CARE HOMES FOR OLDER PEOPLE
Claremont House Lovent Drive Leighton Buzzard Bedfordshire LU7 8LR Lead Inspector
Linda Lilley Unannounced Inspection 3rd November 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 Claremont House DS0000014889.V256528.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. Claremont House DS0000014889.V256528.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Claremont House Address Lovent Drive Leighton Buzzard Bedfordshire LU7 8LR 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) 01525 852628 01525 217242 Mr Derek Abreu Mr Derek Abreu Care Home 13 Category(ies) of Dementia - over 65 years of age (13), Old age, registration, with number not falling within any other category (13), of places Physical disability over 65 years of age (13) Claremont House DS0000014889.V256528.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22/03/2005 Brief Description of the Service: Claremont residential home is a detached property, which is situated in a pleasant residential area close to Leighton Buzzard town centre. The home provides care for 13 older people over the age of 65 years. The resident’s bedrooms were personalised to meet individual tastes and all bedrooms had en- suite facilities. The home had adequate parking facilities to the front of the building. Claremont House DS0000014889.V256528.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The planning for this inspection took place over a two hour period and the inspection took place over 5 hours in the early morning / afternoon of November 3rd 2005. A partial tour of the home took place and staff, residents and visitors were spoken to. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting three residents and tracking the care they receive through review of their records, discussion with them, the care staff and observation of care practices. This inspection report additionally addresses specific areas where requirements and/or recommendations were identified at the previous inspection in March 2005. What the service does well: What has improved since the last inspection?
A clear policy and procedure for the use, storage and disposal of disposable gloves has been provided for staff. Disposable gloves are now kept within locked cupboards. Claremont House DS0000014889.V256528.R01.S.doc Version 5.0 Page 6 Staff training records seen included a training grid that indicated who had had specific training and when this had been completed. The assessment tools and care plans are specific in terms of the relationship between assessment and care planning with clear instructions for care staff to follow. The Manager now provides regular recorded managerial supervision for the Deputy Manager to support her development into her role. Recent review of staffing included changing the rota to enable two waking night staff, to meet the resident’s needs. 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. Claremont House DS0000014889.V256528.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 Claremont House DS0000014889.V256528.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1.3.4.5. Residents and their families who use the service receive information to enable them to make a choice about whether or not they might want to live in the home. Residents undergo a full assessment of their needs prior to entering the home and are able to visit to assess the quality and suitability of the home. EVIDENCE: The homes Statement of Purpose and Service Users guide provides details of the services the home provides. Individual records are kept for each resident and sets of records examined included a full assessment of the residents needs. Residents spoken to were able to describe the trail period they undertook prior to choosing the home, and staff spoken to indicated they found the process of trail visit very helpful in assessing whether the home was the most suitable place for the resident. Examples were given of residents being able to undergo a more complete assessment in the home environment, over the period of a full day, enabling appropriate choices to be made.
Claremont House DS0000014889.V256528.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7.8.9.10.11. The resident’s needs are set out in an individual plan and the personal, social and health needs of the residents are generally well met. There are some minor record keeping errors in relation to dates and labelling of records within the residents plan of care. The medication at his home is generally well managed, however there are minor shortfalls in the storage of medication. Residents are treated respect, and their privacy upheld. The system for ensuring residents wishes regarding their wishes concerning terminal care and arrangements after death is not robust. EVIDENCE: The assessment tools and care plans are specific in terms of the relationship between assessment and care planning with clear instructions for care staff to follow. The care plans and evaluations seen showed that health professionals are accessed and resident’s health care needs are being met. There is a need to ensure some cross reference in the residents care plan to any health care professionals separate plan of care and care should be taken to record the full date, and residents name on all records. The files seen also had various risk assessments for residents completed.
Claremont House DS0000014889.V256528.R01.S.doc Version 5.0 Page 10 The medicine trolley has recently been moved from the lounge, where it was fixed to the wall, to the main hall. This was as a result of staff concerns regarding the number of interruption and distractions the staff received during the process of medicine administration. The trolley now requires to be fixed to the wall in the new position. Within the home there are two oxygen cylinders, one in a residents room and a spare cylinder in the resource cupboard. A risk assessment is required regarding the storage of these cylinders and appropriate action taken to prevent the cylinders being accidentally knocked over. Residents spoken to said they were treated with respect, and their wishes taken into account regarding activities, meals, and furnishings in their rooms. The home does have a record of some residents last wishes, recorded on a kardex record card. This information needs to be incorporated into the assessment documentation and kept with the plan of care. Claremont House DS0000014889.V256528.R01.S.doc Version 5.0 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): 12.13.15. Resident’s daily life and social needs are well catered for, promoting a wide variety of daily activities for people living in the home. The residents maintain contact with family and friends. Residents receive a well-balanced and very well presented range of meals. EVIDENCE: The home had made many efforts to ensure the residents have the opportunity to engage in a variety of activities. A weekly activities programme is displayed in the home, which included forthcoming events. This is displayed in the hall in a pictorial and written format. The residents also have a personal diary where events were recorded. Residents spoke about a personal trainer visiting the home, who helped them with gentle exercises. One resident said she can now does up the zip in her own dress since undertaking these exercises. Residents were engaged with staff in reading and discussing the news, asking about the Christmas planning, and talking to visitors. Residents talked about being given choices and not being made to join in, which was important to them. Some care plans indicated, “offer all activities but respect her wishes” and “has had a lay in today with breakfast in bed”. The home also has a formal activity evaluation for residents to highlight their likes or dislikes.
Claremont House DS0000014889.V256528.R01.S.doc Version 5.0 Page 12 Residents are also given the choice to eat in their rooms or sit in the dining room. There area range of menu choices available and residents said the meals were delicious. Visitors spoken to said they are always offered the opportunity to eat with the resident or have a cup of tea. Claremont House DS0000014889.V256528.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16.18. Residents are aware of the complaints procedure and are confident their issues will be listened to, however the homes complaints policy is not as clear as the information provided to residents and families. The Deputy Manager has a good knowledge of the Adult Protection issues, there is a policy in place and staff have undergone specific training, which raises awareness and protects the residents from abuse. EVIDENCE: The home has a complaints procedure displayed in a frame in the hallway. This clearly indicates the complaints procedure including time frames for response, and the Commission for Social care Inspection contact details and residents spoken to were aware of the process if they wished to make a complaint. The complaint policy for the home however does not mirror this information, it is not specific for the home has no information regarding time frames, process or specific contacts and is not dated or signed. Staff records seen indicated staff have completed training to improve her knowledge of the issues of Adult abuse and there is a policy for the Protection of Vulnerable Adults available in the home. Claremont House DS0000014889.V256528.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19.24.25.26 The standard of décor within the home is good and provides the residents with an attractive and homely place to live. The overall quality of the furnishings in the resident’s bedrooms assures comfort and privacy and the home is a clean and pleasant place to be. EVIDENCE: The lounge and dinning room areas are bright and cheerful and allow for ease of movement for all residents. Recent changes to the stair lift and the door at the top of the stairs has resulted in easier transfer from sitting to standing for residents at the top of the stairs. The residents rooms visited contained appropriate furnishings to meet their needs and many personal items. Residents have a locked cupboard for keeping any items they wish to remain private, have their own keys unless the risk assessment indicates otherwise, and all rooms have en-suite facilities. The home had a policy on infection control and a new policy for the use, storage and disposal of disposable gloves. Staff spoken to could outline the correct procedures for use. The disposable gloves are kept in locked cupboard. Claremont House DS0000014889.V256528.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27.28.30. Staff is available in appropriate numbers and with appropriate skills. They work positively with the residents and their families to sustain and improve the quality of the resident’s life. EVIDENCE: Staffing rotas seen indicated the number of staff and skill mix to be good. Recent improvements to staffing included the allocation of two waking night Staff, instead of one waking one sleep in, to me the residents needs. Staff spoken to said they are impressed with the level of support and supervision they receive and are encouraged to undertake training. 80 of the care staff have obtained their NVQ level 2 in care and in addition to this some staff had commenced their NVQ level 3. Training has also been provided in relation to “Dementia care” and “The Protection of vulnerable Adults”. Staff training records seen included a training grid that indicated who had had specific training and when this had been completed. Claremont House DS0000014889.V256528.R01.S.doc Version 5.0 Page 16 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): 31.32.33.36.38. The Manager and Deputy Manager provides effective leadership within the home that promotes good standards of care and support for staff. Clear indication is provided regarding the standards expected and there is an open and positive atmosphere in the home. This results in effective communication and consistent standards of care. There is an excellent supervision system in place for all staff including the Deputy Manager, which enables the staff to develop effectively in their roles. There are systems in place to protect the health and safety of the residents and staff. There are a variety of systems in place to ensure the residents, visitors and staff have an opportunity to give their views on the running of the home. Claremont House DS0000014889.V256528.R01.S.doc Version 5.0 Page 17 EVIDENCE: The Deputy Manager has completed her NVQ level 4 in care management and Registered Managers Award as well as an assessor’s qualifications and trainer’s qualifications for a variety of training aspects within the home. Staff spoken to say they were clear about the aims of the home, the standards to be achieved and felt they had good support from the Deputy Manager and could approach her at any time. Evidence of staff supervision was seen including managerial supervision for the Deputy Manager. The documentation used provided clear structures, for example, contracts, records of supervision and action plans, to ensure the process was effective. Health and safety policies and procedures are available in the home and the use, storage and disposal of disposable gloves has been addressed since the last inspection. (There is a need to review the storage of oxygen cylinders, see standard 9). A clear policy and procedure has been provided for staff, and staff spoken to were able to highlight the main procedures within the policy. Disposable gloves are now kept within locked cupboards. The home had developed several quality assurance systems, and the results of surveys are evaluated and displayed in the resident’s guide. The home also had a comments book in the main hall, for any comments residents or relatives wanted to make. The residents and staff said they had said they had regular meetings. Claremont House DS0000014889.V256528.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 4 X 3 Claremont House DS0000014889.V256528.R01.S.doc Version 5.0 Page 19 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 OP9 Regulation 13.2 Requirement The Registered Manager must ensure a risk assessment and action plan is carried out regarding the storage of oxygen cylinders in a resident room and any spare cylinders kept in the home. This is to ensure this medicine is stored correctly and cannot be accidentally knocked over which could result in an explosion. The Registered Manager must ensure the system for discussing and recording resident’s feelings regarding their wishes concerning dealing with any increasing infirmity, terminal illness and arrangements after death is robust. Timescale for action 10/11/05 2 OP11 14.2 30/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Claremont House DS0000014889.V256528.R01.S.doc Version 5.0 Page 20 No. 1 Refer to Standard OP16 Good Practice Recommendations The complaint policy for the home needs revising to include name of home, date produced, stages of the complaints process, guidance for staff, and CSCI name and contact details, to ensure it can be used effectively by the staff. The medicine trolley now requires to be fixed to the wall in the new positioning in the main hall to ensure the safety of the drugs within. There is a need to ensure some cross reference in the residents care plan to any health care professionals separate plan of care and care should be taken to record the full date, and residents name on all records. This will ensure continuity of care. There is a need to ensure there is a system in place that enables the policies for the home to be reviewed regularly, identified as belonging to the home, dated and signed. 2 OP9 3 OP8 4 OP37 Claremont House DS0000014889.V256528.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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