Inspection on 06/05/09 for Claremont Nursing Home

This inspection was carried out on 6th May 2009.

CQC 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 10/05/08

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 12/10/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Claremont Nursing Home New Street Farsley Leeds Yorkshire LS28 8ED Lead Inspector Valerie Francis Key Unannounced Inspection 6th May 2009 15:00 DS0000045220.V375401.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Claremont Nursing Home DS0000045220.V375401.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Claremont Nursing Home DS0000045220.V375401.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 Manager post vacant Care Home 63 Category(ies) of Old age, not falling within any other category registration, with number (63) of places Claremont Nursing Home DS0000045220.V375401.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (N) To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Old Age, not falling within any other category, Code OP - maximum number of places 63 The maximum number of service users who can be accommodated is: 63 10th May 2008 2. Date of last inspection 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. The home is registered to accommodate sixty three older people who can have nursing needs. Accommodation is offered in a combination of forty seven single and eight double rooms; all bedrooms but one has en-suite facilities. Twenty six single rooms have a walk in shower. The communal facilities are four bathrooms and ten toilets. People have a choice of three lounges, and there are two spacious dining rooms, although only one was being used at this time. Gardens are available consisting of lawns and an 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.V375401.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. Two inspectors made an unannounced visit to the home between 3.00pm and 10.45pm. This report is based on information gathered in a number of ways. A review of the information we have received about the home since its last Inspection. Information sent to us by the registered provider in a document called the Annual Quality Assurance Assessment (AQAA) self assessment information, which tells us what the home does well, what improvements they have made and what they could do better. Surveys sent to health care professionals who visit the home. Surveys for people who live at the home, relatives and staff were given at the inspection. We received four from people, four from relatives and four from staff. Our finding is also based on comments made by people, visitors and staff during the inspection. This visit included a tour of the premises and talking to people who live at the home, staff and management. We also looked at menus and people’s care plans and watched staff looking after people. Although there has been some improvement in the home and people’s care, some people’s relatives told us that they still feel their relatives do not receive a good standard of care. Weekly charges are from £551:77 to £781:51. This information was provided during the site visit. Extra charges are made for hairdressing, and chiropody. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Claremont Nursing Home DS0000045220.V375401.R01.S.doc Version 5.2 Page 6 What the service does well: Assessments are carried out before a person moves into the home, so they can be sure that the person’s care needs can be met. Visitors are always welcome at the home and people are encouraged and supported to maintain and develop relationship with other people in the home, their families and friends and to maintain links with the local community. People’s relatives told us,” care staff are caring and friendly always willing to help when they have time.” “The home is clean and tidy and you are always welcomed.” “Care staff interact very well with residents. “ The home works well with health care professionals. What has improved since the last inspection? What they could do better: The home’s written information should clearly state who they can care for. So that people know that they will get the care and support they need. In the AQAA the home told us that they are providing care to people with mental health illnesses. Staff must have training on any specialist care the home provides. This will make sure people know their care needs can be met by the home. Claremont Nursing Home DS0000045220.V375401.R01.S.doc Version 5.2 Page 7 Bathrooms and toilets should have soap in the soap dispensers and provide waste bins. This is to make sure people have access to facilities to wash their hands and infection control is not compromised. Work is needed to the gardens around the perimeter of the house so that people can use it in the good weather to sit out. The home must make sure that the staffing levels, over each twenty four hour period, are sufficient to meet the needs of people. That means that staff have time to spend with people and all their needs will be met. The home should make sure that people and staff have access to day to day management in the home that is consistent. So that people are confident their care will be met and staff have consistent guidance and support. 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. Claremont Nursing Home DS0000045220.V375401.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.V375401.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 who use the service and their representatives have the information needed to choose a home that will meet their needs. EVIDENCE: Information is made available to anyone interested in moving into the home. During their visit to look around the home they are given a copy of the home’s brochure, which contains information about the home and the services provided. People and their representatives told us that they felt they were given enough information about the home before they decided to move in. The home told us that they can provide people with their information in other written formats such as Braille. Each person living in the home is provided with a service user guide. Claremont Nursing Home DS0000045220.V375401.R01.S.doc Version 5.2 Page 10 The relatives of someone who had recently moved into Claremont described the procedure. A senior member of staff visited the person as soon as the relatives asked, in order to assess whether or not the home could meet their needs. They then spoke to one of the relatives for an hour, to gather background information to give the home a fuller picture of the individual. On the day the person moved in, the home sent their own vehicle to collect them. Where possible the home encourages people and their families to visit the home and talk to the people who already live at the home, their relatives and the staff. The home invites them to come and spend time at the home, share a meal and maybe take part in the days activities. Two day free trial stays, as well as going to stay for short breaks, are offered to help the person get to know the home. This means that the home can get to know the persons needs and the individual has the information he or she needs to make a decision. We found that the home carries out a comprehensive assessment for all people wanting to use their service before they move in. This is to make sure that they can meet people’s care and support needs. This assessment process, as well as Social Services needs assessments when available, forms the basis for the individual plan of care and support. Claremont Nursing Home DS0000045220.V375401.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all people living in the home get a good standard of care, only some people appeared to get the care and support they need. People are protected by the medication practices in the home. EVIDENCE: From observation and discussions with staff and people living at the home, it was clear that the staff are aware of each person’s needs and preferences. The staff try to make sure they provide the help people need in the way they prefer. Seven care and support plans were looked at, to make sure that people’s health and personal care needs are being met in the way the person prefers. The plans cover each area of the individual’s care needs. They all contain enough information to guide staff on how to care for and support each person. Claremont Nursing Home DS0000045220.V375401.R01.S.doc Version 5.2 Page 12 The plans included risk assessments and management plans where someone is at risk of falling, developing a pressure sore, becoming malnourished or any other area the staff feel may put the individual at any risk. The plan of one person who sometimes leaves the home without informing staff, had no information in their care plan to remind staff of the action they must take, such as making sure this person has the name and address of the home should she or he get lost whilst out. One person’s care plan needed to be clearer on how staff should assist them with their regular pain relieving medication. This means that their pain will be under control. Records kept in people room of fluids and food taken should be current for the day to make sure there is no misunderstanding and all previous records should be removed and filed. Health care visits and treatments are recorded in detail and some people who commented said they always receive the healthcare they need. The care plans are now being reviewed regularly and show that, where possible, the individuals and their families are involved in developing, reviewing and agreeing their plans. Relatives we spoke to confirmed that they are involved in this process. Some people’s families and friends said they are very satisfied with the quality of care and support their relatives receive. We saw evidence to show that since moving to Claremont one person’s physical and mental health has improved considerably. We were told by health care professionals that sometimes when they are called to see a patient, the staff assisting them do not always know the person or where to find their care records. This means that they may not get the person’s full health history. We were told that the home gets a substantial amount of support from health care professionals, to help them to provide a good standard of care to people and to make sure that people get the care they need. We were told “Although the home has improved their delivery of care to people, the home still have some way to go to makes sure they continually provide people with a good standard of care.” People’s relatives said “there is not enough care and attention to detail; nursing depends too much on nursing opinion when a Doctor is required.” The medicines are kept safe and secure in locked cabinets. Most of the medicines are supplied by the pharmacy in a monitored dosage system, but Claremont Nursing Home DS0000045220.V375401.R01.S.doc Version 5.2 Page 13 some remain in the original packaging. The Medicines Administration Record (MAR) charts, which must show clearly the quantities of medicines received and in stock for each person, were examined. The medicines supplied in the monitored dosage system appeared to be recorded accurately. The medicine trolleys, and the room where they are stored when not in use, were locked when unattended. We checked some of the medicines that were supplied in their original packaging, to make sure the numbers that had been signed as administered tallied with the amounts received and the quantities remaining. There is now a system for keeping an up to date record of the quantities of medicines in stock, although two of the medicines we checked were not completely accurate. The controlled drugs administration appeared to be accurate. The refrigerators used for storing some medicines were being monitored, to make sure their temperatures were within an acceptable and safe range. To support their nutritional health, some people have been prescribed supplement drinks by their doctor. Each person’s supply is stored separately. This is good practice and makes sure people receive the drinks supplied specifically for them. During the visit, all the staff were seen to treat people with respect and maintain their dignity. The people who commented said that they receive the care they need and are supported to maintain their independence for as long as they are able. People’s relatives confirmed this. Everyone said the staff listen and act on what they say. Claremont Nursing Home DS0000045220.V375401.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to exercise choice and control over their daily life and social activities. More nutritious meals should be served to people, to eradicate the high proportion of nutritional supplement drinks used. EVIDENCE: There is a weekly activities plan and the home employs an activities coordinator who leads the activities, with support from the care staff, and people take part or not as they wish. We saw information in people’s care plans showing, for example, what type of music people like and the sort of activities they have enjoyed during their lives. This helps the co-ordinator plan activities that people will enjoy. However, some relatives and people said “activities could be developed further. So that people do not get bored.” We were also told by staff that there could be more activities and entertainment for people, to stop them getting bored. The people we spoke with said they would like there to be more activities available. Claremont Nursing Home DS0000045220.V375401.R01.S.doc Version 5.2 Page 15 Since the extension was completed, the activities co-ordinator has to divide her time between people in two lounges. An additional member of staff has been employed to work between 10am and 6pm and we were told that this has helped them to offer more individual and group activities. Entertainers visit the home occasionally and some outings are arranged. Special days through the year are now being celebrated and relatives are invited to join in. On Valentine’s Day this year, the main meal was moved to the evening and held in a ‘restaurant’ atmosphere, in keeping with the occasion. The co-ordinator and the staff also spend time with people on one to one activities. During our visit we saw members of staff spending time with people talking to them. The people who live at Claremont said they can do what they want, when they want. This confirmed our observations that the staff support people to live their life in the way they choose. We were told the cook plans the menus, to include the wishes of the people who live at the home and to meet any special dietary needs. There are always alternatives available if people do not want the choices on the menu. A cooked breakfast is available for people who want one, as well as a cooked meal at lunchtime and a choice of hot and cold dishes at teatime. People said that they enjoy their meals. The kitchen is always accessible to staff, so that they can make people a snack at any time of the day or night. We saw plenty of fresh fruit and vegetables and the cook said she also makes ‘smoothies’ each day. These can be particularly good when trying to tempt the appetite of people who may not always want a full meal. We were told by the home “We undertake nutritional assessments for all residents on admission and, if necessary, ‘over weight’ or ‘under nourished’ care plans.” Health care professionals indicated that the home should look at the amount of nutritional supplements used for people and look more towards providing people with meals that are well balanced and of a suitable consistency, to meet people dietary needs. People are offered hot and cold drinks and snacks throughout the day and there are jugs of juice in the lounges and bedrooms. During our visit we observed the evening meal which was fish fingers and beans, sandwiches and fruit salad and jelly. Most people had sandwiches. Claremont Nursing Home DS0000045220.V375401.R01.S.doc Version 5.2 Page 16 People’s relatives said when staff took people to the toilet they did not give them the opportunity to wash their hands, and they were concerned about infection control. On observation we did not see any of the people being given the opportunity to wash their hands before their meal. We saw at the evening meal that the tray of sandwiches and the bowl of jelly and fruit salad were left uncovered on the trolley. We saw staff assisting people with their tables and chairs, then picking up sandwiches with their hands to give to people, which we felt compromised basic food hygiene. People and their relatives said. “More variety of food is needed both at dinner and tea time. And more help is needed with drinks.” During the time of the inspection we did not see any person being offered a milky drink, despite there being several people who have food supplements prescribed for them. Claremont Nursing Home DS0000045220.V375401.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main, people who use the service are able to express their concerns and are protected from abuse. EVIDENCE: Any complaints or concerns are recorded in a complaints file. The actions taken and the outcomes are recorded. The responses to complaints dealt with all the issues raised and answered the persons concerns thoroughly. Where they are needed, improvements are made as a result of complaints investigations. The people who live at the home, and their relatives and friends, said they know what to do if they have a concern or complaint. The staff also said they know what to do if anyone has concerns. The acting manager said she is always available and makes a point of being in the home on at least two evenings each week, to give people’s relatives a greater opportunity to speak to her. The acting manager also makes sure she spends time with the people who live at the home, listening to their views and any concerns they may have. Claremont Nursing Home DS0000045220.V375401.R01.S.doc Version 5.2 Page 18 Since the last key inspection we have received five complaints. One was sent directly to the home for them to investigate, three were referred to the safeguarding adults unit at Leeds Social Services and one was sent to us from the organisation. The home had also received a further seven complaints. All the complaints were investigated and five were upheld. A copy of the outcome report was sent to the complainant and to us. We were told that complainants were given the opportunity to discuss their complaint with the registered provider. Discussion with relatives and information in some surveys indicated that there were still ongoing concerns from relatives about the standard of care their relatives received and the staffing levels in the home. Newly employed staff are made aware of the homes whistle blowing policies and procedures, to be used if they suspect abuse or see examples of poor practice. From discussion with staff it would appear that they know the procedure to follow if they become aware of any safeguarding adult issues. Some of the staff have had adult protection training in February 2009. The rest of the staff need to take this training, to make sure they all understand fully how to protect the people who live at the home. All the appropriate policies and procedures are in place to guide staff. Claremont Nursing Home DS0000045220.V375401.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 live in a clean, comfortable environment. EVIDENCE: The home is clean and fairly well maintained and everyone we spoke to said the home is always kept fresh and clean. The rooms are comfortably furnished and have a welcoming feel. A programme of re-decoration has been taking place throughout the house. This has made those rooms feel lighter and brighter. The windows in the small lounge have now been made safe, as we requested at our last inspection. Claremont Nursing Home DS0000045220.V375401.R01.S.doc Version 5.2 Page 20 There are sufficient, accessible toilets and bathrooms on all floors of the house. Two of the bathrooms are in need of re-decoration, as the walls have been ‘patched’ and not re-painted and the paintwork is generally marked. The floor covering in them is also discoloured and unattractive and looks in need of replacement. The two shower rooms, next to these bathrooms, are not used and seem to be storage spaces for commode chairs at present. Staff are employed to help look after the maintenance of the house and grounds as well as keeping the gardens tidy. There is a patio area for people to sit out in during the better weather, but some of the gardens around the perimeter of the house are unkempt and unattractive. For example, the area outside the main dining room windows, which is currently covered in grass, ivy and weeds, could be a very pleasant place for people to look out on when having their meals if it was planted attractively and properly maintained. The laundry looked well organised and hygienic. Protective gloves, aprons and disinfecting hand rub are available for staff to use when needed, to support the homes infection control measures. Claremont Nursing Home DS0000045220.V375401.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not always have access to enough staff, to make sure that their care needs are met and they are safe. Staff are given training so that they can meet people’s care and support needs and to make sure they are safe. EVIDENCE: When we visited the home there were forty two people living in the home, most of whom needed nursing care, and some who depend on staff more than others. During the day there are six care staff and two nurses on duty until 4pm, when there is one nurse and five carers. However, we were told that the home had recently employed another carer in the evening to make sure that people have another member of staff available to them. At night there are only three care staff and one nurse. People living in the home and staff told us: • There are usually enough staff available. • Sometimes there are enough staff. Some people and their relatives were concerned about the staffing levels in the home. Relatives said ”Carers interact with residents very well and are Claremont Nursing Home DS0000045220.V375401.R01.S.doc Version 5.2 Page 22 concerned with the residents welfare that is provided that they have enough time, as they have to see other people who are bed bound and the bell is frequently rung for people wanting attendance.” “ Although I have been informed that the home has the required number of staff that is needed for the amount of residents, I think that more staff is needed, extra staff could ensure that each resident drink the drinks they are given and eat the food they are given.” I have no complaints about the carers they work hard and always seem to have so much to do.” Several relatives told us that the home should have a member of staff in resident’s sitting rooms. They told us an example “someone was falling from their chair and no staff were about to assist and it was visitors who had to shout for help, because the carers had to be elsewhere. If people are sitting in these areas there should be staff readily available to them to assist them to the toilet.” Staffing levels in the home are also a concern of staff and they asked for more staff to be provided. Although during the time of the inspection there appeared to be several staff in sitting areas. We saw people in their rooms who needed attention, for example whilst walking around the building one person asked us for help to sit up, they told us they had been waiting for some time for staff to come and assist them. When we asked people if their bells were answered they, said sometimes they had to wait, but staff would come to ask them to wait whilst they completed what they were doing. They said “they are not always enough staff and they are very busy.” We were told by the provider that they have enough staff to support and care for the number of people living in the home. They also said “We have a good skill mix of staff, with both male and female care staff and registered nurses, on both days and nights.” The staffing levels appear not to meet the needs of the people using the service, whose health and welfare could therefore be adversely affected. This could also affect the importance of individualised person centred support and limit the care and support provided. We looked at the files for three staff that had been employed since the last inspection. They showed that all the required checks including two written references were completed before they started work. Three members of staff told us that they had POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) checks, and they were able to work with a POVA check but were not allowed to work unsupervised until the home received their satisfactory CRB check. The home told us “We have a good induction programme for all new starters.” Claremont Nursing Home DS0000045220.V375401.R01.S.doc Version 5.2 Page 23 Staff told us that their induction covered everything they needed very well and said they are being given training that is relevant to their role. We were sent a copy of the home’s training matrix, which showed training courses staff had attended, such as moving handling, infection control and adult protection. However, the matrix information showed that health and safety, infection control and adult protection training course are only given once. Staff should be given updated training to make sure that they are aware of current information and instructions. This would mean people are safe and staff carry out safe practices and procedures. The home told us in the AQAA that they have several people living in the home with dementia and some who have mental health needs, but we did not see any specialised training that staff had undertaken to care for these people. Some staff said they had completed a dementia course, but not all staff had done the training. Seven members of staff have an NVQ (National Vocational Qualification) level two or above; there is a plan in place for all care staff to have an NVQ. Level two. Claremont Nursing Home DS0000045220.V375401.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 day to day management of the home is not consistent, which means that people and staff do not consistently get the support and guidance they need. EVIDENCE: The acting manager has the necessary experience and qualifications to manage the home, in the best interests of the people who live there. The people who live at Claremont, their relatives and the staff said the acting manager is approachable. Since the last key inspection the home has had three managers who the organisation wanted to appoint as a registered manager for the home, however none has remained in post. Claremont Nursing Home DS0000045220.V375401.R01.S.doc Version 5.2 Page 25 We were told by senior management that the organisation was actively looking for a manager for the home, so that staff and people living in the home have consistency. Relatives said that they were concerned about the amount of managers that have been appointed in the last two years, and the home needed a manager for the day to day running of the home for continuity and consistency. The law requires managers of care services to be registered and we are concerned that the service has not had a registered manager since May 2008. A registered manager is needed to provide stability and make the required improvements to ensure people using the service receive good quality outcomes. The acting manager should submit an application to register with us without delay Staff do not have regular one to one supervision meetings with their line manager. This would support them to plan their personal and professional development and give them the opportunity to discuss any areas of concern in a confidential setting. The home told us in the AQAA, “we want to have a management team that is qualified, very proactive, supportive, caring and professional and this will be completed once a suitable manager has been appointed. Implement regular 1:1 supervision sessions for all staff.” The staff said that they are well supported and they work well together as a team. Staff meetings are not held regularly, which would encourage them to make their views known and contribute towards the running of the home. Staff told us in the surveys that what the home does well are “Training, communication a good manager and nurses.” “Our current manager supports staff clients and their families very well. “ Relatives said “when the home has a good manager and sufficient staff it runs very efficiently. Peoples personal information is stored securely when it is not being used. Where the home helps people to manage their personal finances, accurate records are kept of all transactions and all monies are securely stored. Regular audits are carried out, to make sure everything is in order. The homes policies and procedures are kept up to date, to make sure they provide relevant information to guide staff on how to act in every situation. All the regular health and safety checks for the home are carried out in a timely manner. These measures make sure that the health, safety and welfare of the people at the home is promoted and safeguarded. The laundry is well run and peoples personal clothing, as well as their bedding and towels, are properly cared for. Claremont Nursing Home DS0000045220.V375401.R01.S.doc Version 5.2 Page 26 Following their most recent inspection, the Environmental Health Officer has awarded the homes kitchen a score of 3 stars out of a possible 5, for hygiene and kitchen practice. The home is working towards implementing the requirements of their report. For example, they have arranged for a specialist firm to come in and ‘deep clean’ the kitchen. The kitchen floor needs to be replaced as it is badly cracked in the storage pantry, making it potentially unsafe as well as unhygienic. The home has regular audits and residents’ questionnaires, which help determine the quality of service the home offers. These include surveys for the people who live at the home and their relatives. The result of the audits is published in the home. We saw a result of the recent audit on the notice board in the entrance to the home. Claremont Nursing Home DS0000045220.V375401.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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X X X 3 Claremont Nursing Home DS0000045220.V375401.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 OP27 Regulation 18 Requirement The home must make sure that the staffing levels, over each twenty four hour period, are sufficient to meet the needs of people. This is to make sure that staff have time to spend with people and all their care and support needs will be met. Previous timescale of 16/6/08 not met. Staff must have training on any specialist care the home provides. This will make sure people know their care needs can be met by the home. Timescale for action 28/07/09 2 OP30 18 30/08/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP19 Good Practice Recommendations Work to the gardens around the perimeter of the house is needed so that people can use them in the good weather DS0000045220.V375401.R01.S.doc Version 5.2 Page 29 Claremont Nursing Home to sit out. 2 3 OP28 OP30 50 of care staff should be trained to NVQ level 2 or above. A registered manager is needed to provide stability and make the required improvements to ensure people using the service receive good quality outcomes. The acting manager should submit an application to register with us without delay. To make sure the home has day to day management continuity. 4 OP31 Claremont Nursing Home DS0000045220.V375401.R01.S.doc Version 5.2 Page 30 Care Quality Commission North Eastern Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northeastern@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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