Inspection on 27/09/05 for Clare House

This inspection was carried out on 27th September 2005.

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

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

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 19/04/05

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 Irene Miller Unannounced Inspection 27th September 2005 13:00 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 DS0000012744.V253533.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 DS0000012744.V253533.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Clare House Address Whittlebury Road Silverstone Northants NN12 8UD 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) 01327 857202 01327 858976 apopat@aol.com Clarex Limited Vacant Care Home 25 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (25), of places Physical disability over 65 years of age (25) Clare House DS0000012744.V253533.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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. To limit the number of service users in the categories DE (E) 19th April 2005 Date of last inspection 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 pleasant dining room which can accomodate all of the residents at meal times. 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 refurbished laundry to cater for all the residents needs. Clare House DS0000012744.V253533.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The primary method of inspection used was ‘case tracking’ which involved tracking the care of three residents, through a review of their records, discussion with them where possible, observation of care practices, discussion with the registered person, residents and staff. The inspection took place over a period of 4 hours following a period of one hour’s preparation, which included reviewing previous inspection reports and other documentation. What the service does well: What has improved since the last inspection? Staff have received dementia care training. and moving and handling refresher training. A further three staff have achieved their National Vocational Qualification level 2. Clare House DS0000012744.V253533.R01.S.doc Version 5.0 Page 6 In the absence of a registered manager, the homeowner has introduced an additional senior part-time post to liaise with health care professionals and be available to meet with residents and visiting relatives. In addition an experienced member of the care team, has been delegated the responsibility of implementing new care plan documentation and to carry out ongoing reviews to care plans. 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 DS0000012744.V253533.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 DS0000012744.V253533.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): 3&4 Assessments need to be fully detailed to ensure the home can fully meet the needs of prospective residents. EVIDENCE: There was pre assessment documentation, however it is not a fully comprehensive assessment of the needs of prospective residents entering the home who have dementia. The pre-assessment documentation looked at did not contain the date or the signature of the responsible person for conducting the assessment. There were entries within a correspondence book that indicated that there is some challenging behaviour displayed towards staff, however when reading through the care plans of the residents, there was no detailed instructions for staff to follow to ensure that there is a consistent approach, to managing challenging behaviour and ensure that residents needs are met. Clare House DS0000012744.V253533.R01.S.doc Version 5.0 Page 9 Clare House DS0000012744.V253533.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 & 11 The care plans do not provide clear and consistent information for staff to satisfactorily meet resident needs. EVIDENCE: The home introduced new care plan documentation in August 2005, to include assessment forms for recording residents daily living activities, moving and handling, pressure area care, nutrition, cognitive and physical dependency needs. The care plans looked at lacked information and instruction on identifying and meeting the needs of residents, several of the assessment forms were left blank and the assessments which were completed lacked the date of assessment, frequency of review and signatures of the person who completed the assessment and of the residents whom the care plan related to. There is a correspondence book in use, which contains information on the needs of resident’s, emotional and physical health and well being. There was reference to the district nurse and general practitioner visits and entries of Clare House DS0000012744.V253533.R01.S.doc Version 5.0 Page 11 staff experiencing problems with residents who exhibit challenging behaviour towards them. The care plans did not identify these needs and there was no formal review system in place to monitor resident’s physical and emotional needs. The care plans, which were previously in use prior to the introduction of the new care plans, were not available, hence there was no indication as to how frequently the care plans are updated and reviewed. Residents said they enjoyed living at the home and said the staff were very helpful and that they were treated with respect. Staff and residents were observed interacting well. On speaking with staff they had an in-depth knowledge of each residents needs, however this was not reflected within the care plans or the risk assessments. Falls prevention was not reflected in the care plans and risk assessments of residents who are prone to falls, there was numerous entries within the accident reports for one resident who experiences frequent falls, the care plan did not address this area of need and the risk assessment was blank. Medication charts were looked at there was two signatures missing from the record of medication given to one resident during the morning, this was brought to the attention of the senior on duty who had administered the medication and the signatures were obtained immediately. The care plans contained brief information on the wishes of residents at the time of their death, the home has regular visits from the clergy and Holy Communion is offered to residents weekly. Clare House DS0000012744.V253533.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Choice and options are available to residents and how they spend their day and includes social activity involvement. EVIDENCE: Resident spoken with said that there was activities for them to join in with if they wished. A group of residents were sitting in the conservatory; one resident said that they enjoyed sitting in the conservatory and watching the seasons change. Staff were observed assisting residents with a small group crossword activity, the residents participating said that they enjoyed doing the crossword. The staff were observed spending time with residents, who just wanted to have a chat. The home has regular visits from the clergy and Holy Communion is offered to residents weekly. Visitors were seen to be made welcome by the staff, comments from visitors were very positive, that the staff always make themselves available if they need anyone to speak to regarding their relatives care, that the staff are very caring and kind. Clare House DS0000012744.V253533.R01.S.doc Version 5.0 Page 13 Residents were observed moving around within the home with independence of choice as to how and where they wished to spend their time. All residents spoken with said that the food was good and that they could choose alternative to what was on the menu. The daily menus were on display on the resident’s notice board. The evening meal was ham salad one resident was observed asking for an alternative, and the staff were observed to respond promptly offering an alternative of scrambled eggs which was accepted by the resident. The meal was served in a very relaxed and pleasant environment. Clare House DS0000012744.V253533.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Information is available for residents and their representatives if they wish to make a complaint about the service. EVIDENCE: Information is available on the residents and relative’s notice board as to how to make a complaint about the service. Clare House DS0000012744.V253533.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,23,24,25 & 26 Residents are provided with a pleasant internal and external environment. EVIDENCE: Access to maintenance and fire records was not possible as the registered person was not available and the office locked. However the registered person was available to speak with over the telephone. The registered person verbally confirmed that staff fire training has taken place, and that records were retained of all electrical, gas and water checks and of any remedial action required to ensure that these essential services all function correctly. A limited tour of the building was conducted and resident’s rooms were furnished to a high standard pleasantly decorated and personalised with pictures, ornaments, television, radio and small items of individual furniture. Clare House DS0000012744.V253533.R01.S.doc Version 5.0 Page 16 One resident wanted to make their bedroom available to view, and spoke highly of their satisfaction with the room, and how pleasurable the outlook into the garden was. The garden is well maintained with flower borders and outdoor seating available for residents to access. The home has a standing aid for residents who require extra help and assistance in this area, residents were seen to be using walking aids. On speaking with the registered person it was established that the home is unable to meet the needs of residents who require the use of hoists for moving and transferring. There is a bath hoist for residents who require help in this area. The home was clean and free from any offensive odours Clare House DS0000012744.V253533.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 & 30 There is a committed staff team, and staffing levels are adequate to meet the residents needs and EVIDENCE: On the day of inspection there was one senior carer on duty, three care staff, two domestic staff, one cook and one maintenance worker, in addition there was a part time senior member of staff on duty whose role is as a support worker. There was one member of staff who was undertaking a National Vocational Qualification level 2, (NVQ) and was visiting the home to meet with their tutor. The member of staff said that they were enjoying working towards their Qualification. Staff training records were not available to see during the inspection, however the registered person did confirm over the telephone that three staff have achieved their National Vocational Qualification level 2 in care this was again confirmed on speaking with staff. Staff confirmed that they had received dementia care training and that this training was very practical and informative. Dementia care training had been made available in the structure of a workbook that covered individual learning modules and also through a half-day course. Clare House DS0000012744.V253533.R01.S.doc Version 5.0 Page 18 Staff also confirmed that they had recently attended a moving and handling refresher course. Clare House DS0000012744.V253533.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 & 38 The staff are at risk of not being effectively supervised and residents needs not being fully met as there is no qualified and experienced registered manager in post. EVIDENCE: In the absence of a registered manager in post, the registered person has introduced an additional part-time senior staff post to assist in the smooth running of the home. This senior roles purpose, is to liaise with health care professionals and be available to meet with residents and visiting relatives. A member of the care team, has been delegated the responsibility of implementing the new care plan documentation and to carry out ongoing reviews to care plans. Clare House DS0000012744.V253533.R01.S.doc Version 5.0 Page 20 The homes documentation system is fragmented and causes a separation of information, the care plans are not utilised effectively, which places the residents at risk of their needs and expectations not being fully met. Records were not available to determine how often staff received supervision, however when speaking with staff they said that they were happy working at the home, felt well supported, that training was available and they could approach the registered person if they had any cause for concern. The registered person said that staff supervision is now taking place and that there has been some interest in the registered managers vacancy and the application is being processed. The residents care plans and other confidential information are stored securely. Clare House DS0000012744.V253533.R01.S.doc Version 5.0 Page 21 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 X X 2 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 3 X 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X X X X 2 Clare House DS0000012744.V253533.R01.S.doc Version 5.0 Page 22 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 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. (Previous timescale of 01/06/08 not met) Pre assessment documentation must include the date of when the assessment took place and the signature of the responsible person who conducted the assessment. Care plans must identify how all assessed needs for residents are to be met. (Previous time scale of 30/06/05 not met) Where challenging behaviour is present the management of the behaviour must be recorded within the care plans and regularly reviewed. Risk assessments must be completed to identify all areas of risk for individual residents to include the intervention needed to reduce these to an acceptable level, with particular attention given to the prevention of falls. The registered person must DS0000012744.V253533.R01.S.doc Timescale for action 31/10/05 2 3 14 (1) 31/10/05 3 7 12 (1) (a) (b), 15 12 (5) 31/10/05 4 8 31/10/05 5 8 13 (4) (c) 31/10/05 6 8 13 (4) 30/11/05 Page 23 Clare House Version 5.0 inform the Commission for Social Care Inspection of the arrangements to be made for the recruitment of a registered manager. (Previous time scales of 20/12/04 and 01/06/05 not met) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard 7,8,9,12, 38 37 Good Practice Recommendations Information relating to the residents health care and welfare should be recorded directly into the care plans and not in a correspondence book. In the absence of the registered person and the registered manager the senior member of staff on duty should have access to policies and procedures, fire and maintenance records, required by regulation for the protection of service users and for the effective and efficient running of the home. Clare House DS0000012744.V253533.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Northamptonshire Area Office 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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