Inspection on 11/01/06 for Claremont

This inspection was carried out on 11th January 2006.

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.

Other inspections for this house

Claremont 05/06/07

Claremont 09/03/05

Claremont 15/09/04

Claremont 22/03/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Claremont Linleys, Gastard Road Corsham Wiltshire SN13 9PD Lead Inspector Malcolm Kippax Unannounced Inspection 11th January 2006 10:40 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 Claremont DS0000028418.V278063.R01.S.doc Version 5.1 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. Claremont DS0000028418.V278063.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Claremont Address Linleys, Gastard Road Corsham Wiltshire SN13 9PD 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) 01249 713084 01249 701381 Warrington Homes Limited Mrs Mandy McCulloch Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places Claremont DS0000028418.V278063.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th July 2005 Brief Description of the Service: Claremont is one of two homes in Wiltshire that are run by the charity, ‘The Warrington Homes Limited’. The home has been in existence since 1946 and occupies a large site on the main road between Corsham and Melksham. The original building has been extended and modified over the years. Many of the rooms look out onto the home’s grounds. The accommodation is on the ground and first floors. A passenger lift is available. There are 38 single rooms, of which 16 have en-suite facilities. The communal rooms include a large lounge, a conservatory and a dining room. There are two bathrooms on the ground floor and two on the first floor. Respite care (temporary) stays can be arranged, subject to the availability of a vacant room. For the majority of service users, Claremont is their permanent home for as long as this remains appropriate to their needs and wishes. Claremont is not registered to provide nursing care and district nurses attend to the service users’ nursing needs. Service users receive care and support from a permanent staff team. A keyworker system is in operation. Claremont DS0000028418.V278063.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection started at 10.40 am and lasted for six hours. Several service users were met with in the communal areas and in their own rooms. Time was spent with four service users in particular, who described the service that they receive and what it is like to live at Claremont. The relatives of two service users also spoke about their experience of the home. This inspection focussed on a number of key standards that were not looked at during the previous inspection of the home. Members of the management and staff team were met with. There were individual conversations with the home’s registered manager, care manager, training manager and a carer. Records were looked at, including health, medication, money, fire, complaints, quality assurance and health & safety. What the service does well: What has improved since the last inspection? What they could do better: The views of service users are not yet contributing sufficiently to the home’s improvement plans and system for annual development. The current arrangements for quality assurance should be reviewed, with a view to establishing a more comprehensive system. Claremont DS0000028418.V278063.R01.S.doc Version 5.1 Page 6 Space for wheelchairs and hoists appears to be very limited and the conservatory continues to be used as a storage area. This reduces the choice that is available to service users about where they can sit and spend their time. The home has experienced difficulties with providing NVQ for staff. This is being resolved following a change of assessment centre. The home has not yet achieved the ratio of qualified staff that is expected, although the training officer was confident that this situation would now improve. Staff members need to be reminded of the need to wait for a reply, as far as is possible, when knocking on the service users’ bedroom doors. The home’s fire risk assessment needs to have some additional information. 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. Claremont DS0000028418.V278063.R01.S.doc Version 5.1 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 Claremont DS0000028418.V278063.R01.S.doc Version 5.1 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): These standards were not looked at on this occasion. (Standard 3 was inspected and met at the last inspection). EVIDENCE: Claremont DS0000028418.V278063.R01.S.doc Version 5.1 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): 8, 9 and 10 Service users are well supported with their medication and health needs. Service users feel that their rights are respected and that they are treated well by staff. (Standard 7 was inspected and almost met at the last inspection). EVIDENCE: The new system of record keeping provides a good format for the recording of health care matters. This includes a short term care plan which is mainly used for temporary conditions. An example of this was seen which included instructions for care staff following a referral to the district nurse. The service users’ main care plans have some relevant health related sections, such as ‘breathing’, ‘eating & drinking’ and ‘mobility’. The system of record keeping includes individual pressure sore prevention and nutritional risk assessment forms. Some of these had been completed and the home’s care manager was working on others at the time of the inspection. Each of the service users who were asked felt that staff members were responsive to their health needs and assisted well with making appointments. Claremont DS0000028418.V278063.R01.S.doc Version 5.1 Page 10 The care manager said that the majority of service users were registered with a local GP who made a visit to the home each week, in addition to other appointments. During the last year the storage of medication has moved to a more spacious location. A monitored dosage system is used for most of the medication and there were suitable facilities in place. The practical arrangements looked well organised, with non-dosage system stock medication stored in individual containers. In the office there was a list of staff who had been assessed as competent to administer medication. The procedure for the administration of medication includes the involvement of two staff on each occasion. Both staff sign the records of administration, which were seen to be up to date and complete. Medication is signed in and dated on the records of administration. The care manager also keeps a checklist of medication that comes in with the monthly order. It is recommended that this checklist is signed, rather than ticked. The care manager said that the service users did not manage their own medication, other than in respect of one service user to a small degree. This was identified on the medication records. The service users spoken with said that they were happy for staff to look after their medication and to manage the arrangements. The GP had signed a homely remedies list giving approval for administration to his patients in the home. Each service user has their own room in which they can receive personal care in private. Appropriate interactions between staff and service users were observed during the inspection. The service users met with in their rooms had their own private telephones. There is a also a pay phone which is located in a quiet area. A service user said that post was received promptly from staff. During conversation with one service user, a staff member knocked on the door, but entered quickly without waiting for a response. This was not a problem for the service user, however this approach could catch a service user unawares or be seen by another person as having an impact on their private space. Claremont DS0000028418.V278063.R01.S.doc Version 5.1 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 the following standard(s): 13 and 14 Visitors are welcomed into the home and service users can keep in touch with local events. Service users have the independence that they want and can exercise choice in some important areas. (Standards 12 and 15 were inspected and met at the last inspection). EVIDENCE: The relatives of two service users were met with while they were visiting the home. Both expressed their satisfaction with the visiting arrangements and felt that they were made to feel welcome. Information for visitors was readily accessible in the front hall, including copies of the home’s statement of purpose. Service users described ways in which they keep in touch with the local community. Outings with relatives are the main way and there are also social events and entertainments arranged involving people from outside the home. A holy communion service had taken place during the morning. There was a notice on display giving the dates when a local minister would be visiting the home in the coming months. Claremont DS0000028418.V278063.R01.S.doc Version 5.1 Page 12 Service users manage their own finances with the support of relatives. The home’s manager said that the home’s involvement with the service users’ financial affairs was limited to the safekeeping of some personal money. The practical arrangements were discussed with the manager and examples of the account records were looked at. Money is signed in on an individual basis and receipts given. It was agreed with the manager that a change in the storage arrangements would be beneficial. Service users can bring their own possessions with them when moving into the home. This was evident in the rooms seen, which had been well personalised. Claremont DS0000028418.V278063.R01.S.doc Version 5.1 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 Service users and others have not found it necessary to make any serious complaints during the last year. Arrangements are in place for acting upon the service users’ concerns, although an amendment to the recording of these would be beneficial. (Standard 18 was inspected and met at the last inspection). EVIDENCE: The home’s manager showed a file that is kept for the recording of complaints. This included details of one complaint that had been made during the last year. This was not of a serious nature and the manager said that concerns raised by service users are followed up, although they would not necessarily have been received as a formal complaint. With this in mind, a form is available to staff on which they can record any relevant matters that have been raised with them during the course of their duties. These are then passed to the manager to be followed up and investigated as appropriate. The manager was recommended to amend the form in order to show how the outcome is reported to the service user, the date on which this happens and whether the service user is satisfied. Information about the home’s complaints procedure was available to service users and visitors. Claremont DS0000028418.V278063.R01.S.doc Version 5.1 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): 26 Service users live in clean and tidy surroundings. The location of a new laundry will need to receive careful attention. (Standards 19 and 20 were inspected and met at the last inspection). EVIDENCE: The areas of the home seen during the inspection were clean and tidy. Those service users who were asked said that they are satisfied with the standard of cleaning within their own rooms. Cleaning staff are deployed between Monday and Friday, when most of the work takes place. There are no cleaning staff at the weekends and the care staff are expected to deal with any jobs that arise. This was not raised as a concern during the inspection. However it is unusual for a home the size of Claremont to have no cleaning cover at the weekends and the success of this arrangement should be kept under review. The home’s sluicing facility is relatively new. The manager said that a decision had been made about the building of a new laundry. The planned location is outside the main building and the manager reported on the initial plan for how Claremont DS0000028418.V278063.R01.S.doc Version 5.1 Page 15 washing would be taken through the home. This would involve it being carried through the main lounge in order to reach an exit door. Alternatives were discussed and the final plan will need to ensure that soiled items can be taken in a way that does not intrude on service users, as well as being well away from food areas. An environmental health officer had inspected the kitchens in September 2005 and reported that standards were generally good. Two requirements had been identified. The manager said that one of these had received attention and another concerning chipped tiles was in the process of being completed. A recommendation was made at the last inspection concerning the storage of equipment. The conservatory continues to be used for the storage of hoists and other items, which means that a potentially nice seating area is not available to service users. Claremont DS0000028418.V278063.R01.S.doc Version 5.1 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 and 28 Service users receive the support that they need. Staff members have well defined roles. Service users benefit from the individual attention that they receive from staff members, although the staff team as a whole has not yet achieved the level of qualifications that is expected. (Standards 29 and 30 were inspected at the last inspection. Standard 29 was met and the home was commended in respect of standard 30). EVIDENCE: There is a written staff roster, although the deployment of cleaners is not shown. The manager said that the cleaners clock in and out at agreed times. The manager said that there was no system or model in place for determining staffing levels and how staff members are deployed. The manager felt that staffing levels are maintained at a sufficiently high level to take account of changes in the service users’ dependency levels. On the morning of the inspection there were six carers working, in accordance with the roster. One of the carers was new and was shadowing another carer at the time. Other staff included the assistant care manager (shift leader), the home’s manager, the care manager and the training manager. Staffing is being maintained at previously agreed levels. Ancillary staff on duty during the morning were a cook, kitchen assistant, laundry person, maintenance person, social activities organiser and three cleaners. Claremont DS0000028418.V278063.R01.S.doc Version 5.1 Page 17 Service users and relatives met with said that staff members were readily on hand when needed. No concerns were raised about the current staffing levels. The training of staff was looked at during the last inspection, when the home was commended for the range of courses and the attention that is given to staff members’ individual training needs. It was evident from discussion with the training manager that this is continuing to receive good attention and that a pro-active approach is being taken. An example of this was training in catheter care that was being arranged in advance of a new service user moving into the home. In contrast, the home has experienced difficulties with staff members being able to undertake their NVQs. The training manager said that progress was now being made with a new assessment centre. Six carers are currently registered for NVQ and another 18 are due to start. Three domestic staff members are also due to start NVQ. Claremont DS0000028418.V278063.R01.S.doc Version 5.1 Page 18 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, 35 and 38 The home has an experienced management team with well defined roles. There is an organised approach to the running of the home and recent developments have been beneficial. Service users benefit from the approach that is taken to health & safety and improvement. However the views of service users are not yet contributing sufficiently to the home’s improvement plans. (Standard 36 was inspected and met at the last inspection). EVIDENCE: Mrs M. McCulloch has over twenty years’ experience of managing the home. Mrs McCulloch has now registered for the registered managers award and is looking at some new areas of training that will be relevant to her role. Other people have specific responsibilities for different areas of the home. The care manager takes the lead in care planning and medication. Claremont DS0000028418.V278063.R01.S.doc Version 5.1 Page 19 There are name plates in the front hall which inform service users and visitors of who is in charge of the home and who is on-call at any particular time. There has been a change of Responsible Individual for the Warrington Homes since the last inspection. Members of the management team said that this had been a good opportunity to look at how aspects of the home are being managed and to discuss new ways of doing things. Improvements are evident in the refurbishment and upgrading of facilities that take place as part of the Warrington Homes’ business plan. The manager said that questionnaires had been sent out to service users in October 2005 and that these were still being returned. There is no current action or improvement plan based on the views of the service users and their representatives. If questionnaires are to continue to be used they need to be part of a cycle of planning, action and review and to contribute to a plan that reflects the aims and outcomes for service users. The importance of quality assurance in the future was discussed with the manager. The home’s statement of purpose refers to systems that are in place for monitoring the home’s services and procedures. However some of these, for example three monthly residents’ meetings and a suggestions box in the front hall, are not happening as stated. The home’s fire log book and records of fire instruction to staff were up to date. The care manager described various ways in which health & safety is monitored and actioned in the home. There is a repairs book, with most jobs being dealt with by the home’s maintenance person. There is a risk assessment file. Examples of the risk assessment forms were looked at. Hazards within each service user’s room are being assessed on an individual basis. Certain staff and managers attend a risk assessment meeting that is held about every six months. A meeting had last been held in October 2005, with minutes kept. The meetings are a chance to discuss both general and individual matters in relation to hazards and health & safety in the home. A fire risk assessment had been written separately. This showed that risks and the precautions in place are being assessed although some significant information was missing. It was not dated, had no review date and had no ‘outcome’ statement to confirm whether the precautions in place are sufficient or not. Servicing arrangements are in place for different items of equipment and facilities in the home, such as the passenger lift. Claremont DS0000028418.V278063.R01.S.doc Version 5.1 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 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 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 X X 2 Claremont DS0000028418.V278063.R01.S.doc Version 5.1 Page 21 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 OP33 Regulation 4 Requirement The Statement of Purpose must accurately reflect the arrangements being made for the monitoring of services and procedures in the home. A quality assurance action plan must be produced. The fire risk assessment must be amended to include all appropriate details. Timescale for action 31/03/06 2 2 OP33 OP38 24 13(4) 31/03/06 28/02/06 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 2 3 Refer to Standard OP9 OP10 OP16 Good Practice Recommendations That the medication checklist is signed rather than dated. That staff members are reminded of the correct way of entering service users’ rooms. That the concerns / complaints form is amended to show how the outcome is reported to the service user, the date on which this happens and whether the service user is satisfied. DS0000028418.V278063.R01.S.doc Version 5.1 Page 22 Claremont 4 5 6 OP19 OP33 OP33 That alternative and appropriate arrangements are made for the storage of hoists and wheelchairs. That a policy on quality assurance is produced. That the arrangements made for quality assurance are reviewed, with a view to establishing a more comprehensive system. Claremont DS0000028418.V278063.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Claremont DS0000028418.V278063.R01.S.doc Version 5.1 Page 24 - 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!