Inspection on 14/06/10 for Claremont Nursing Home

This inspection was carried out on 14th June 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Claremont Nursing Home 30/07/09

Claremont Nursing Home 01/08/07

Claremont Nursing Home 31/08/06

Claremont Nursing Home 11/11/05

Claremont Nursing Home 26/04/05

Claremont Nursing Home 20/10/04

Claremont Nursing Home 20/05/04

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The Vicarage

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Trevaylor Manor

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Stallcombe House

Stepping Stones

Extracts from inspection reports are licensed from CQC, this page was updated on 03/09/2010.

Key inspection report Care homes for older people Name: Address: Claremont Nursing Home 5 Nelson Gardens Stoke Plymouth Devon PL1 5RH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Clare Medlock     Date: 1 4 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 37 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Claremont Nursing Home 5 Nelson Gardens Stoke Plymouth Devon PL1 5RH 01752606799 01752606799 care@claremont-nursing.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): St Nicholas Homes Limited Name of registered manager (if applicable) Mr Ian Johnston Type of registration: Number of places registered: care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia physical disability Additional conditions: Registered for maximum 3 PD Registered for maximum 32 PD(E) Service Users 65 years and over Registered for maximum of 3 DE Registered for maximum of 3 MD Registered for maximum of 32 DE(E) Service Users 65 years and over Registered for maximum of 32 MD(E) Service Users 65 years and over Date of last inspection Care Homes for Older People Page 4 of 37 Over 65 32 32 32 3 3 3 Brief description of the care home Claremont Nursing Home is situated in Stoke, a suburb of the City of Plymouth, which is a short distance away by road. It is a large property, as part of a terrace, built on four floors each of which provides accommodation for the people who live there. Nelson Gardens is a private road, there is some allocated off road parking at the front of the building accessed directly from the road. The home is registered to care primarily for up to thirty-two (32) Service Users who have a mental health problem or dementia types illnesses. The ground floor provides the day space for the Service Users by way of a large lounge/diner to the rear of the ground floor and a further lounge room in the middle of the building. At the time of inspection fees range between GBP489.88 and GBP572.22 according to the needs of individual people using the service. Respite fees range from GBP413.33 but also depend on the needs of the individual person. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who live at Claremont Nursing home experience adequate quality outcomes. Prior to the inspection, the manager sent us the completed annual quality assurance assessment for inspection (within timescales). The AQAA is a self-assessment record that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. This key inspection included a visit to the home on Monday the 14th June 2010. During this time we spoke to the registered manager, the administrator, four members of staff and the visiting the external training provider. We spoke at length with three people who live in the home and four visitors. Care Homes for Older People Page 6 of 37 We case tracked three people who use the service- This means we looked in detail at the care these people receive. We spoke to staff about their care, we looked records that related to them, and made observations if they were unable to speak to us or provide feedback. We spent a period of just over one hour observing interactions between staff and people in the home. This period of observation took place in the dining and lounge area. We looked at care plans, three staff recruitment records, training records, medication processes and policies and procedures. We did this because we wanted to understand how well the recruitment and safeguarding systems work and what this means the people who use the service. All this information helps us to develop a picture of how the home is managed and what it is like to live at Claremont nursing home. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: Safety at the home must be the main priority of staff. This must be achieved by ensuring that the recruitment process is robust. Staff must only be employed at the Care Homes for Older People Page 8 of 37 care home when full pre-employment checks, including two references have been performed. This will show that staff are suitable to work with vulnerable people. Safety can also be promoted by orientating all staff, including agency staff, when they first work at the home to the emergency procedures and exits. Staff must be reminded that some practices and actions they take can place people at risk and mean that people are not treated with dignity and respect. Staff must be reminded when transferring people in wheelchairs to use the foot plates, to avoid entrapment and accidents. Staff must also be reminded to work at a correct pace to people in the home, so that people do not feel rushed and treated roughly. Consideration should be given to people with capacity to have locks on their bedroom door if they request, to make themselves feel safer. People should also have easy access to call bells where appropriate. Treating people with respect should also be very important at the home. For people who share a room, adequate screening should be provided for when personal care is provided. Staff should be reminded that some of their practices are placing people at risk, and mean people are not treated with dignity and respect. Staff should be reminded to interact with people in a way that promotes respect, acceptance, and acknowledgment, validation, empowerment and recognition. Staff should be reminded to give people warning when care is provided to prevent shock and distress. Staff should also be reminded about good practice when helping people eat a liquidised meal. People should be offered opportunities for stimulation and leisure activities at the home. Staff should find out about the persons life story to help plan a programme of meaningful activities on a daily basis. Staff should be reminded that activities can be both formal and informal. Communal areas, although well decorated, should be reviewed to include the use of colour, texture and design to assist in the identification of/or conceal where appropriate, environmental features. Furnishings in communal areas could, more clearly, indicate their purpose/function of the room or contain features or objects for orientation and stimulation. People at the home should also be offered choice with regards to all aspects of their life. People should be aware that there are alternatives for meals and have opportunity to bath rather than shower. Systems should also be in place so that access to peoples personal money is possible when the administrator and manager are not present at the home. Health can be improved at the home by ensuring the finer details of care are provided, to include adequate foot wear, nail care, mouth care, male grooming and hair care. The management of medications could be improved by considering environmental issues, improving the recording of controlled drugs and improving the safety of the storage of medications when they are being administered. Care planning could improve by ensuring all plans are reviewed on a regular basis, Care Homes for Older People Page 9 of 37 dated and signed. Care plans should also be improved to clearly show what action is taken when people lose weight. Infection control must be improved at the home by ensuring ancillary staff have access to suitable personal protective equipment, hand washing facilities and suitable training, to prevent the spread of infection. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The clear admission process means that staff have all the information needed to decide whether they are able to care for people before they are admitted. Evidence: Relatives informed us that the admission process was quite smooth, made easier by staff at the home. One relative said that communication was not as good from social services, but on admission to the home all the information was provided by the manager and staff. The home have a statement of purpose and service user guide. These were not inspected on this occasion. A pre-admission assessment form showed sufficient information about people is obtained before they move to the home. Information from other healthcare professionals, services and multidisciplinary team members was also obtained. Care Homes for Older People Page 12 of 37 Evidence: The AQAA read the home continues to provide a robust pre-admission form which enables the home to cater to the needs of the individual resident. The AQAA also read the home continue to have a good relationship with RITA (local hospital emergency admission team) and the supportive discharge team. As most of the residents have dementia we now have good links with the mental capacity team using their role in advocating for a prospective residents. Care Homes for Older People Page 13 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although healthcare and the care planning is adequate at the home, personal care is not always provided in a respectful way. Evidence: Although generally people appeared well cared for, we noted that on some people, the finer details of care had been missed. We saw men who had not been shaved, men with overgrown beards, ladies with un brushed hair, people with dirty nails and people who needed mouth care/teeth brushing. We also noted three people who did not have any footwear on. Reasons for this were not provided in care plans. We noted that people have access to NHS services both at the home and in the community. Referrals to other healthcare professionals were appropriate and care plans indicated that specialist health care was sought where necessary. Records were used to record when a person was seen by a healthcare professional. Some consultations with general practitioners were performed over the telephone with action points recorded on a persons record. Care Homes for Older People Page 14 of 37 Evidence: The AQAA read we continue to have good links with the continence service, tissue viability and mental health team. Care plans were well constructed and secure. The majority of care plans were typed using the computer. However, some care plans had not been dated and it was noted that many assessments and care plans had gone through a period of not being reviewed for a number of months. However, care plans seen had been reviewed within the last month. People each had a care plan which included pre-admission information, personal details, past medical history, diagnosis, medication information, skin assessment records, falls assessments, initial behaviour assessments, activities of daily living assessment, and mental health and well-being assessments. Other assessments seen included mobility and transfer, personal hygiene, sleep assessments, communication assessments, medication assessments, and bladder assessments. Although some people had nutritional assessment and weight records, it was noted that no records were provided to say what was action was being taken for three people who had either declined to be weighed or experienced a significant weight loss. Care plans seen appeared to be reactive plans of care rather than how staff could prevent deterioration is in behaviour or condition occurring. Medications are managed by the registered nurses at the home. It appeared that registered nurses were spending a lot of time moving between the two clinic/medication storage rooms located on separate floors. Medication administration records were kept in an office on the first floor, whilst the controlled drugs register and controlled drugs were kept on the ground floor. This would mean registered nurses would be travelling between two areas when administering controlled drugs. This has the potential of increasing errors and interruptions of the registered nurse. An inspection of controlled drugs register confirmed that staff had not recorded when a controlled drug medication had been destroyed or returned to the pharmacy. This has the potential of confusing staff and increasing the rate of drug errors being made. (It was noted in this situation that there was an audit trail of controlled drugs being destroyed or returned.) Robust procedures were in place for the receipt and return process of medications at the home. Storage facilities were suitable, clean and tidy, although in two separate areas of the home. There were policies in place for homely remedies, patient Care Homes for Older People Page 15 of 37 Evidence: information leaflets for each person and staff specimen signatures for audit purposes. During the inspection it was noted that as medications were being administered, the drug trolley was left open in the office which was also unlocked. People spoken to said medications were given usually on time, but were sometimes late if the member of staff was busy. We noted two pots of medication which the nurse had prepared, which one person had refused and another had been asleep for. The registered nurse on duty said he knew which residents these were for, and intended to try again for the person that had refused, and give the other person their medication when they were awake. A discussion was held regarding the importance of not potting up medication. We were informed by the member of staff that this was not done in advance, and the medications would be disposed off should the person refuse to take the medications. Relatives spoken to were appreciative of staff sorting out their relatives medicines to ensure he was able to wander and be more alert. One relative said it took a number of weeks of the Doctor and staff sorting it out, but we have really noticed the difference in dad. Relatives also told us that whenever they visited the home their relative was always wearing their own clothes. One person living at the home said the staff were very efficient with the laundry. We saw some very good interactions between staff and people who live at the home, but also saw some poor practice which show that staff did not always respect people and treat them with dignity. We saw some staff ignoring peoples requests and one member of staff dragging a chair backwards with no warning to the person who was sitting in it whilst asleep. This resulted in a physical reaction from the person. When a different member of staff approached in a gentle manner with explanation, the person cooperated and had a more positive reaction. We heard some staff calling out a persons name as if they were calling a dog. We saw staff placing drinks in front of people with no explanation or interaction. Some poor practice place also have the potential to people at risk. We noted a number of staff moving people in wheelchairs with no foot plates in place, which is extremely poor practice that has the potential of tripping people and causing injury. However, other interactions seen were extremely good and showed a level of respect and affection for people at the home. The best interactions seen were from ancillary Care Homes for Older People Page 16 of 37 Evidence: staff and agency staff. We saw examples of staff providing reassurance to people who were displaying anxious behaviour, we saw the use of humour and jokes shared between staff and people in the home. We noted that people were able to walk freely around the home, and in situations lie down freely where they chose to and be supported up when they wanted to stand. We saw staff offer choice of where to sit and saw staff providing gentle coercion as a form of encouragement. All interactions seen were well paced and did not appear to rush people living at the home, although we were told that some staff, when busy, would rush and sometimes be a little rough. One person said they were extremely happy at the home, and liked the fact they could go out regularly. We were told that this person did not have a call bell in their room, although later inspection confirmed that there was one in place which they could not access. This was fed back to the manager. People told us staff were very prompt in responding to call bells at night. The manager explained that he is trying to ensure that all rooms are for single occupancy at the home. A tour of the home confirmed that this is in progress. However, one room that was still being shared did not have adequate screening, to ensure that a persons privacy is not compromised when personal care is provided. Training records showed that staff had attended an end of life training programme, which is recognised nationally and seen as good practice. Care Homes for Older People Page 17 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of leisure and recreational activities in and outside of the home means that people do not receive meaningful stimulation. Staff do not always treat people with respect and dignity which can cause distress. Evidence: The people we spoke with said they were generally happy at the home. One person said I go out regularly, I get my hair done in Stoke (the local area) and one of the girls takes me to get my nails done regularly, which I really like. Another person said its okay -- Im reasonably happy here and sometimes there are things going on but not often. There was no activities programme displayed, although the administrator explained that a regular visit by musicians and singers took place, for which those people that attended were charged a nominal fee. There was no formal activity programme taking place on the day of inspection. One Care Homes for Older People Page 18 of 37 Evidence: person asked several times for the radio to be switched on. It took an agency nurse to response to this request after two separate members of staff walked past the person ignoring the request. The clock in the dining area was difficult to read from a distance. Although the dining and lounge areas were decorated to a good standard there were no pictures or use of colour, objects, articles, or prompts to providing orientation. People were not prompted to know the day of the week, the weather or significant events that were occurring in the world and local area. There were no examples seen to encourage the use of any skills and interests that people may have, or used to have. There were no facilities or individual activities or examples which may provide stimulation for men e.g. maintenance. There were no examples to encourage a person to maintain or take part in spiritual aspects of their life. People told us a hairdresser visits the home on a regular basis which was appreciated by people. The AQAA informed us that due to the financial restraints we have been unable to continue the role of the social activities coordinator at the home. and then states The home was hoping to incorporate the activity benchmarking tool but due to various constraints the home has not yet been able to achieve this. We sat in the dining area for a period of just over one hour observing interactions between staff and residents, and the events that took place. Those people who were able to respond received more attention from staff, whilst those who were quiet and withdrawn were ignored and left alone for long periods of time with no interaction or stimulation. Some people were able to leave the home, but this was reliant on visitors and friends performing this role. We were told that there were no formal trips out of the home, and thats the home did not have a minibus or mode of transport to facilitate this. We asked the manager and other staff about the background history of people at the home, including their previous role and interests. Staff were unable to inform us of this information, which could be useful when planning a meaningful programme of activities and stimulation. One person was calling out reasonable requests. Following a period of being ignored for 10 minutes, the inspector handed the person a tissue and a member of the Care Homes for Older People Page 19 of 37 Evidence: ancillary team provided a person with some handcream they had requested. The interaction that followed when the handcream was provided resulted in a very positive experience for the person. We noted that visitors were able to visit the home at any time. However, we noted that visitors were ignored by staff unless they had a specific question to ask. We noted that two visitors stood for the entire visit and were not offered a seat. Two other visitors were offered a seat after a period of five or 10 minutes, when a member of the ancillary staff came into the room. People told us food at the home was OK Good Wonderful and Alright. One person told us that staff knew that she did not like a cooked meal at lunchtime and all ways provided a salad. The chef explained to us that she had a list of what people liked and needed. This list included specialist diets and personal requests. Staff were seen to request finger food for some people, and this was provided with minimal fuss. The chef informed us that she has enough food and equipment. The kitchen was well maintained, with suitable cleaning schedules and checks in accordance with the Food Standard Agencys: Safer Food Better Business Programme. Observation confirmed that the food appeared hot, well presented and nutritious. On the day of inspection a pork casserole was served with mash potato, sprouts and broccoli. We were told by staff and people who use the service that there was no choice of meal available at the home, although people could request alternatives if they had capacity. The AQAA stated that the kitchen provides a choice of meals. We noted that liquidised and pureed meals were served separately, but noted that one member of staff had mixed all three portions together. This poor practice was fed back to the member of staff and manager, who was informed that it was important that people should have access to different flavours and textures. Care Homes for Older People Page 20 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that complaints will be well managed at the home. Improvements in care practices would mean that people feel safer at the home. Evidence: People told us they feel safe living at the home with regards of outside influences such as burglaries and intruders. However, people told us that sometimes they felt unsafe at night because of people wandering at the home. A tour of the building confirmed that people who liked to walk around the home were encouraged to do so during the day, and those that liked to get out of bed and walk at night had pressure mats which alerted staff to their movements without restricting mobility. This is seen as good practice. We noted that none of the bedrooms had locks fitted. Whilst this is appropriate for the majority of people living at the home, a very small number of people, who had capacity were also not provided with a lock on their bedroom door. One person said it would make them feel safer if they were able to lock their bedroom door at night. This particular situation was discussed with the manager confirmed that he would look into this. People told us they felt safe with the majority of staff at the home, although one or two were sometimes rough. We were told that this was not staff intentionally being Care Homes for Older People Page 21 of 37 Evidence: rough, but staff rushing their work, and out pacing the person being assisted. We did not see any examples were people were having their liberties deprived, or were being restrained. One care plan showed that an independent mental capacity assessment had been performed by an approved assessor. It was evident that staff at the home are aware of the local safeguarding procedures to be followed when it is identified that a person is at risk. There is a clear complaints procedure to be followed at the home, with appropriate timescales and processes to follow. The manager explained he is aware of one complaint that has been made. The Care Quality Commission received one anonymous complaint regarding the service prior to the inspection. Some aspects of the complaint have been identified within this inspection, whilst others were not evident at the inspection. The AQAA read the home provides training for care staff that comply with the latest policies and procedures in relation to protection and safeguarding issues and the rights of residents. The home also recognises the importance of advocates under the mental capacity act and liaises with appropriate external agencies. Advocacy is sought for all residents who do not have a relative or friend to advise and support them; all staff at the home are trained in all aspects of safeguarding. Care Homes for Older People Page 22 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in the environment would mean that people had more choice, stimulation, and assistance with orientation. Improvements in staff training and in infection control procedures would mean that people and staff were protected from the spread of infection. Evidence: Generally the environment was well maintained, clean and tidy. The home employ two full-time cleaners to ensure that the home is cleaned effectively. The home also employ a full-time maintenance man who is responsible for the routine and ad hoc repairs. All areas of the home appeared safe and free from unnecessary risk. Cleaning products were appropriately stored. Some bedrooms had been redecorated as part of a refurbishment programme. All areas of the home were painted with pale colours in neutral tones. Some rooms did not contain items to reflect the persons identity or personal interests. However, other rooms contained more personal items. The lounge and dining areas contained furniture that was robust and suitable although parts of the communal areas appeared more institutional than other parts of the home. Care Homes for Older People Page 23 of 37 Evidence: Communal areas, although well decorated, clean and tidy lacked the use of colour, texture and design to assist in the identification of/or conceal where appropriate, environmental features: example rooms, doorways, the junction between walls and floors etc. Furnishings in communal areas did not clearly indicate purpose/function of the room or contain features or objects for orientation and stimulation. The home did have a fish tank and a pet bird. However these pets were in the corner of the dining room. The fish tank was very dirty, so it was difficult to see the fish. A tour of the building confirmed that two of the baths were out of use. One was worn, chipped and could cause an infection control risk. The other specialist bath on the ground floor was not in use and the bathroom was being used as a storage room. Discussion with the manager confirmed that the home have two wet rooms which are used to shower people. People told us that they usually had a shower and had never been offered a bath, although this would be nice occassionally. There are disabled toilets and a mechanical disinfecting sluice on the lower ground floor. There are disabled toilet facilities close to service users bedrooms and also next to the lounge on the ground floor. The home has a laundry located on the lower ground floor. It has two commercial sized washing machines, one has a sluicing cycle. There is also a full-sized commercial cloth dryer. The laundry is manned by full time laundry assistants who wash and iron the clothes for people who live in the home and place them in baskets with their names on for delivery to their bedrooms.There are separate areas for clean laundry and dirty laundry. Although there are hand washing facilities for laundry staff, there was no hand soap present and gloves and aprons were not readily available. Discussion with the laundry member of staff raised concerns regarding use of personal protective equipment and training in infection control. Staff training records did not provide evidence that laundry staff had received adequate infection control training. Observation of care staff confirmed that the use of personal protective equipment was appropriate when performing personal care duties. Care Homes for Older People Page 24 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They 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 cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the recruitment process would show that staff are suitable to work with vulnerable people. Evidence: People spoken to said the majority of staff were kind, caring and attentive. However, some staff were described as too busy or a bit rough. This is addressed in a previous section of the report. Agency staff are used to complement the existing staff group, to cover sickness and staff abcence. We were informed that currently the home have 27 people living at the home. We were informed that on a morning shift they are usually five care staff and one registered nurse. In the afternoon this reduces to 4 care staff and one registered nurse, and at night reduced to 2 care staff and one registered nurse. We were also informed that the home did employ a twilight member of staff to help at peak times of activity, although this had been stopped because of reduced resident numbers. On the day of inspection there were four care staff (including one agency member of staff) one registered nurse, one cleaner, a maintenance man, an administrator, two kitchen staff and the manager on duty. Care Homes for Older People Page 25 of 37 Evidence: There appeared to be sufficient staff on duty to meet the needs of people on the day of inspection. Staff told us that training was very good at the home and that regular mandatory staff training updates were provided. On the day of inspection and external training provider was visiting the home to deliver further training for staff. The administrator provided a staff training matrix which showed details of the programme of training. Three recently appointed staff files were inspected on this occasion. All staff files contained an application form, criminal records bureau check and protection of vulnerable adults/Independent safeguarding authority pre-employment checks, health declaration and evidence of current fees if appropriate. None of the staff files contained an up-to-date photograph. None of the files contained two written references. One staff file contained no references. One file did not contain two forms of identity. These shortfalls were fed back to the manager and administrator. We were told that each new member of staff is provided with a formal induction programme to be completed within a set time scale of being employed at the home. Care Homes for Older People Page 26 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the home is well managed, changes to some systems would help to protect people and staff at the home. Evidence: The registered manager is a qualified registered nurse who has worked in care home settings since 2001. The registered manager has been the current manager of Claremont nursing home since 2006. The manager was popular with staff, people living in the home and relatives. Staff said the manager was approachable and met with them on a regular basis to discuss how they were getting on. Relatives appreciated the communication of the manager. One relative said they were particularly appreciative of the regular e-mail updates they received from the manager regarding their father. Other relatives said that they had confidence that the manager would contact them should any problems arise. One person said Ian is really helpful. Many staff at the home had been working there for a number of years and liked the team atmosphere. Care Homes for Older People Page 27 of 37 Evidence: The AQAA read the home has a clearly defined management structure with the registered manager having overall responsibility. The home has clarity of purpose which is shared by staff. Individual needs are catered for within the home for those that require it. My role is registered manager is one of leadership and empowerment to enable the home to move forward as a centre of excellence. The home did employ a deputy matron who has subsequently left. The AQAA read the home needs to look at recruitment of the new deputy and to review and adapt the job description to reflect the role. The new administrator at the home has introduced a new complete accounting system which the AQAA states enables a more accurate overview of the home and resident finances. Staff payroll is also managed through the system. Personal monies are also managed through this system. Accurate auditing systems are in place to identify what money comes in and goes out of the account. The administrator explained that although the money is held centrally any deficits are covered by the directors and not other people in the home. A discussion was held regarding access to personal monies out of hours, as the administrator and manager of the only people who have access to the petty cash. Discussions were held regarding other ways of ensuring people could have access to their money when the administrator or manager were not present at the home. The AQAA stated that barriers to improvements have included the current financial climate and continuing issues with the way we are being funded have prevented us from being able to move forward with some of the changes we wish to implement. The AQAA also states that service to try to reduce the impact of this barrier by continually auditing and reviewing our spending ensuring that the standard of care that is provided resident is not affected. Evidence seen at the inspection in comparison to the inspection three years ago shows that there has been a substantial withdrawal with regards to activities and occupation of people living in the home. It was evident that health and safety is generally taken seriously at the home. Ancillary staff knew of their responsibilities with regards to the control of substances hazardous to health (COSHH). All fire exits were clear from obstructions, and there were no obvious hazards identified during inspection. The AQAA listed service dates for the maintenance of equipment such as electrical circuits, portable electrical equipment, lifts and stairs, hoists, fire systems, emergency equipment, heating systems, soiled waste disposal and gas appliances. Care Homes for Older People Page 28 of 37 Evidence: We asked and were told by agency staff that they had not been orientated to the emergency exits and procedures of the home on arrival and were left to find this information about themselves. Staff explained that they have regular mandatory training provided by an outside company. On the day of inspection an external training provider was present conducting further mandatory training. The administrator holds training records for staff which showed that the training is performed on a rolling programme. Care Homes for Older People Page 29 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Finer details of care must be 08/04/2011 provided. This must include attention to a persons hair, beard, nails, foot wear, mouth and teeth. This will mean that people are cared for to a satisfactory standard and would ensure their comfort and safety at all times. 2 7 12 The manager must ensure 08/04/2011 that systems are in place to follow-up any changes in weight and nutritional status of a person This will mean that unnecessary weight loss is noted and treated accordingly. 3 7 15 The manager must ensure that care plans are well maintained, kept under review and assessed on a regular basis. 08/10/2010 Care Homes for Older People Page 31 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will mean that any changes in care can be monitored and communicated appropriately. 4 8 13 The manager should ensure 08/04/2011 that people have access to a call bell if appropriate. This will mean that people can call the help when they need it, without placing themselves at risk. 5 8 13 The manager must ensure 08/04/2011 methods of transporting people in wheelchairs is safe. This should include the use of foot plates on wheelchairs when transporting people. This will mean that people can be transferred safely and will minimise any trips or limbs being entrapped whilst being transferred. 6 9 13 The manager must ensure that medication trolleys are locked when not being attended This will reduce unnecessary risk. 7 10 12 Screening must be provided in shared rooms. 08/10/2010 08/10/2010 Care Homes for Older People Page 32 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure that a persons privacy is not compromised when personal care is provided. 8 10 12 The manager must ensure that people are treated with respect. This will prevent distress and avoidable reactions and mean that interactions between staff and people are positive. 9 12 12 The manager should introduce systems so that staff interactions result in people feeling relaxed, accepted, respected, acknowledged, and well cared for. This will prevent distress and avoidable reactions. and mean that interactions between staff and people are positive. 10 12 16 The manager must consult 08/04/2011 service users, or find out information, about their social interests and personal history, and make arrangements to enable them to engage in a programme of activities and stimulation -- with particular consideration for people with 08/10/2010 08/10/2010 Care Homes for Older People Page 33 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action dementia and other cognitive impairments. This will provide people with meaningful stimulation through leisure and recreational activities. 11 18 12 The manager must ensure that staff do not out pace people. This will mean that people will not feel like they have been roughly handled. 12 19 22 The manager must ensure 08/04/2011 that the environment is suitable for the purpose of meeting the needs of people who live there. This would mean that changes to the environment would promote orientation and stimulation for people living at the home. The manager must ensure that the lack of baths does not affect the requests or choice of people at the home. This will mean that people have choice of how they are washed or bathed at the home. 14 26 13 The manager must ensure that all staff, including 08/10/2010 08/04/2011 08/10/2010 13 21 12 Care Homes for Older People Page 34 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action ancillary staff receive adequate training regarding infection control and are aware of, and have access to personal protective equipment. This will prevent this spread of infection in the home. 15 28 18 The manager must ensure 08/10/2010 that staff are not working in the home unless full and satisfactory information has been obtained. This must include: proof of the persons identity, including a recent photograph and two references relating to the person. This will mean that staff only care for vulnerable people once they have had full preemployment checks performed. The manager must ensure safe working practices are a priority at the home, for all staff including agency staff. This would mean that agency staff are aware of the appropriate fire procedures, exits and action to be taken in the event of emergency. 08/10/2010 16 38 13 Care Homes for Older People Page 35 of 37 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 The manager should ensure that registered nurses complete the controlled drug register correctly to reduce risk and improve the audit trail of where controlled drugs have been disposed of or returned. The manager should consider the location and storage of medicines to ensure that unnecessary risks are removed. The manager should ensure that potting up is not a practice that occurs at the home. The manager should ensure the environment promotes orientation and stimulation The manager should ensure the service is run in a way that maximises choice for people Food which is liquidised should be served in separate portions to enable a person to enjoy different flavours and textures. The manager should consider providing a clock that can be clearly read. The providers should ensure that the accounting and financial procedures in the home do not affect the lifestyle of people living in the home. Systems must be in place for ensuring people can have access to their money when the administrator or manager are not present at the home. 2 3 4 5 6 9 9 12 14 14 7 8 19 34 9 35 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 37 of 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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