in the event of a fire. Staff stated that no residents used or Clare House C51 S12744 Clare House V222046 190405.doc Version 1.30 Page 16 wanted to use a key to their room but this is not documented as an agreement. Two resident rooms showed a level of personalisation and residents all spoke highly about their bedrooms. The laundry facilities have been refurbished and new equipment has been purchased to maintain hygiene and control of infection requirements. Clare House C51 S12744 Clare House V222046 190405.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30 Staffing levels are adequate to meet the current needs of the residents in the home. Training for staff in dementia is insufficient in order to meet their specialised needs. EVIDENCE: Duty rotas demonstrated that staffing levels are sufficient to meet the current needs of the residents. Staff spoken to confirmed this although there was some concern that as the needs of the residents change and more individuals with dementia are admitted the levels will need to be reviewed. The residents spoke very highly about the staff and said they were nice, helpful, and caring. One resident said, “everything I need is here, and staff are lovely” another said she “wouldn’t want to go anywhere else as staff are so good”. The National Vocational Qualification (NVQ) assessor was present in the home and there are currently two staff working towards their NVQ. With a further two due to commence training shortly. Staff have been given an introduction to dementia by the Community Psychiatric Nurse but it was evident that there was apprehension about dealing with behaviours and no clear guidance or leadership on how to provide care to this specialised category of residents. Staff spoken to confirmed they have received statutory training including manual handling, first aid, and fire safety. Clare House C51 S12744 Clare House V222046 190405.doc Version 1.30 Page 18 Clare House C51 S12744 Clare House V222046 190405.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36 and 38 The lack of a suitably qualified and experienced registered manager is impacting on the leadership and guidance for staff and so affecting resident care. EVIDENCE: The staff are lacking the support, skills and experience of a registered manager. The quality of records kept are insufficient to provide clear direction for staff in providing the care required. The staff spoken to confirmed there is no formal supervision process. There was no evidence of the recent testing of the fire system and equipment. Staff confirmed they had received statutory training for fire and manual handling procedures. One resident’s manual handling assessment did not reflect recent changes in the level of need. Clare House C51 S12744 Clare House V222046 190405.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 1 1 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 x x x 2 x 3 STAFFING Standard No Score 27 3 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x x 1 x x x x 1 x 2 Clare House C51 S12744 Clare House V222046 190405.doc Version 1.30 Page 21 yes 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 3 Regulation 14(1) Requirement The assessment of a prospective resident must be in sufficient detail to ascertain all needs and confirm these can be met. The provision of dementia care must be evidenced in resident care plans. Care plans must identify how all assessed needs for residents are to be met. Pressure ulcer risk assessments must be completed and details of any action taken recorded. Records must be kept to show the receipt, administration and disposal of all medication. The complaints procedure must be provided to every resident, include timescales, details of action to be taken and include the Commission for Social Care inspection details. The type of locks fitted to resident bedrooms must be reviewed to ensure the health and welfare of Service Users.(Previous timescale of 20.12.04 not met.) Staff must receive appropriate training to provide dementia care. Timescale for action 01/06/05 2. 3. 4. 5. 6. 4 7 8 9 16 12(1)(a)( b) and 15(1) 12(1)(a)( b) and 15 !2(1)(a)(b ) 13(2) 22(1)(2)( 4)(5)(7) 30/06/05 30/06/05 30/06/05 01/06/05 30/06/05 7. 24 13(4) 01/06/05 8. 30 18(1) 30/07/05 Clare House C51 S12744 Clare House V222046 190405.doc Version 1.30 Page 22 9. 31 8 10. 38 11. 38 23(4) and 17(2) Schedule 4 (14) 13(5) The Registered Person must 01/06/05 inform the Commission for Social Care Inspection of the arrangements to be made for the recruitment of a Registered Manager (previous timescale of 20.12.04 not met) A record of fire practice, drills, 01/06/05 and tests of equipment and fire systems must be maintained. Manual handling assessments must be regularly reviewed and updated to reflect resident needs. 01/06/05 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. 3. Refer to Standard 9 28 38 Good Practice Recommendations Refusal of medication should be referred to the GP for advice as to action required. Action should be taken to ensure that 50 of care staff have National Vocational Qualification level 2, by 2005 A formal supervison process should be implemented for all staff in the home. Clare House C51 S12744 Clare House V222046 190405.doc Version 1.30 Page 23 Commission for Social Care Inspection 1st Floor, Newland House Campbell Square Northampton NN1 3EB 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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