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Inspection on 28/02/06 for Claremont Nursing Home

Also see our care home review for Claremont Nursing Home for more information

This inspection was carried out on 28th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users said that the staff were very good. Staff said they were part of a good team of carers working in a good care home. They confirmed that lots of staff training was being organised. The manager said that staff were very interested in attending training courses. Activities are well organised and individualised. Interactions between service users and staff were good. Records were well kept.

What has improved since the last inspection?

Two bedrooms have been redecorated and new floor covering fitted in an ensuite bathroom. A second sluice has been provided. For those service users at risk of falling from wheel chairs lap straps have been provided. Care documentation has become more focused on the individual needs of service users.

What the care home could do better:

Many areas of the home require redecoration and new carpeting. The company have plans to extend but the work has not started. The comfort of existing service users must be maintained in the interim period. 50% of the care staff must be trained to NVQ level 2.

CARE HOMES FOR OLDER PEOPLE Claremont Nursing Home New Street Farsley Leeds Yorkshire LS28 8ED Lead Inspector Susan Knox Unannounced Inspection 28th February 2006 9:30 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.V283454.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Claremont Nursing Home DS0000045220.V283454.R01.S.doc Version 5.1 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.V283454.R01.S.doc Version 5.1 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 14th September 2005 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. Nursing care for up to thirty-seven older people is provided. Accommodation is offered in a combination of twenty-one single and eight double rooms; all bedrooms have en-suite facilities. Service users 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. Claremont Nursing Home DS0000045220.V283454.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector and took place between 9.30 am and 3.15 pm. Ms Carole Prior registered manager was present. Time was spent talking to residents, staff and observing practice. Records including duty rotas, care records and staff training records were seen. Some bedrooms and other areas of the building were checked. All of the requirements from the last inspection have been addressed. Requirements and recommendations from this inspection are included at the end of the report. Feedback was to Ms Prior and Mr Jason Sykes operations director. What the service does well: What has improved since the last inspection? Two bedrooms have been redecorated and new floor covering fitted in an ensuite bathroom. A second sluice has been provided. For those service users at risk of falling from wheel chairs lap straps have been provided. Care documentation has become more focused on the individual needs of service users. Claremont Nursing Home DS0000045220.V283454.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Claremont Nursing Home DS0000045220.V283454.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Claremont Nursing Home DS0000045220.V283454.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 Information about the terms and conditions of residency is given to service users/relatives. Service users are assessed before admission to the home to make sure that their needs can be met. EVIDENCE: Service users and/or their representatives are provided with terms and conditions of residency (contracts). The operations director confirmed that the numbers of rooms allocated to individuals have been added to the document. Detailed pre assessments records were evident in the care documentation seen during the inspection. The manager or the deputy had undertaken the assessments and ensured that the home could meet individual needs. Claremont Nursing Home DS0000045220.V283454.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9. Care planning is good and meets the individual needs of service users. Health needs are met. The administration of medication is well managed and ensures that service users are protected. EVIDENCE: Three-service user’s care records were case tracked. Care planning was good, person-centred and up to date. For example, the care planning for one about communication included details about tone of voice, to ensuring the hearing aid was effective and for staff to observe non-verbal signs. For one service user the care plans were cross-referenced as some health needs affected one another. Recognised assessment tools are in use and risk assessments such as falls, nutrition and moving and handling were in place. Monthly evaluation takes place ensuring that changing needs are identified and appropriate action taken. Signatures were evident on some care plans that confirmed service users or relatives were involved. Claremont Nursing Home DS0000045220.V283454.R01.S.doc Version 5.1 Page 10 The manager advised that three service users had minor skin tissue problems. Body maps had been introduced for one service user showing the location and size of the skin breaks. A pressure prevention mattress had been obtained. The tissue viability nurse had been asked to visit one service user. The medication system and paperwork was checked. The home operates with a Monitored Dosage System (MDS) and storage of medication was satisfactory. Four-service users medication was tracked. Records including controlled drugs were well kept apart from two instances where the Medication Administered Record (MAR) for the month checked had no record of quantity and date received. The manager said this was medication carried forward from the previous month. In this case carried forward should be recorded in the MAR. There is a list of specimen initials of those staff responsible for medication. Disposal of unused medication complies with requirements. The nurse confirmed that the chemist used is licensed to dispose of unwanted medication. Policies and procedures for the administration of medication were readily available to staff in the drug room. Claremont Nursing Home DS0000045220.V283454.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13. Stimulating meaningful activities are regularly organised that are of interest to service users. Relatives and friends are welcomed into the home and to join in activities. EVIDENCE: On arrival at the home many of the service users were still in their rooms. Many have breakfast taken too them there. Discussions with service users confirmed that they were happy with the care provided by staff. They said that the staff were very good. Two issues raised in conversation by two service users were referred to the manager. Visitors were observed being made welcome by staff and this was confirmed in discussions. By 11 am many service users were in the main lounge and mid morning refreshments were served. Those service users requiring help with personal care looked well cared for. It was noted that the staff paid attention to details such as ensuring a small table was readily available to place a drink on. Good interaction was noted between staff and service users. An activity organiser is employed and each day is structured with some activities organised. Notices with dates and times about these are displayed in the home for service users and visitors. Group and individual activities are Claremont Nursing Home DS0000045220.V283454.R01.S.doc Version 5.1 Page 12 organised and can include walks to the local park and bowling green or to the shops. Religious representatives regularly visit the home to give communion. This was confirmed during discussions. A recent successful event was a Valentine lunch and entertainment when relatives and friends were invited to attend. A similar event is being organised for Mother’s day. Claremont Nursing Home DS0000045220.V283454.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The complaint procedure ensures that people know how to complain in order to protect service users. EVIDENCE: Detailed information is displayed in the home about how to make complaints. This is also included in the Statement of Purpose. It includes details about the CSCI and its role in the complaint process. The manager advised that no complaints were on going. The CSCI have received no complaints about the home since the last inspection. A recent relative’s meeting had been held to provide information about the proposed extension to the home. Concerns have been raised about the affect this could have on the existing service users and about the redecoration that is on hold until this work is completed. The operations director was dealing this with. Parts of the home are looking very shabby with redecoration and new carpets required. Claremont Nursing Home DS0000045220.V283454.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26. Some areas of the home are well maintained. However the company must be heedful of the concerns expressed about the proposed building work and maintain the comfort of existing service users. The availability of specialist equipment ensures that service user’s needs are met and independence is promoted. EVIDENCE: The providers have had plans passed to extend the building. No date has been set to start the work. Due to this pending work many areas such as corridors and bedrooms are looking shabby and need attention. The two lounges and separate dining room are well maintained and floor covering and furniture is good. There is level access to the garden from the main lounge. There are a number of bathrooms and WC’s and many bedrooms have ensuite facilities. Odour control was good. The majority of areas were clean and Claremont Nursing Home DS0000045220.V283454.R01.S.doc Version 5.1 Page 15 attempts have been made to make one of the bathrooms less institutionalised with pictures and ornaments. The main WC opposite the main lounge was the only room in need of cleaning and redecoration. It was agreed at this time this would be carried out speedily. The commode with wheels in this WC also required renovation or disposal. Due to the proposed building work decoration has not been maintained, some bedrooms are looking shabby with faded carpets. It was agreed at the last inspection that redecoration would start. Two bedrooms have been redecorated since the last inspection and new flooring fitted in an en suite bathroom. This needs to continue. Discussions were held with some service users in their rooms. Those who were able said that they liked their rooms and were very comfortable there. Many had personal possessions displayed such as photographs, ornaments and pictures. They confirmed that they had brought in with them belongings from home. In one room there was a very noisy motor operating the specialist mattress. The manager was advised to have this checked. Some bedside cabinets were seen to have worn and sharp edges these need to be repaired or replaced. Linen stocks appeared to be low and some poor quality towels were seen. The manager advised that new stocks were due to be delivered. The home has a number of specialist equipment to ensure that service user’s needs could be met. These include hoists and specialist baths. An additional hoist has been provided since the last inspection. Two hoists were awaiting repair at this time. There is also a passenger lift. A number of profile beds are in place for those with significant nursing needs. It was noted during the inspection that a number of items of smaller equipment such as long reaches and handgrips near beds have been provided to ensure that service users remain as independent as possible. Staff confirmed that they have no problems with availability of equipment. It was noted that wheelchairs with footplates in place were in use when transporting service users. This ensures their safety. The manager was advised to check the date of the pending delivery of a new specialist chair for one service user, as the present chair had no footrest. Claremont Nursing Home DS0000045220.V283454.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28. Staffing levels are sufficient to meet the service user’s needs and maintain good standards in the kitchen and the home. NVQ training is on going but the home is failing to achieve the standard of 50 of care staff achieving this qualification. EVIDENCE: A copy of the rota for the week of the inspection was made available. Staffing levels comprise of two qualified staff and six carers working the early day shift and two qualified staff and five carers for the later shift. Night cover is one qualified staff and three carers. Ancillary staff are five domestic/laundry assistants, two cooks and three kitchen assistants. Care staff confirmed that although some days are very busy staffing levels were good. The manager advised that she had recently attended training about the home taking what was formerly known as adaptation nurses. These are overseas nurses who are required to complete additional training before being able to practice in this country. NVQ training is ongoing but has not progressed very far since the last inspection. At that time some staff had achieved this training but terminated their employment. At the present time one member of care staff have achieved NVQ level 2 and one NVQ level 3. Six staff are currently undergoing NVQ level 2. Two are near completion. Some staff have been experiencing difficulties with written English. Claremont Nursing Home DS0000045220.V283454.R01.S.doc Version 5.1 Page 17 There is a significant shortfall in the required 50 of care staff to be trained to NVQ level 2. The home is to concentrate on promoting this training in the next few months. Claremont Nursing Home DS0000045220.V283454.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 36, 37, 38. Regular supervision of care staff means that staff are well informed about the needs of service users. Record keeping is well managed and they are securely kept. The health and safety of service users and staff is promoted. EVIDENCE: Supervision of care staff has started and records were available. Some supervision sessions were about the use of equipment such as a hoist or a new mattress. This is acceptable provided that some of the required six sessions include staff development and discussions on a one to one basis, rather than all being group sessions. The records seen during the inspection were up to date and well kept. Where confidentiality was required records were securely kept. Claremont Nursing Home DS0000045220.V283454.R01.S.doc Version 5.1 Page 19 The safety labels on some hoists appeared to be out of date but the maintenance records showed that this equipment was last serviced March 2004 and August 2005. Fire safety records were also up to date. The weekly check of fire alarms and emergency lights was well maintained. Fire extinguishers were last maintained June 2005. Claremont Nursing Home DS0000045220.V283454.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 3 3 3 Claremont Nursing Home DS0000045220.V283454.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP24 Regulation 16 Requirement The registered providers must continue to redecorate bedrooms. Repair or replace bedside cabinets with sharp and worn edges. Ensure that the noisy motor is checked that operates a specialist mattress. Redecorate the main WC adjacent to the main lounge. 50 of care staff must be trained to NVQ level 2 or above. Timescale for action 31/03/06 2 OP28 18 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP9 OP14 OP38 Good Practice Recommendations Ensure that ‘carried forward’ is recorded on the following month’s MAR where necessary. The manager to discuss the issues raised in conversation with two service users. The manager to check when the new specialist chair will DS0000045220.V283454.R01.S.doc Version 5.1 Page 22 Claremont Nursing Home arrive and until then that the service user is comfortable without the footrest. Claremont Nursing Home DS0000045220.V283454.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Claremont Nursing Home DS0000045220.V283454.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!