CARE HOMES FOR OLDER PEOPLE
Claremont Linleys, Gastard Road Corsham Wiltshire SN13 9PD Lead Inspector
Elaine Barber Unannounced Inspection 10:00 5 and 11th June 2007
th 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.V336163.R01.S.doc Version 5.2 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.V336163.R01.S.doc Version 5.2 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 claremontresidentialhome@msn.com 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.V336163.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th January 2006 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 and open fields beyond. 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 people who live in the home, 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 people’s nursing needs. People receive care and support from a permanent staff team. A keyworker system is in operation. There is a statement of purpose which provides detailed information about the service. The fees range between £2035 and £2440 each calendar month. Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection included one unannounced visit to the home on 6th June 2007 and a planned visit on the 11th June. During the visits information was gathered using: • • • • • • • Observation Discussion with twelve people who lived in the home Discussion with the manager Discussion with the care manager Discussion with staff Discussion with one of the cooks Reading records. Other information and feedback about the home has been received and taken into account as part of this inspection: • • • • • The care manager provided information prior to the inspection about the running of the home. Comment cards were received from ten people who lived in the home. Comment cards were received from four relatives and visitors. Comment cards were received from four members of staff. A comment card was received from a GP. The judgements contained in this report have been made from all this evidence gathered during the inspection, including the visits. What the service does well:
There was a statement of purpose and copies were available in the home. People who were interested in moving into the home were given a copy. This ensured that people had sufficient information to make an informed decision about whether to move into the home. Each person had a detailed assessment of their personal, social and health care needs to ensure that all their needs would be met. Each person also had a contract and statement of terms and conditions so that they knew what to expect from the service. Support with personal, social and health care needs was recorded in each person’s care plan. The plans were very detailed and included the outcomes that people wished to achieve from their care. These measures ensured that people’s personal, health care and diversity needs were being met. People were helped to take their medication in a safe manner. Staff who administered
Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 6 medication had training. Medication was stored safely and the required records were kept accurately. Each person had their own room and people had brought personal items into their rooms to make them individual and homely. Some people had their own phones in their rooms and there was a shared phone in a quiet area. Staff knocked on doors and waited for a reply before entering. People were treated with respect and their right to privacy was upheld. People found that the lifestyle in the home suited their needs, wishes and choices. Each person had a record of their preferred routine to ensure that routines were flexible to meet their needs. There was an activities organiser who arranged activities every morning and afternoon. There were opportunities for exercise and people who were able could go out. People kept in contact with family and friends and went out into the community. Visitors were welcome in the home at any time. People went out with their relatives and the staff also took them out individually and in groups. People had opportunities to exercise choice and control over their lives. They were supported to manage their own care, money and medication of able. Nutritional needs were assessed and there was information about nutrition. This was taken into account when planning the menus to ensure that these needs were met. People had a choice of meals and they enjoyed their food. There was a complaints procedure and information in the statement of purpose about how to make a complaint. There was a complaints and comments folder. Any complaints and comments were recorded and investigated. The person who raised the concern was informed of the outcome. If people were unhappy with the care home, they or their relatives knew how to complain. Any complaint was looked into and action taken to put things right where appropriate. Staff received information and training about how to protect people from abuse. People could be sure the care home safeguarded them from abuse and neglect. Each person had a single room and the rooms were individually decorated. Many people had brought items of furniture and personal effects into their rooms to make them homely. This meant that people’s rooms felt like their own and were comfortable. There was a large lounge and a large dining room. There was a programme of maintenance and each bedroom was decorated when it became vacant. There were plans to redecorate the dining room and one of the corridors. The home met with the requirements of the environmental health officer and fire officer. There was a large laundry room and two laundry staff to meet people’s laundry needs. People said that the home was always fresh and clean. People stayed in a safe and wellmaintained home that was homely, clean, pleasant and hygienic. People have safe and appropriate support as there are enough competent staff People who were spoken to and who completed comment cards said that there were enough staff on duty. There were five or six care staff in the morning
Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 7 and four in the afternoon and evening. There was also a manager and deputy manager. Three staff worked at night. There was a recruitment procedure and staff received the required checks before starting work. People could have confidence in the staff at the home because checks had been done to make sure that they were suitable to care for them. There was a training assistant who ensured that all staff received the training that they needed to do their jobs. More than half the staff had a National Vocational Qualification (NVQ) at level two. People’s needs were met and they were well supported by staff who had the relevant training. People could have confidence in the care home because it was led and managed in their best interests by people who knew how to provide high quality support. The manager was qualified and had over twenty years’ experience of working in care. She was supported by a care manager, training assistant and activities organiser. People or their families managed their own money. Small sums of money were managed by the care home on their behalf in their best interests. There was a programme of supervision for staff. The training assistant provided supervision every two months. Each member of staff had an annual appraisal. People had good quality support because the workers were supervised and well supported by their managers. The environment was safe for them and the staff because the managers and workers carry out good health and safety practices. What has improved since the last inspection?
Improvements had been made to the arrangements for receiving medication. At the last inspection it was recommended that the checklist for medication received in the monthly order should be signed, rather than ticked. This had been addressed to show who was responsible for ensuring that the correct medication had been received. There was a recommendation at the last inspection that the concerns and complaints form is amended. This had been done and the form showed how the outcome was reported to the person who complained, the date on which this happened and whether the person who complained was satisfied. This would ensure that people were happy with the way that their complaints were dealt with. In response to two requirements and two recommendations at the last inspection the quality assurance system had been developed further. Information about how the managers monitored quality had been added to the statement of purpose. A policy on quality assurance had been produced. A quality assurance questionnaire had been sent to all people who used the service, responses from the questionnaires had been analysed and a report of the findings had been produced. Areas for improvement were identified. This ensured that the home was run in people’s best interests. Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 8 A requirement was made at the last inspection that the fire risk assessment must be amended to include all appropriate details. This had been updated in May 2007 to include an assessment of fire risk in all areas of the home and the precautions to reduce risks. There were plans to review it annually. This would ensure that people were protected from the risk of fire. 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. The summary of this inspection report can be made available in other formats on request. Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 9 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.V336163.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, Quality in this outcome area is good and the assessments were excellent. This judgement has been made using available evidence including a visit to this service. People had sufficient information to make an informed decision about whether to move into the home. Each person also had a contract and statement of terms and conditions so that they knew what to expect from the service. Each person’s needs were assessed in detail to ensure that all their needs would be met. EVIDENCE: There was a detailed statement of purpose, which contained all the required information. Copies were given to people who were interested in moving into the home. Copies were also available in the entrance hall along with copies of the most recent inspection report. A requirement was made at the last inspection that the statement of purpose must include the arrangements for monitoring services and procedures in the home. Information about how the
Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 11 managers monitored quality had been added to the statement of purpose. Ten people completed comment cards. All said that they had received enough information about the home to decide if it was the right place for them. Each person had a contract with Warrington Homes Ltd setting out the terms and conditions and the fees. Each contract was signed by the person or their representative, for example a relative who had power of attorney. Where a third party was responsible for some of the fees they also signed the contract. Eight out of ten people who completed comment cards said that they had received a copy of their contract. Each person had a brief assessment of their needs and a care plan, which also contained assessment information. These contained detailed information about their personal, health and social care needs. They included comprehensive information, which exceeds this standard. Each person also had a pressure sore risk assessment, nutritional risk assessment, a handling assessment and a dependency profile. Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People’s personal, health care and diversity needs were being met. People were helped to take their medication in a safe manner. People were treated with respect and their right to privacy was upheld. EVIDENCE: The care plans of four people were read. Each person had a very detailed care plan which included support required with their health, personal and social care needs. The plans also contained information related to diversity issues including cultural needs, sexuality and dietary needs. The plans included the outcomes the people wished to achieve from their care. Three of the plans were signed by the person to show that they were involved in developing their plan and were in agreement with it. The fourth person was not physically able to sign their plan and it was not signed by a representative. The plans were
Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 13 reviewed once a month. The detailed information included in the plans exceeded that required by the National Minimum Standards. Ten people who completed comment cards said that they always received the care and support that they needed. Nutritional screening, manual handling, risk of falling, sight, hearing, oral care and health care needs all formed part of the care plans. Each person was registered with a GP. Visits from and to health professionals including the GP, district nurse, physiotherapist, optician and chiropodist were recorded. The people who completed comment cards said that they always received the medical support that they needed. There were opportunities for physical activity included in the activities programme. People who were able also went out for walks or walked in the garden. When people could manage their own care this was recorded in the care plan and supported by staff. People’s preferences for routines and activities were recorded. Four relatives who completed comment cards said that they were satisfied with the overall care provided. A GP stated in their comment card that the service always sought advice and acted upon it to manage and improve people’s individual health care needs. A district nurse said that they always referred people when appropriate to the district nursing service and they asked advice if they were unsure about a person’s needs. Both these healthcare professionals said that people’s health care needs were always met by the service. A monitored dosage system was used for most of the medication and there were suitable storage facilities. The practical arrangements looked well organised, with stock medication stored in individual containers in a large cupboard. Controlled drugs were stored correctly and there was a record of their use in a controlled drugs register. In the office there was a list of staff who had been assessed as competent to administer medication. These staff had received a certificate in administration of medication from Swindon College. The procedure for the administration of medication stated that two staff would administer on each occasion. Both staff signed the records of administration, which were seen to be up to date and complete. Medication was signed in and dated on the records of administration. The care manager also kept a checklist of medication that came in with the monthly order. At the last inspection it was recommended that this checklist should be signed, rather than ticked. This had been addressed and there was a place to sign at the bottom of the checklist of medication received. There were also records of medication returned to the pharmacy. Most people did not manage their own medication, other than one person to a small degree. This was identified on the medication records. A GP had signed a homely remedies list giving approval for administration to his patients in the
Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 14 home. The GP who completed a comment card said that the home always managed medication correctly. The district nurse said that they could not comment for everyone but the home took the diabetes of one person very seriously and managed it well. Each person had their own room. People had brought personal items into their rooms to make them individual and homely. Personal care took place in the privacy of people’s rooms. Respectful interactions between staff and people who lived in the home were observed during the inspection. Some people had their own private telephones. There was also a pay phone, which was located in a quiet area. At the last inspection it was recommended that staff members were reminded of the correct way of entering people’s rooms. Staff were observed to knock on people’s doors and wait for a reply before entering. The GP and district nurse who completed comment cards said that the home always respected people’s privacy and dignity. The nurse said that the home requested them to see people in their own rooms to ensure privacy. One person who was spoken to said that the carer always helped them to get up in the morning. They said that the carer helped them to dress and put on their make up and jewellery and always ensured that they were well turned out. Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People found that the lifestyle in the home suited their, needs, wishes and choices. They kept in contact with family and friends and went out into the community. People had opportunities to exercise choice and control over their lives. They had a choice of meals and they enjoyed their food. EVIDENCE: People’s preferred daily routines, hobbies and interests were recorded in their care plans. People were able to exercise choice in relation to activities, when they got up and went to bed and ate their meals. There was also a choice of religious observance and several ministers from different denominations visited the home. Each person had a social activity plan in their personal notes. These showed that people took part in a range of activities. Information about activities was posted on a board in the corridor outside the lounge in large print. There was an activities organiser who arranged activities in both the mornings and the afternoons. She also produced a monthly news letter which included
Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 16 news of the home and forthcoming events such as the annual fete and annual trip. Each person was given a copy in large print. The news letter also included information about entertainment and activities for the next month. Three people who were spoken to said that there was an annual trip. The following week people were going to Bristol Zoo and the previous year they had been to Weston super Mare. They also said that people tended to go out with relatives. One person said that they went for a walk if they wished. They said that there were planned activities. The activities programme showed that activities included bingo, word searches, hangman, bowls, knitting, nailcare, quizzes, board games, the library van, jigsaws, family tree work, reminiscence, singing and music on the piano. At weekends people watched a film on DVD. On the morning of the first day of inspection people were doing word searches in the lounge. People also said that they watched TV and read in their rooms. On the afternoon of the second day they were playing Hangman. The activities co-ordinator said that they took people to hospital appointments and they also took people to do their personal shopping. Care staff took small groups of people out, for example to the garden centre. Families also took people out. Special occasions were celebrated, for example, Christmas, Easter, Valentine’s day and birthdays. Eight people who completed comment cards said that there were always activities arranged by the home that they could take part in and two said that there usually were. One person said that there was a good mix of activities. There was information in the statement of purpose about maintaining contact with family and friends. Four relatives who completed comment cards said that they were welcome in the home at any time and they could visit their relative in private. During the inspection relatives and friends were seen visiting at different times throughout the day. People spoken with said that they could have visitors at any time. Information about people’s social contacts and family members was recorded in their individual plans to ensure that contact was maintained. Information about visits from relatives and trips out was recorded in people’s daily records. These showed that people were maintaining contact with relatives and were enjoying trips out into the community. People said that they enjoyed the activities. They also said that some people sat out in the garden when it was sunny and enjoyed cream teas. There was information about maintaining dignity, choice, privacy and independence in the statement of purpose. Examples of people’s choice of routines were seen in their care records. Those who were able could choose to go out. People chose where they sat and where they spent their time. Many chose to be in the lounge in company while others chose to be in their rooms. People had brought personal possessions and items of furniture into their rooms. They had lockable storage in their rooms for their valuables. People managed their own money with the help of relatives. One person, who was able, managed their own medication. Staff supported people to maintain their own personal care.
Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 17 People’s nutritional needs were recorded in their nutritional risk assessments. Additional needs for fluid and nutrition were recorded. There was a policy about nutrition and menu planning. This stated that the manager and care manager developed the menus to ensure that special dietary needs were met and food was available to meet nutritional needs. The policy sated that menus would take into account nutritional needs, care needs, personal preferences, seasonal availability, variety, appearance, presentation and flavour. There was information about daily nutritional requirements for people aged 65 to 74 and over 75. There was detailed information about serving meals, nutritional content, choice, health related and cultural diets and water requirements. Examination of the menus and observation of two meal times showed that this information was being taken into account when planning the menus. Some people had diabetic diets and vegetarians were catered for. Staff sometimes involved people in cooking and making cakes for the following day. There was always a choice of a cooked meal and a cold meal. Meals were served in the dining room and most people came to the dining room for lunch and tea. Some people had breakfast in their rooms. People said that they could have meals in their rooms if they chose. The dining tables were attractively set with co-ordinating table cloths and napkins and matching cutlery. People had a choice of vegetables served in dishes and people could help themselves. Lunch was a pleasant social occasion and was unhurried. There was a choice of meals posted on the board in the corridor each day. People who were spoken to at lunch said that there was always a three course meal for lunch and there was always a choice. People said that they enjoyed the food. Four people who completed comment cards said that they always liked the meals and six said that they usually did. One of these said that they were particularly grateful for the attention given to their low fat diet. Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. If people are unhappy with the care home, they or their relatives know how to complain. Any complaint is looked into and action taken to put things right where appropriate. People are sure the care home safeguards them from abuse and neglect. EVIDENCE: There was information in the statement of purpose about the complaints procedure. There was also a copy of the complaints procedure in the reception area of the home. The procedure stated that complaints would be responded to within twenty eight days. The manager reported that there had been no complaints since the last inspection. There was a complaints and comments form. There was a recommendation at the last inspection that the concerns and complaints form should be 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. The form had been amended to include these changes. There had been one comment from a relative. The comment form showed the issue that was raised, the action that was taken and the response. It also included the date that the outcome was discussed with the relative and the fact that they were satisfied with the outcome. Nine out of ten people who completed comment cards said that they knew how to make a complaint.
Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 19 Eight of these said that they always knew who to speak to if they were unhappy. Two people said they usually knew who to speak to and one of these people was the person who said that they did not know how to make a complaint. All the relatives who completed comment cards were aware of the complaints procedure. There was a policy about protection from abuse, which included information about reporting allegations to the Vulnerable Adults Unit. Staff received training about prevention of abuse and were given copies of a booklet about the Swindon and Wiltshire multi-agency safeguarding adults procedure. There had been no allegations of abuse. Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s rooms feel like their own and are comfortable. People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. EVIDENCE: The accommodation was arranged on two floors. All the bedrooms were single and seventeen had en-suite facilities. Several also had built in wardrobes. All the bedrooms had a pleasant outlook over the garden and surrounding fields. People had brought personal items and some items of furniture into their rooms to make them homely. People who were spoken to said that they liked their rooms. Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 21 There was a large lounge where many of the activities took place. There was also a separate dining room. Outside was a large garden where people said that they sat out in fine weather. The manager said that there was an ongoing programme of maintenance and there was a member of staff employed to take charge of maintenance. There was a plan to redecorate and refurbish the dining room and to redecorate one of the corridors. When rooms became vacant they were redecorated and furnished. There was a conservatory with seating so that people could entertain visitors. However part of the conservatory was screened off and hoists were stored in this space. At the last inspection a recommendation was made that alternative and appropriate arrangements should be made for the storage of hoists and wheelchairs. At the time of the inspection a room was being painted and a new floor had been laid. When it was ready the food storage area was to be moved into this room and the hoists would be stored in the previous food storage room. The fire officer last visited in 2003 and all their requirements had been met. The environmental health officer visited in January 2007. They said that the food safety arrangements were ‘generally found to be well run and managed’. They left some advice about recording and food management, which were being followed up. There were infection control guidelines and a waste management policy. There were domestic staff who did the cleaning. All ten people who completed comment cards said that the home was always fresh and clean. One person commented that sometimes the toilet near the lounge smells but if staff spot it they clean it up. The laundry had relocated into a building in the grounds. This was a large laundry shared with another home run by the charity. There was one full time laundry person and one who worked part time. There was access from the home to the laundry through doors in the corridors so that soiled washing was not taken through the lounge of dining room. There was a separate sluice room downstairs. Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People have safe and appropriate support from competent, qualified staff. They can have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are well supported by staff who have the relevant training. EVIDENCE: The staff showed that there were five or six care staff on duty in the morning and four in the afternoons and evenings with three night care staff. On weekdays there were also an activities organiser, cleaners, a maintenance person and a cook. There were also the manager, care manager and training assistant. Two relatives who completed comment cards said that there were always enough staff on duty. Two said that there were not and one of these said that more staff were needed at the weekends. None of the people who used the service expressed this view. Six out of ten people who completed comment cards said that staff were always there when they needed them. One of these commented that there was sometimes a brief delay if another person was having a problem. Four people said that staff were usually there Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 23 when they needed them. The people who were spoken to said that there were always enough staff on duty. There was a training assistant who was responsible for training. The training assistant had received training to be a trainer at Swindon College. They had produced a training matrix, which identified the training that staff were expected to have for their job role. This was to ensure that each member of staff had the right training. The training assistant said that the organisation had a very thorough approach to training and was very supportive of training. Training needs were identified in supervision and appraisal. Each member of staff had a training plan. All staff, including the domestics had an induction based on the Skills for Care induction standards including health and safety, infection control and abuse awareness. There was in-house training. Staff also attended training courses at Swindon College including infection control, care skills, medication, MRSA, dealing with the elderly and nutrition. There were very detailed records of training for each member of staff. These contained information about the training that they received that was specific to their role and health and safety and fire safety training. More than half the staff had achieved a National Vocational Qualification at level 2. The two cooks had received training about nutrition in a care setting and food hygiene. There was a recruitment procedure. There had been two new recruits since the last inspection. Examination of their recruitment records showed that the procedure was being followed. Both members of staff had completed an application form. This contained a declaration that the applicant was physically and mentally fit and had no convictions. Two written references and a Protection of Vulnerable Adults (POVA) First check were received for each member of staff. Criminal Records Bureau (CRB) checks had been applied. Both members of staff had started work before the CRB checks had been received and were being supervised at all times which is permitted by the amended Care Homes Regulations. There was a note in the office to say that two new members of staff had started work following POVA First checks and must be supervised at all times. Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People have confidence in the care home because it is led and managed in their best interests by people who know how to provide high quality support. People or their family manage their money, small sums of money are managed by the care home in their best interests. People have good quality support because the workers are supervised and well supported by their managers. The environment is safe for them and staff because the managers and workers carry out good health and safety practices. Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 25 EVIDENCE: Mrs M. McCulloch, the registered manager, has over twenty years’ experience of managing the home. Mrs McCulloch is working towards the registered managers award and is looking at some new areas of training that will be relevant to her role. She also has a National Vocational Qualification (NVQ) level four in care and a NVQ level five in management. Other people have specific responsibilities for different areas of the home. The care manager takes the lead in care planning and medication. The training assistant takes the lead on training and the activities organiser takes the lead on activities. Between them these senior staff ensured that any areas for improvement were identified and addressed. Inspection requirements were dealt with promptly. 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. At the last inspection it was recommended that a policy on quality assurance should be produced. A policy about quality assurance had been developed. A requirement was made that a quality assurance action plan must be produced. This had been addressed. A quality assurance questionnaire had been sent to all people who used the service in July 2006. Responses from the questionnaires had been analysed and a report of the findings had been produced. This identified areas for development and the action to be taken to address these issues. A further recommendation was made that the arrangements made for quality assurance are reviewed, with a view to establishing a more comprehensive system. This had been addressed through the sending out of the questionnaires, the analysis of the responses and the identifying of the action which needed to be taken. An audit of different service areas had also been done is February 2007. This identified areas for improvement and action for improvement. The manager intended to send out a customer satisfaction questionnaire again in July 2007, to analyse the findings and produce an improvement plan. The home did not generally manage money for people. People managed their own finances with the help of relatives or representatives. However, small amount of money were kept for people for hairdressing and small items. Each person had a folder in the safe for this money. Records were kept, with receipts, and the records were audited. The training assistant was responsible for the supervision of staff. They had a system of booked supervision sessions for each member of staff to ensure they had supervision about every two months. Records of supervision were kept. These showed that practice issues and training needs were discussed. The manager conducted annual appraisals with staff. Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 26 There was a policy about health and safety. There were infection control guidelines and information about Control of Substances Hazardous to Health (COSHH). Staff received training about health and safety, manual handling and infection control. Each person had an individual health and safety risk assessment for their room. Control measures were identified. These included the safety of the flooring, furniture, windows, fire hazards, fore prevention measures, electrical appliances and portable appliance testing. Each person had a wash hand basin in their room or en-suite but no risks or control measures were identified for hot water. The manager said that the temperature of the hot water was regulated on the tank to prevent the risk of scalding. Each person also had a risk assessment in relation to going out, hot drinks, falling, bathing and choking. The manager said that staff test the temperature of the bath water before people bathe. There were certificates to show that equipment, the boiler, the lift and nurse call system were serviced. The hot water was tested for legionnaires’ disease. The electrical installation was tested in March 2006. Portable appliances had been tested the previous year and these were due again. Health and safety risks were identified. The managers and some staff attended a risk assessment meeting about every six months to discuss issues of risk. Problems were identified as either a health and safety or a fire risk. A record was made of each issue, the action taken to put it right and the outcome. There was a fire risk assessment. A requirement was made at the last inspection that the fire risk assessment must be amended to include all appropriate details. This had been updated in May 2007 to include an assessment of fire risk in all areas of the home and the precautions to reduce risks. A record sheet showed that this was to be reviewed annually. Records were kept in the fire log book of the checks of the fire safety measures. Fire instruction to staff was up to date. Most of the checks were taking place at the required intervals except a monthly check of the emergency lighting had been missed in April 2007 and a monthly check of the fire fighting equipment had been missed in December 2006. Recent checks had occurred on time. Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 27 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 4 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 3 x 3 3 X 3 Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 28 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. Standard Regulation Requirement Timescale for action 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 When a person is not able to sign their care plan it would be good practice for a relative or representative to sign on their behalf to ensure that their views are reflected in the plan. Alternative and appropriate arrangements should be made for the storage of hoists and wheelchairs. The individual room risk assessments should include the risks posed by access to hot water and control measures to reduce these risks. 2. 3. OP19 OP38 Claremont DS0000028418.V336163.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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