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Inspection on 12/12/05 for Clare House Nursing Home

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

This inspection was carried out on 12th December 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

What the care home does well

The home and gardens are well maintained and provide pleasant and homely surroundings in which to live. All service users surveyed confirmed that they feel the staff treat them well and all GPs and health care professionals agreed that they are satisfied with the overall care provided. One relative surveyed commented `I feel I must commend the family feeling at Clare House and the obvious affection the staff feel towards the residents.`

What has improved since the last inspection?

All medication records were well-maintained in line with the home`s policies and procedures and current legislation. The ongoing maintenance and redecoration of the home and gardens provide the service users with homely and comfortable surroundings in which to live.

What the care home could do better:

Requirements have been made regarding staff recruitment and supervision during induction, which need to be addressed to protect the safety and well being of the service users.

CARE HOMES FOR OLDER PEOPLE Clare House Nursing Home 36 Hersham Road Walton On Thames Surrey KT12 1JJ Lead Inspector Denise Debieux Announced Inspection 12th December 2005 10:00 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 Nursing Home DS0000017598.V258284.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 Nursing Home DS0000017598.V258284.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Clare House Nursing Home Address 36 Hersham Road Walton On Thames Surrey KT12 1JJ 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) 01932 224881 maxwellp@bupa.com BUPA Care Homes Limited Patsy Ann Maxwell Care Home 32 Category(ies) of Physical disability over 65 years of age (32) registration, with number of places Clare House Nursing Home DS0000017598.V258284.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 32 beds providing nursing care for elderly people from the age of 60 years. Up to 3 beds may be used for physically disabled people from the age of 50 years. 2 places for elderly day care (E) Date of last inspection 30th August 2005 Brief Description of the Service: Clare House is an attractive Tudor style home situated in a residential area of Walton-On-Thames. It enjoys the benefit of a pretty, secluded garden, which is accessible to all service users. There are three sitting rooms, a conservatory and a large dining room all of which which have a homely atmosphere. An activities room offers a variety of interests and personal hobbies are encouraged. The home is owned by BUPA who are the registered providers. The home offers nursing care to 32 older people. Clare House Nursing Home DS0000017598.V258284.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over 5 hours and was the second inspection to be undertaken in the Commission for Social Care Inspection year April 2005 to March 2006. This inspection was carried out by Denise Débieux, Lead Inspector for the service. Mrs Patsy Maxwell (Registered Manager) and Miss Nicola Skinner (Deputy Manager) were present as the representatives for the establishment. Prior to the inspection, survey forms were sent to the home and distributed to service users, with six being returned, to their relatives, with twenty-five being returned, to GPs and health and social care professionals, with nine being returned and to Care Managers, with two being returned. The results of these surveys and comments made are used in this report. A tour of the building took place with sixteen service users and eight on-duty staff being spoken with during the tour. The menus, staff rota, staff files and medication records were all sampled. The inspector would like to thank the service users and staff for their time, assistance and hospitality during this inspection and the service users, their relatives and health and social care professionals who participated in the surveys. What the service does well: What has improved since the last inspection? All medication records were well-maintained in line with the home’s policies and procedures and current legislation. The ongoing maintenance and redecoration of the home and gardens provide the service users with homely and comfortable surroundings in which to live. Clare House Nursing Home DS0000017598.V258284.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Clare House Nursing Home DS0000017598.V258284.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 Nursing Home DS0000017598.V258284.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): 6 EVIDENCE: Clare House does not offer intermediate care. This standard does not apply. Clare House Nursing Home DS0000017598.V258284.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): 9 and 10 Policies, procedures and practices are in place to ensure the safe handling and administration of medication. The arrangements for health and personal care ensure that service users’ privacy and dignity are respected. EVIDENCE: The medication administration record sheets, medication storage, controlled drug storage and controlled drug record book were all sampled during this inspection and found to be accurate and well-maintained in line with the home’s policies and procedures and current legislation. At lunch-time, the medication round was observed and was seen to be carried out in line with the home’s policies and procedures. During the tour of the home staff were observed to always knock before entering the service users’ bedrooms and all interactions observed between staff and service users were seen to be caring and respectful. All service users surveyed confirmed that they felt the staff respected their privacy. Clare House Nursing Home DS0000017598.V258284.R01.S.doc Version 5.0 Page 10 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): 14 Service users are encouraged and enabled to exercise choice and control over their lives. EVIDENCE: The routines of daily living are arranged to suit individual service users’ preferences and choices. This was confirmed by service users spoken with. Service users are able to choose which activities they attend or participate in and the menus were seen to include three choices for the main meal each day. One service user stated that ‘I can always find something I like’. Service users handle their own financial affairs where appropriate. The inspector was advised that the home do not handle the financial affairs of any service users. The service users’ rooms seen all contained many personal possessions and were arranged to suit the service users’ wishes. Clare House Nursing Home DS0000017598.V258284.R01.S.doc Version 5.0 Page 11 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): None EVIDENCE: These standards were all assessed and met at the last inspection and were not covered on this occasion. Clare House Nursing Home DS0000017598.V258284.R01.S.doc Version 5.0 Page 12 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 The location and layout of the home is suitable for it’s stated purpose. It is accessible, safe and well-maintained with a pleasant and homely atmosphere. EVIDENCE: All service users spoken with expressed their satisfaction with the accommodation provided at the home. During the tour of the home the premises were seen to be well maintained with service users able to access all areas of the home and grounds. On the day of inspection the home was found to be warm and bright with a homely atmosphere and a high standard of housekeeping apparent. One relative surveyed commented ‘I have nothing but praise for their care and the general atmosphere of the home.’ Clare House Nursing Home DS0000017598.V258284.R01.S.doc Version 5.0 Page 13 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): 28 and 29 The home has a staff training programme which is designed to ensure, as far as reasonably possible, that service users are in safe hands at all times. Action must be taken to improve the staff recruitment procedures to ensure that service users’ safety is protected. EVIDENCE: The manager expressed a firm commitment to National Vocational Qualification (NVQ) training for the staff. The home had achieved the target of having 50 of their care workers qualified to National Vocational Qualification (NVQ) level 2 in care or higher by 31st December 2005. Recent staff changes have reduced this percentage to 38 , however, seven of the eighteen care workers have already achieved the qualification and three are currently on the course. Three staff files were reviewed and were found to contain the majority of the information required. However, the files seen did not include a full employment history and gaps in employment were not fully explained. One file did not include a recent photograph and another did not have a health declaration form. The home obtains two written references and applies for Criminal Record Bureau (CRB) checks for all staff. In some instances staff commence employment on the basis of a POVAfirst check whilst waiting for the CRB certificate to be returned. In these instances measures had not been put in place in line with recent legislation. Requirements and a recommendation have been made regarding these areas of recruitment. Clare House Nursing Home DS0000017598.V258284.R01.S.doc Version 5.0 Page 14 One relative surveyed commented that they felt there was poor communication between all grades of staff. This was discussed with the manager and possible ways of identifying areas which could be improved were explored. Another relative surveyed commented ‘Occasionally a staff shortage which is rectified. A well managed home plus caring staff.’ Clare House Nursing Home DS0000017598.V258284.R01.S.doc Version 5.0 Page 15 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 and 35 Service users benefit from the clear management approach at the home. Service users’ financial interests are safeguarded by the policies and practices of the home. EVIDENCE: The manager is a registered nurse and has now completed her Registered Manager’s Award (RMA) training. All interactions observed between the manager and staff during this inspection clearly demonstrated that the home has a close and caring staff team. The manager stated that she meets regularly with all staff and it was apparent that the staff felt at ease and able to approach the manager at any time. One relative surveyed commented ‘Clare House is a well run home, always clean and welcoming. The management and nurses are always ready to hear our views and act on them.’ Clare House Nursing Home DS0000017598.V258284.R01.S.doc Version 5.0 Page 16 The inspector was advised that the home do not handle financial affairs for any service users. However, on occasions when service users want valuables stored securely for a short period of time, the home has a safe which can be used. Any items stored in this way are recorded in the service users’ files and service users or their relatives are provided with receipts. All service users surveyed and spoken with confirmed that they felt safe at the home. Clare House Nursing Home DS0000017598.V258284.R01.S.doc Version 5.0 Page 17 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X X STAFFING Standard No Score 27 X 28 2 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X X Clare House Nursing Home DS0000017598.V258284.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? NO 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 OP29.1-6 Regulation Requirement Timescale for action 12/12/05 19(1)(a-c) The registered person must not Schedule employ a person to work at the 2 care home unless the person is fit to work at the care home and he/she has obtained, in respect of that person, the information and documents specified in paragraphs 1 to 9 of Schedule 2 of the Care Homes Regulations 2001, as amended by The Care Standards Act 2000 (Establishments and Agencies)(Miscellaneous Amendments) Regulations 2004. 2 OP29.1-6 12/01/06 19(1)(a-c) The registered person must Schedule obtain the information and 2 documents specified in paragraphs 1 to 9 of Schedule 2 of the Care Homes Regulations 2001, retrospectively for each member of staff employed by the company after The Care Standards Act 2000 (Establishments and Agencies)(Miscellaneous Amendments) Regulations 2004 came into force on 26th July 2004. DS0000017598.V258284.R01.S.doc Version 5.0 Page 19 Clare House Nursing Home 3 OP29 18(2)(b) 19(11)(ac) 4 OP29.4 18(4) Where the registered person 12/12/05 permits a new worker to start work with a POVAfirst check but pending receipt of a valid CRB certificate and for the duration of a new workers induction training, the registered person must: • Appoint a member of staff (the staff member), who is appropriately qualified and experienced, to supervise the new worker. • So far as possible, ensure that the staff member is on duty at the same time as the new worker. • Ensure that the new worker does not escort service users away from the care home premises unless accompanied by the staff member. The registered person must 12/03/06 provide all care staff with copies of the code of conduct and practice set by the GSCC. 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 OP29 Good Practice Recommendations It is recommended that BUPA Care Homes Ltd review their employment application form to encompass the new requirements of Schedule 2 of the Care Homes Regulations 2001 (as amended by The Care Standards Act 2000 (Establishments and Agencies) (Miscellaneous Amendments) Regulations 2004). E.G. request a full employment history instead of the past 10 years only; ask for reasons for leaving previous jobs; ask for gaps in employment to be explained; etc.. Clare House Nursing Home DS0000017598.V258284.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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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