Inspection on 10/05/08 for Claremont Nursing Home

This inspection was carried out on 10th May 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

Claremont Nursing Home 12/01/10

Claremont Nursing Home 06/05/09

Claremont Nursing Home 22/01/08

Claremont Nursing Home 24/01/07

Claremont Nursing Home 28/02/06

Claremont Nursing Home 14/09/05

Claremont Nursing Home 16/12/04

Claremont Nursing Home 23/06/04

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Claremont Nursing Home New Street Farsley Leeds Yorkshire LS28 8ED Lead Inspector Valerie Francis Key Unannounced Inspection 10th May 2008 09:30 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 Nursing Home DS0000045220.V364661.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 Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Claremont Nursing Home Address New Street Farsley Leeds Yorkshire LS28 8ED 0113 2360200 0113 2360472 clmont@aol.com 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) Park Homes (UK) Ltd Mrs Carol Prior Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39), Physical disability (2), Terminally ill (1), of places Terminally ill over 65 years of age (1) Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. PD places are for specified service users only TI(E) place is specifically for named service user Date of last inspection 22nd January 2008 Brief Description of the Service: Claremont is a converted, extended, detached property, situated near the centre of the village of Farsley. The home is close to local bus routes and within easy access of a mainline railway station and the main roads to Leeds and Bradford. The home was first registered in September 1991. Park Homes UK Limited owns it. Accommodation is offered in a combination of twenty-one single and eight double rooms; all bedrooms have en-suite facilities. People have a choice of two lounges, and there is a spacious dining room. Gardens are available consisting of lawns and an attractive enclosed garden to the rear, with level access from one of the lounges. Car parking is provided to the front of the property. At the time of this inspection the building work had completed and registration was made to increase the beds available at the home from 39 to 60. Weekly charges are from £518:88 to £559:58. This information was provided during the site visit. Extra charges are made for hairdressing, and chiropody. Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is *1 star. This means the people who use this service experience adequate quality outcomes. As part of this inspection we looked at all the information we have received about the home since the last key inspection. Two inspectors also made an unannounced visit to the home between 9.30am and 5.45pm. The Manager, Operational Director and the Training and Care Standard Manager came to the home to facilitate in the inspection process. We have received five complaints about the staffing levels and the standard of care people were getting, which prompted us to bring our inspection date forward. Therefore the purpose of this inspection was to ensure that the home was providing people with good care and support they need with enough staff to do this. The home was sent an Annual Quality Assurance Assessment (AQAA) selfassessment form to complete a week before the inspection. This gave the home and the organisation an opportunity to put forward their views on how they provide their service to people using it or wanting to use it. This form was not returned to us until after the inspection. Because people with dementia are not always able to tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand their experience of the home. We call this, the Short Observational Framework for Inspection (SOFI). This involved us observing four people for 2 hours and recording their experiences at regular intervals. This included their state of well being, and how they interacted with staff members, other people who use services, and the environment. We also spoke to the manager, staff members, visitors and people who live in the home. The other methods we used included looking at care records and observing working practices. We did not send questionnaires out to the home for people who use the service, relatives and staff or to professionals involved in the home. On the day of the inspection we were able to speak to people, relatives, visitors and staff. We have put comments people made in the body of this report. Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 6 We gave detailed feedback of our findings to the Manager, Operational Director and the Training and Care Standard Manager. Requirements and recommendations made during this visit can be found at the end of the report. We have told the provider that staffing level must improve so that people have enough staff available to them so that they can get a good standard of care. Since the inspection the home has sent us information of the increase of staffing levels for the current number of people living at the home. This is positive. However, this increase must be maintained so we can be sure people’s needs will be met at all times. What the service does well: What has improved since the last inspection? Written consent is now in place for the home to look after and administer people’s medication, to make sure people have a choice and they are involved in their care. Since the last inspection a new nurse call system has been installed, giving people easy access to a call bell wherever they sit. All senior staff have had Adult Protection Training (safeguarding) and are now aware of the process to follow when an allegation of abuse is made. The clutter in the upstairs bathroom and laundry has been cleared to remove the potential fire hazard. We were told that people who are diabetics have now got the opportunity to enjoy a full range of puddings available. Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 7 The training manager told us that staff would receive three days induction that includes Skills for Care Common Induction Programme. And training such as caring for people with dementia, infection control, safe moving and handling and safeguarding adults from abuse, to ensure they are competent to care for people living at Claremont. 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 Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 8 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 Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 9 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, 3 & 4. Standard 6 does not apply to this service. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People receive the information they need to be able to make a decision about moving into the home. Anyone wanting to use the service has their needs assessed before they are admitted. EVIDENCE: At the time of the inspection the home was updating the Statement of Purpose and Service User Guide, so that it reflected the additional 39 beds that are being registered with us. We were told that people who wanted to use the service and their representatives are encouraged to visit the home. During the visit they would Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 10 be given a copy of the home’s brochure, which contains information about the home and the service provided. All new people have a comprehensive assessment before they move in, to make sure their needs can be met. The information is also used to put together a care plan. We were told that care plans are done with people and or their relatives. Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 11 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. People who use the service experience Adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Although there is good written information about people, and staff are knowledgeable about them and their care, people do not get the care they need. People are not protected by the medication practices. EVIDENCE: We looked at three people’s care plans. We found that generally the information was good and staff had action plans to follow to meet people’s care needs. However, additional information is needed, so that staff have an overview of the person in their care. For example there was no information about people’s likes and dislikes, or people’s last wishes for their end of life care. Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 12 One relative said they had only just been asked to sign their relative’s care plan, although the plan had been written a long time ago. This person also said the plan was difficult to read because the language used was not easy to understand. There was information in care files that clearly indicates that health care professionals are involved in people’s care. We were told that the home works closely with the Community Matron to help to meet people’s needs. We saw information on assessment for pressure area care, moving and handling and nutritional assessments, and risk assessments relating to people’s care. In most cases all identified risks had a plan of action to show how the risk would be minimised or managed. We visited the home on a Saturday and were able to talk to a lot of visitors, many of whom visit the home very regularly. Many relatives said they were not satisfied with the standard of care and support their relative was receiving. They said, “Staff are not always around to assist people to the toilet or with their meals.” One relative, whose mother is nursed in bed, said her mother is well looked after and kept clean and fresh and the bedding is always clean. One person, whose food and fluid intake is monitored and who’s position must be altered regularly to relieve pressure and keep her skin intact, was left in the same position for three hours. Up until 12.30 pm her position had been changed every two hours, but by 3.30pm no further alterations had been made. Some relatives told us that when they are short of staff or time, staff will sometimes transfer people using the hoist on their own. During the inspection we saw staff using the hoist and the ‘stand-aid’ to assist people to transfer. There were always two people and they used the correct techniques and reassured and guided people very well. The staff also used the lap belt when people were moving round the home in a wheelchair, to make sure they are safe. The staff demonstrated very good moving and handling practice. Staff’s approach to people was calm and kind and they maintained people’s dignity and privacy when assisting them. The door to the medication room was not locked; the nurse in charge said it was left open to allow the domestic assistant access to clean the room. In the room were the whole of the next month’s supply of medicines, none of them put away in locked cupboards or secured in any way. The medicines refrigerator was not locked and other cupboards were also unlocked, although the controlled drugs cupboard and the night medicine trolley were locked. Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 13 No controlled drugs were being used at the time of our visit, but there is a controlled drugs register available. The medicines refrigerator was being used for storing antibiotics and nutritional supplement drinks. The temperatures were checked and recorded daily, to make sure these medicines are being stored at the correct temperature. We looked at the medicines records and checked quantities remaining against amounts received and left in stock. One medication, to be administered once a week, showed that four tablets had been received on 29/04/08 and there were three left in the pack. There was no signature on the Medicines Administration Record (MAR) chart to show that the missing tablet had been administered, nor were there any notes to say on what day of the week this medicine should have been administered. Another medication had instructions to administer two doses twice a day, but the handwritten notes on the MAR chart said to administer one dose three times a day. We were told that this person’s relative said the GP had told them to alter the dose, before they were admitted to the home. Care homes cannot accept verbal alterations to the prescribing instructions. They must obtain correctly labelled medicine and only administer it as directed on the packaging. Conflicting information must always be followed up with the person’s doctor. In addition, this medicine was not properly recorded on the MAR chart when it was received. There was no date of admission to the home and the chart showed that 28 doses had been received and the first dose offered on 7/05/08. However, after nine doses had been administered there were only sixteen left in the packet, leaving three doses unaccounted for. One medicine had the instructions ‘Use as directed’. This is unhelpful and the home must ask doctors to write specific instructions on their prescriptions, in order to avoid any confusion. Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 14 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. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are supported in maintaining contact with their family and friends and visitors are welcomed at the home. People did not have enough to occupy them through the day and they were bored. EVIDENCE: The assessment process did not cover people’s social care needs. If staff do not have enough information about people and how they like to spend their time there is the potential for people’s social care needs to be missed. There was no information about people’s life history therefore staff have little knowledge about the individual’s past life. The home told us that they have relatives meetings and that activity takes place in the home. But feel that they could do better by further developing Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 15 their activities programme and activity records. However, we saw no evidence of any planned activities, which would give people the opportunity to choose what they would like to join in with. There is an activities co-ordinator employed at the home. Relatives said she is very good, but is often called away to help with care or administration duties. The home has also employed an outside agency to assist with activities. The care staff have little time to do anything other than the necessary tasks. We saw that they have no time to sit and talk with people or offer any activities. During a period of one hour and fifteen minutes spent sitting in the lounge observing five people and the staff interaction with them, almost the only attention people received was connected with giving out tea and biscuits. When someone called them a member of staff would attend, but the time spent with them was very brief. During this period one person received no attention at all, until the last five minutes when some nursing assistance was given. When we arrived at the home at 9:30 am, we saw people sitting in the dining room having breakfast, many needed assistance with their food but there was no staff around to assist them. One person was sleeping the cereal and a cup of tea which she had been given was cold, it was apparent that she needed assistant with her meal. Some people had tried to help themselves and most of the food was on the “bibs”. There was clear evidence that most people needed assistance but staff were busy getting people up and attending to their personal care. We were later told that a member of staff had been designated to the dining room to assist people but had not turned up to work in time. However, it was obvious to us that one member of staff was not enough to assist all the people who needed help. During lunchtime we spoke to relatives, one relative was assisting his father with his lunch. Staff were seen at this time assisting people individually giving them the time they needed to eat their meal. People told us the meals are very good, and on the day we visited the food looked and tasted very nice. The portions were plentiful and everyone seemed to enjoy their lunch. The choice was minced beef, Yorkshire pudding and vegetables or omelette and salad with rice pudding or sponge and custard for dessert. The food was served hot and the Yorkshire puddings were well risen and crispy. Special dietary needs are catered for, where needed. Jugs of juice were available and everyone had a glass of juice with their lunch, followed by a cup of tea. Staff offered calm and discreet assistance to people who needed help to eat and several people had other forms of assistance, such as a plate guard, to help them maintain their independence. The tables were Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 16 laid with ironed cloths, napkins, flower arrangements and cruet. People who stay in their own rooms had meals taken to them on a tray. One person said they did not know what was for lunch and said nobody had asked them what they wanted. Before the meal started everybody had a large clean ‘bib’ put on them. It was not clear whether everyone needed this, or if it was just part of the pre-meal routine. We were told that the organisation had put together menus, which had food, which reflected different cultural needs. These menus had been sent to all their homes, which mean that they were all cooking the same meal on the same day. People can also have another choice if the food served was not to their liking. Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 17 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. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People living at the home are protected from abuse with the majority of staff aware of adult protection procedures. People feel safe at the home. There is a complaints procedure, but overall concerns are not always taken seriously. EVIDENCE: The home told us that they have a clear accessible complaints procedure, however, this was not displayed in the home at the time of the visit. Since the last key inspection in January 2008 we have receive five complaints about the staffing levels and the standard of care in the home. These were sent back to the provider to investigate and respond to the complainants, with copies of the investigating report sent to us. It was clear that the home was working within the timescale of their complaint procedure and responded to complainants with the outcomes. We were also told that complaints are monitored and audited during the monthly visits by the operational manager. We were told by people’s relatives that they knew how and who to complain to. But they said that they felt that their complaint is not always taken seriously and no changes were made following their complaint. Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 18 Staff also said if they had a complaint they could speak to the manager or one of the Company’s management team. All new staff have a POVA First (Protection of Vulnerable Adults) and an enhanced CRB (Criminal Records Bureau) check carried out before they are employed. We were told that most staff have had training on the protection of vulnerable adults. But the plan for the next twelve months is to deliver this training to all new staff before they start working with people. We saw a good adult protection (safeguarding) procedure in place; this includes information on the different types of abuse people may suffer. There is a “whistle blowing” policy so that staff are clear of the procedure when alerting about a situation, which may involve another member of staff. Staff told us that people’s safety is important and if an issue of abuse was brought to their attention they knew how to report it regardless of which staff were involved. Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 19 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 & 26. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People live do not always have a safe environment, however the home is making improvements to make sure that it continues to provide a safe, pleasant, and suitably equipped place for people to live. Good levels of specialist equipment ensure that people’s independence is maintained. EVIDENCE: The home was generally clean and fresh, although we were told that while the building work has been underway there was a high level of dust and dirt in the home. Ceilings and light fittings have recently been replaced, which caused a lot of dust and mess. Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 20 A building extension to increase the number of places available had almost completed. The provider has applied to register the new area, before moving people in. The internal building work is mostly completed now, but there was still scaffolding outside. We were told that the home has improved in the last twelve months by developing an extension to create a hotel style facility, and to refurbish and redecorate the communal areas and bedrooms in the original building. Some of the carpets in the hallways are to be replaced. Some of them were in a poor condition; thin and ‘rucked’ causing a potential trip hazard. Parts of the home need to be re-decorated and the floor coverings in the upstairs bathrooms were stained and in a poor and unattractive condition. Through the home there were some nice decorative touches such as nautical ornaments in the otherwise stark bathrooms and some attractive pictures in the new extension. Two of the assisted baths were broken and one had been repaired with duct tape. The pan in a wheeled commode/shower chair needed cleaning and one of the level access shower rooms needed cleaning. The other shower room was being used as a storeroom. The fire grate in the small lounge needs cleaning. During lunch we saw one of the ancillary staff ask someone for the key to their room, so they could go in and clean it. This is good practice, showing respect for people’s privacy. The laundry room is well equipped, but there is nowhere to hang people’s clean clothes. All clothing is folded and put in individual boxes, ready to go to people’s bedrooms. There were some pillows in one of the linen cupboards that were lumpy and unfit for use. The wheelchairs were not as clean as they should be and the sit-on weighing scales were dirty. Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 21 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. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There are not enough staff to make sure that people’s needs are met effectively and consistently. EVIDENCE: Because of the high number of complaints received with regards to staffing levels in the home, we had requested that the home send us their weekly duty rotas and the dependency levels of the people living there. From the evidence seen at the time of the inspection, it was apparent that the amount of staff available to the 24 people using the service at the time was not enough to meet their needs. The rotas showed that four health care assistants and one nurse are available to people from 8:00 am to 9:00 pm. One team leader starts work at 7:00 am to 3:00 pm and at night there is one nurse and two health care assistants. Staff told us that the home do not use agency staff, this was confirmed by the Operational Director, because it was felt that they did not know people and how to deliver their care. We were told that vacancies are covered by the home staff working overtime or by staff from other homes in the organisation. Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 22 We were told that it is the plan of the organisation to create a staff bank who can be used to cover any vacancy, sick leave and holidays. The manager had recently carried out interviews for new staff and most of these would be used for the staff bank. The relatives we spoke to, all said they felt there are never enough staff on duty to properly meet the needs of the people who live at the home, most of whom have a high level of dependency. Relatives said the staff are very good and do their best, but there are not enough of them. Most of the people who live at the home need two staff to assist them to move around the home and to help with their personal care. There were only four care assistants and one nurse on duty for 24 people. This means that when someone needs help there are not always sufficient staff available. We saw an example of this, when a relative asked a member of staff to assist her relative to the toilet. There were no other staff around and the staff member continued giving out drinks, instead of finding someone else to help. The manager told us that the day before the inspection she had carried out interviews for new staff, for when the registered places are approved, and any extra staff would be used to form the Staff bank. We were also told that there were plans in place to change the shift time to accommodate the needs of the people who live at the home. There is a good recruitment and selection procedure at the home. We saw three staff recruitment files, in most case all the required checks had been carried out and there was a good audit trail of the recruitment process. However, one member of staff did not have any written evidence to show that a POVA first check had been carried out, to indicate that they were safe to work with people. We were told that new staff would do the basic induction training, plus a period of shadowing an experienced member of staff, before they start working directly with people. The organisation’s Training and Care Standard manager is based at the home. We were told that there is a new arrangement for all new staff to attend three days induction training that includes the Skills for Care Common Induction Programme. This covers training such as moving and handing, basic food hygiene and infection control. Although there was no written training plan in place for all the training over the next twelve months, there were notices displayed in the staff room informing staff of some pending training courses. There were dates for the distant Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 23 learning dementia course, for those staff who had not previously done the course. Claremont Nursing Home DS0000045220.V364661.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 & 38 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is not run in the best interests of people living there, because of the constant change in manager. There is room for improvement especially around systems of communication between the organisation and management of the home, people and relatives. EVIDENCE: We were told that what the home does well is that people and their relatives are encouraged to approach managerial staff whenever they wish. They also told us that the home has a friendly and open atmosphere which is conducive to people and their visitors expressing their views. Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 25 We were told by relatives that one of their concerns that there have been three different managers in the home in the last twelve months. They felt that there was no real leadership in the day to day running of the home. This, they felt, put their relatives at risk as the home is not being run in their best interest. Since the last inspection the organisation has recruited and appointed a new manager who at the time of the inspection had been at the home for four weeks. This person is a registered nurse and has years of experience working with people who have nursing and other specialised care needs and the management of staff. She had been a registered manager and holds a higher education qualification in Health and Social Care Management. We have been told that enquires have been made for the manager to be registered with us. The manager told us that her management style is to have an open door policy that is accessible to people, relatives and staff. There is a policy in place for the handling of people’s finances. We were not able to inspect these records, because we were told, that the home’s administrator handles this. The manager said she did not have access in this person’s absence. We were told that three quality audit questionnaires about the service provided by the home are sent monthly to people, their relatives and professionals involved in the home. Completed ones are returned to the head office and feedback sent to the home, but we saw no evidence that feedback is given to people and others involved in the process. Although we were told that ongoing health and safety checks were made during the building work and the builders had risk managements in place, none was put in place by the home to make sure people were safe at all times during the build. We saw organisational general risk assessments documentations, but there was none particular to the home. The windows in the small lounge are sash windows that open upwards from the bottom. As they are at floor level, and at least one of them has no restrictor, this is a potential hazard as someone could climb out and fall into the rose bed below. The boiler room was not locked and was being used to store paint and other related materials. This is a fire hazard. The room was cleared during our visit. The kitchen has recently had a visit from an Environmental Health Inspector and was awarded four stars (five being the highest) for hygiene and cleanliness. However, there is a very large extractor fan, which seems to be in Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 26 need of servicing and cleaning as it was very dirty and did not appear to be working efficiently. At this and the last key inspection it was noted that the kitchen flooring was damaged and is a health and safety hazard to staff who walk on it. We were told that this would be resolved in the refurbishment plan. The records of hot food, refrigerator and deep freezer temperatures were not being maintained. The cook on duty, who usually cooks only at weekends, said she had never been told she should make these checks and record the temperatures. No records had been made for five days, since the 5th May 2008. Food stored in the deep freezer was not properly labelled with the date or a description of the food. Some food was not properly wrapped and was exposed to the air. This spoils the quality and makes it unfit for use Claremont Nursing Home DS0000045220.V364661.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 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 1 Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement All prescribed medication must be correctly administered and recorded as detailed in the medication chart. This means that a person’s medical condition is being treated as prescribed. There must be ongoing planned social activities so that there is on going stimulation that is appropriate for the group and individual. This must include developing links with the local community and the opportunity for outings where appropriate. A care plan with the actions to be taken to meet social care needs must be in place for all people, taking into account the needs of people with dementia. People must have the care and support they need as detailed in their care plan, To make sure their needs are met. The number of staff available to people must be enough to meet their care and support needs at DS0000045220.V364661.R01.S.doc Timescale for action 08/07/08 2. OP7 OP12 16. 2(m & n) 30/07/08 3. OP7 OP8 16 16/06/08 4. OP27 18 16/06/08 Claremont Nursing Home Version 5.2 Page 29 all times. This must be continually monitored to ensure that staffing levels are appropriate for the needs of people living at the home. 5. OP33 24 The home must provide feedback 30/06/08 of the outcome of the annual quality monitoring review to everyone involved in the process. Previous timescale 30/05/08 not met. 6. OP38 23 & 16 The windows in the small lounge must be risk assessed and appropriate action taken so that people are safe. 30/06/08 7. OP38 23 8. OP38 23 9. RQN 24 Risk assessments for the 30/06/08 environment must be carried out for all potential risks in the home. To make sure that people, staff and visitors are safe at all times. The assisted baths that are 30/06/08 broken must be repaired or replaced, so that people can use them and are safe from hazards. The registered person must send 04/07/08 to the CSCI an improvement plan stating how all issues raised, in this report will be resolved. Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 30 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 OP28 OP15 OP15 Good Practice Recommendations 50 of care staff should be trained to NVQ level 2 or above. The home should consider introducing a large menu board to inform people what food is on offer that day. People should be involved in developing the menus, so that their favourite foods are included. Claremont Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 © 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 Nursing Home DS0000045220.V364661.R01.S.doc Version 5.2 Page 32 - 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. 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