Inspection on 24/10/05 for Clare House

This inspection was carried out on 24th October 2005.

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

The inspector 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 30/08/06

Clare House 11/04/05

Clare House 04/11/04

Clare House 10/05/04

Clare House 07/07/03

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Clare House Harefield Road Uxbridge Middlesex UB8 1PJ Lead Inspector Mrs Clare Henderson Roe Unannounced Inspection 24th October 2005 11:00 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 House DS0000010928.V258205.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 House DS0000010928.V258205.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Clare House Address Harefield Road Uxbridge Middlesex UB8 1PJ 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) 01895 272 766 01895 272 896 BUPA Care Homes Limited Mrs Anna Francis Dempsey Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places Clare House DS0000010928.V258205.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To comply with the Minimum Staffing Notice required by the previous regulator as at 31st March 2002. One named service user with Dementia can be accommodated, as agreed by the NCSC on 21/1/04, for as long as there is no deterioration which affects the well being of other service users. The home must advise CSCI when the service user no longer resides at the home. Three of the beds currently registered may be used as Palliative Care beds. One named service user under the age of 65 years can be accommodated, as agreed by the Commission for Social Care Inspection, on 24th January 2005, for as long as there is no deterioration which affects the well being of other service users. The home must advise the CSCI when the service user no longer resides at the home. 11th & 12th April 2005 3. 4. Date of last inspection Brief Description of the Service: Clare House is a 43-bedded Care Home providing nursing care for elderly service users. The purpose built building is situated on a busy thoroughfare leading into Uxbridge town centre. Transport links are by bus. There are 35 single rooms, thirty-four with en suite washbasins and toilets. One single room has a washbasin. There are four double rooms, all with en suite facilities, which are used for single occupancy. The ground and first floors are connected by stairways and a passenger lift. All parts of the home are wheelchair accessible. Wheelchair access is also provided for some of the bedrooms that open onto the patio. Ramps are put in based on family requests. The home provides a large parking area at the front of the building and a garden to the rear. BUPA, a private company, owns the home. It has a Registered Manager, a Deputy Manager, a receptionist, an administrator, registered nurses, care staff, chef and kitchen assistants, domestic staff and a maintenance person. The home employs an Activities Organiser. There were three vacancies at the time of inspection. Clare House DS0000010928.V258205.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. A total of 7 hours was spent on the inspection process. The Inspector carried out a tour of the home, and inspected service user plans, staff files, finance and maintenance records. 13 service users, 5 visitors and 6 staff were spoken to at the time of inspection and comments were fed back to the Registered Manager in a general manner. The purpose of this inspection was to follow up the requirements and recommendations from the last inspection, and to view some additional standards. The majority of key standards were viewed at the last inspection and it is recommended that this report be read in conjunction with the last report to gain full inspection information for the home. What the service does well: What has improved since the last inspection? What they could do better: Some shortfalls were noted with the care of medications, which should be easy to address. The bath and shower facility provision for the home need to be reviewed as currently the facilities available do not fully meet the needs of the service users, and the shower facility has been out of order for several months, which is not acceptable and needs to be promptly addressed. Clare House DS0000010928.V258205.R01.S.doc Version 5.0 Page 6 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 DS0000010928.V258205.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 House DS0000010928.V258205.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 and 3. The home does not provide intermediate care. Service users and their representatives are provided with information about the home. Service users are assessed prior to admission to ensure the home can meet their needs. EVIDENCE: The Statement of Purpose and Service User Guide had been updated following the last inspection, and the information contained in these documents is very comprehensive. Information to indicate where a copy of the most recent inspection report can be freely accessed within the home was to be added to the Service User Guide, and the Registered Manager said that this would be done and included in all the Service User Guides. Prospective service users are assessed prior to admission to ensure the home are able to meet their needs. The pre-admission assessments viewed had been comprehensively completed. Clare House DS0000010928.V258205.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9 and 10 There is a clear system of care planning in place, which provides staff with the information they require to meet service users needs. Medications are generally well managed in the home, with minor shortfalls to be addressed. Staff care for service users in a courteous manner, respecting their privacy and dignity. EVIDENCE: Three service user plans were viewed as part of the inspection process. These were comprehensive and up to date, giving a clear picture of each service users care needs and how these are to be met. Risk assessments for falls were in place, plus risk assessments for any other areas of risk identified. There was evidence of monthly updating of the service user plans, plus new care plans had been formulated for any additional needs identified. The newer care plans had not been signed by the service user or their representative, and this was discussed. Nutritional assessments and care plans for dietary care needs, plus a record of monthly weights were in place. Waterlow pressure sore risk assessments had been carried out. Wound care documentation was comprehensive and up to date, evidencing input from the Tissue Viability Nurse Specialist. Records of Clare House DS0000010928.V258205.R01.S.doc Version 5.0 Page 10 dressing changes had been maintained. Pressure relieving equipment was seen in use in the home and had been recorded in the wound care documentation to indicate the specific equipment in use for each service user. A record of all wounds is kept in the nurses office and it was clear that staff are up to date with the wound care needs of service users and there was evidence of wounds responding to treatment and healing well. Continence assessments are carried out for service users with identified continence care needs. Care plans for continence care had also been completed. The Inspector recommended that information regarding each service users continence status be recorded on admission to provide baseline information. Moving and handling assessments had been completed. Risk assessments and written consents for the use of bedrails were in place. Input from the GP and from other visiting healthcare professionals is recorded. Medications are securely stored in the home. Receipts of medications were being recorded. The home is using the NOMAD weekly system, which appeared to be working well. All medications had been signed for when administered on the medication administration record (MAR) charts viewed, and where there was a reason for omission this had been clearly coded and identified. Liquid medications had not always been dated when opened. One bottle of eye drops was dispensed in May 2005 and had not been dated when opened. The registered nurse said that she would order new stock that day. Some eye drops viewed had not been dated when opened. Chloramphenicol eye drops were not being stored in the fridge in accordance with the storage instructions, and this was addressed at the time of inspection. In one instance where two strengths of a particular medication were required to make up the prescribed dose, the two tablets for administration had not been individually identified on the MAR chart. For service users on warfarin therapy, information regarding the most recent blood test result and warfarin dosage to be given is kept with the MAR chart, which is good practice. Controlled drugs are well managed within the home. Medication disposal containers in accordance with recent legislation changes for the disposal of medications in nursing homes were available. Documentation to provide two spaces for registered nurse signatures when recording the medications for disposal by this system was needed. The procedures for the management of medication had not yet been updated to include instructions for the correct processes for the disposal of medications from nursing homes. The timing for recording the room and drugs fridge temperatures had been altered from the evening to 12 midday, thus giving a better indication of the temperatures reached during the warmer parts of the day. The drugs fridge temperature had on occasion been recorded as being outside the range of the 2-8º centigrade safe storage temperature. The temperature in the medication room had been recorded as being above 25º centigrade on several occasions during the summer months. The need to look at the provision of air conditioning within the room during hot weather was discussed and the Registered Manager said that this would be addressed. Staff carry out a medication check every week and a list of all registered nurse specimen signatures and initials is kept with the MAR charts. The shortfalls Clare House DS0000010928.V258205.R01.S.doc Version 5.0 Page 11 noted should be easily addressed and overall medications are being well managed at the home. Staff were seen to speak with service users in a gentle and courteous manner. Service users and visitors spoken with expressed their satisfaction with the care provision at the home, and several people were very complimentary about the caring attitude of the managers and the staff, which was also observed at the time of inspection. Clothing is individually labelled for service users. Service users can have their own telephones, landline or mobile. The bedrooms viewed were very personalised and homely. Clare House DS0000010928.V258205.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 Social activities are provided to meet the service users interests, thus improving their quality of life at the home. EVIDENCE: All these standards were assessed at the last inspection and no shortfalls were identified. The Registered Manager described several outings that had been arranged over the summer and some of the service users referred to the outings and had obviously enjoyed them very much. Festive activities for Christmas were being planned. Information regarding the service users individual past hobbies and interests was included in the service user plans. Service users spoken with said that they enjoyed the activity provision in the home. Several service users were having their hair done at the time of inspection and there was a cheerful, chatty atmosphere noted in the hairdressing room. The lunchtime meal was sampled and was well presented and tasty and service users spoken with said that generally the food was good with a choice offered. Clare House DS0000010928.V258205.R01.S.doc Version 5.0 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 the following standard(s): 16 and 18 The home has a clear complaints procedure and service users concerns are listened to and addressed. There are systems in place for the protection of vulnerable adults. EVIDENCE: The home has a clear complaints procedure, which includes contact details for the CSCI. The Registered Manager said that there had been no complaints since the last inspection. Service users are encouraged to voice any concerns and the Registered Manager has implemented service user meetings at which any relevant topics can be discussed, plus the Registered Manager is available to discuss any concerns on an individual basis, if preferred. Staff asked were clear about the protection of vulnerable adults and Whistle Blowing procedures, and said that they would report any concerns of this nature. The home has clear adult protection procedures in place. Clare House DS0000010928.V258205.R01.S.doc Version 5.0 Page 14 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, 21, 22 and 26 The standard of the décor within the home is in need of attention in some areas, to maintain a homely environment for service users. The bath and shower facility provision does not fully meet the needs of the service users, thus limiting the facilities available to individuals. Storage facilities within the home are limited, causing bathrooms to be used as storage areas. EVIDENCE: An audit of the home for redecoration and refurbishment purposes had been carried out following the last inspection, and the Registered Manager had evidence of the areas of work that had already been carried out, for example, replacement of the boilers and redecoration of the external rear of the building plus some bedrooms. The ground floor corridors and stairwell are to be redecorated and re-carpeted in the near future. It was clear that some areas of redecoration required had not been covered in the current budget. This needs to be reviewed and finances provided as all the corridors within the home require redecoration and re-carpeting. The home is an old building, and this needs to be taken into consideration when budgeting for ongoing redecoration and refurbishment. Clare House DS0000010928.V258205.R01.S.doc Version 5.0 Page 15 The ground floor shower room had been out of order for several months and work is needed to provide appropriate shower facilities to meet the needs of the service users. At the time of inspection some standing water was seen the shower tray, and this was dealt with promptly. The need to flush the shower system in line with legionella prevention guidelines was discussed. Two of the bathrooms in the home are not used as the assisted baths do not meet the moving and handling needs of the service users and could pose a risk. An action plan to show how the shower and bathing facilities are to be brought up to standard to ensure the needs of the service users are met must be drawn up and actioned as a matter of priority. One bathroom in regular use had a damp odour and the Registered Manager said that she would look into this. At the time of inspection the tap in the hairdressing room was problematic and had been reported promptly to the maintenance man. The bathrooms were being used to store items of equipment and the need for additional storage was discussed. The Registered Manager said that a shed is to be provided in the grounds, but the need for some additional storage within the home must also be addressed. The laundry room was clean and tidy. Clothing is labelled for service users individually. Infection control procedures were on display. Check lists for cleaning schedules had been completed. The home was clean and fresh. Clare House DS0000010928.V258205.R01.S.doc Version 5.0 Page 16 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, 29 and 30 The home is appropriately staffed to meet the needs of service users. Staff recruitment procedures are robust and safeguard service users. Staff undergo training to provide them with the skills to meet the needs of the service users. EVIDENCE: The home was appropriately staffed to meet the needs of the service users. Staff had received training to meet any specialist needs for service users. Since the last inspection photographs of existing staff are being obtained, and for all new staff, they are requested to provide a recent photograph with their application form. This standard was examined in depth at the last inspection. BUPA have a 6 week induction programme which is based on the Skills for Care (formerly TOPSS) core standards. The Registered Manager said that following the induction training, new staff go on to undertake NVQ in care training. The Registered Manager is aware of the NVQ qualification requirements for the home. Clare House DS0000010928.V258205.R01.S.doc Version 5.0 Page 17 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): 35, 36 and aspects of 38 The systems for maintaining service users personal monies are robust, thus ensuring that monies held for service users is safeguarded. Staff receive regular supervision, thus promoting communication and review of practice. Work is taking place to upgrade the fire safety within the home, thus safeguarding service users. EVIDENCE: The administrator was not present on the day of inspection. The Registered Manager said that individual records of all monies held on behalf of service users, to include income and expenditure records, are maintained on the computer system. A file was available with a comprehensive list to show the amount of money being held for each individual, which is banked in a ‘pocket money’ account. Generally these are small amounts of money only to pay for day-to-day expenses such as hairdressing, chiropody and outings, and this was Clare House DS0000010928.V258205.R01.S.doc Version 5.0 Page 18 evidenced in the documentation viewed. There was a clear reconciliation sheet for the monies held. Staff do not act as appointees for any service users. The Registered Manager has put a system in place for staff supervision. The Registered Manager supervises the heads of department, who in turn supervise their group of staff. Evidence of staff supervision was available. The home has a fire risk assessment in place. Fire drills have taken place and these have been documented with outcomes and recommendations, if any, recorded. The Registered Manager said that magnetic door closures are being installed throughout the home, plus a new fire escape is also being installed. In addition the lift doors are to be compartmentalised for additional safety provision. This standard was viewed in depth at the last inspection. Clare House DS0000010928.V258205.R01.S.doc Version 5.0 Page 19 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 2 X X X 3 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 3 X 3 Clare House DS0000010928.V258205.R01.S.doc Version 5.0 Page 20 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. 2. Standard OP9 OP9 Regulation 13(2) 13(2) Requirement Liquid medications must be dated when opened. Where more than one strength of tablet is required to be administered to obtain the prescribed dose, these must be individually entered on the MAR chart for each strength of tablet and each strength must be individually signed for. The medications procedures must be updated in line with current legislation to include disposal of medications from Nursing Homes and practices put in place to meet this. The temperature in the medication room must at all times be maintained at no more than 25º centigrade. The temperature of the medications fridge must be maintained between 2-8º centigrade. The décor throughout the home must be maintained to a good standard and provision must be made for the redecoration and re-carpeting of the first floor corridors, in addition to the DS0000010928.V258205.R01.S.doc Timescale for action 24/10/05 01/11/05 3. OP9 13(2) 18/11/05 4. OP9 13(2) 18/11/05 5. OP19 23(2)(b)& (d) 01/02/06 Clare House Version 5.0 Page 21 6. OP21 23(2)(j) 7. OP21 13(3) 8. OP22 23(2)(l) works already planned. An audit of the bath and shower facilities must be undertaken. An action plan with timescales for completion must be forwarded to the CSCI. These timescales not to exceed 01/04/06. A system for flushing water outlets in line with legionella prevention guidance must be put in place. Adequate storage facilities must be available in the home. 18/11/05 18/11/05 01/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations It is recommended that service users and/or their representatives be involved with the formulation and review of the service user plans, and this be evidenced each time a review takes place. It is recommended that each service users continence status be recorded at the time of admission to provide baseline information. 2 OP8 Clare House DS0000010928.V258205.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection West London Area Office 58 Uxbridge Road Ealing London W5 2ST National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Clare House DS0000010928.V258205.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!