CARE HOMES FOR OLDER PEOPLE
Claremont Parkway Nursing & Residential Home Holdenby Kettering Northants NN15 6XE Lead Inspector
Stephanie Vaughan Key Unannounced Inspection 21st May 2007 08:45 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 Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Claremont Parkway Nursing & Residential Home Address Holdenby Kettering Northants NN15 6XE 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) 01536 484494 01536 524262 claremont@averyhealthcare.co.uk Avery Healthcare Limited Vacant Care Home 57 Category(ies) of Old age, not falling within any other category registration, with number (57), Physical disability (30), Terminally ill (30) of places Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. To include up to four (4) service users with Dementia, excluding Mental Disorder, providing personal care To provide care for Physical Disability from the age of 35 years To provide care for the Terminally Ill from the age of 35 years The maximum number registered Fifty Seven (57) Date of last inspection 29th January 2007 Brief Description of the Service: Claremont Parkway is a large purpose built facility on the outskirts of Kettering. It has recently been further extended to provide accommodation in 66 single rooms. It is Registered to provide both Personal Care and Nursing Care. Its location in the town makes it easily accessible by private or public transport, being close to the main A14 road. Local amenities in close proximity include a cinema, supermarket, gym, pubs and restaurants. The home is spacious and well equipped. All rooms have telephone facilities, ensuite wash and toilet facilities and TV points. There are pleasant grounds, easily accessed by wheelchair users. The provider makes information available to prospective residents through the Statement of Purpose; Service Users Guide and by direct communication. The Commission for Social Care Inspection reports are included within the Statement of Purpose. Fees at the present time are between £ 404:00 & £ 1000:00 per week, with other variable charges for hairdressing, aromatherapy, chiropody, escort services, one to one outings, holiday’s newspapers and other personal items. Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Prior to this statutory inspection, a period of six hours was spent in preparation. This comprised reviewing previous inspection reports and associated requirements and recommendations; the service history, risk assessment, returned residents and relatives comment cards and other documentation. Since the last inspection the Commission have received no complaints about this service. However has received notification of one potential Safeguarding Adults referral, which is addressed in the main body of the report. The Commission have a focus on the outcomes for residents against Key National Minimum Standards and Equality and Diversity, issues relating to this are included in the main body of the report. This site visit to the home was conducted over a period of seven and a half hours and a Pharmacist Inspector was also present for approximately five hours, to review medication systems within the home. During the inspection the inspector made observations and spoke to residents and staff. A limited tour of the premises was conducted which involved viewing some of the communal areas and a selection of the private accommodation. Case tracking is the method used during inspection where of a sample of five residents were selected and all aspects of their care and experiences reviewed, including individual plans of care and associated documentation. A significant number of the residents selected for case tracking purposes had communication difficulties, in these circumstances observations made during the inspection and discussion with relatives and staff have been used to support the inspection process. The Acting Manager was present throughout this visit. Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 6 What the service does well:
Claremont Parkway Nursing Home is a modern purpose built care home, close to local facilities and transport links. Having recently been extended it is now registered to provide nursing care to sixty-six residents, from thirty-five years of age onwards, who require care for conditions due to old age, physical disability and dementia. All residents living at the home at present are white Europeans with a good command of the English language. The staff group is reflective of the cultural and gender mix of the residents. The management at Claremont Parkway Nursing Home make sure that people thinking of living at the home have the right information and can visit the home to make sure that it is somewhere that they would like to live. New residents are provided with the good information about the home and are only admitted after the staff know that the have the right skills and experience to look after the resident properly. Staff try hard to help the residents settle in to their new home and enable them to make choices about their routines and accommodation. Each resident has an individual plan of care developed, which sets out the care that the resident needs and how it is to be provided. The individual plans of care are of a good standard and contain the right information to make sure that residents are well cared for, are safe and are kept up to date. The care plans show that staff are providing the right care to individuals and that when problems occur the right action is taken to put things right and if possible prevent them happening again. Health care is managed well and as a result some residents have been able to move out to more independent living accommodation. Residents are assessed for risks to their health and have access to the right care, equipment and specialist services to prevent or manage problems. Staff support residents to access health care services such as chiropodists and opticians. Medication records are accurate and fully completed. There are regular checks to ensure that competent and well-trained staff manage medication safely. Residents and their relatives confirmed that they were in general happy with the care that is provided at Claremont Parkway Nursing Home. Staffing levels are generally good and arrangements are in place to cover staff shortages in unforeseen circumstances. Staff were seen to relate well to residents and are respectful of residents privacy. All residents were well presented and looked well cared for. Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 7 There is a good activities programme, which is circulated to residents and provides a wide range of in house activities, social events and outings. Staff also organise specific activities suitable for residents who are younger or who may not wish or be able to attend the group activities. Residents are able to go out and use the local facilities with support and are able maintain links with their family and friends. The staff at Claremont Parkway Nursing Home support residents to remain as independent as possible and to make choices in their daily lives. The service aims to promote equality and diversity and has developed policies and procedures to support this. There is evidence that care is person centred and that the service is able to meet the needs of individuals. The menu is reflective of the culture of the residents and residents are encouraged to participate in the selection of food choices included. Residents have a choice of food at each meal and the food offers a healthy balanced diet. Management have taken steps to ensure that resident’s food is consistently served at the right temperature and that residents do not have food to which they are allergic. Fresh fruit and fluids are available throughout the day. One of the relatives commented ‘The home make wonderful cakes for residents tea and generally provide wholesome food and a very good variety’. Another commented ‘The menu seems good and portions reasonable’. Complaints and the protection of adults is managed well, the service make the right information available to residents and staff are aware of their responsibilities. The standard of the environment is excellent, being spacious, well maintained and tastefully decorated. Residents are able to make choices about the layout of their rooms, fixtures and fittings. All rooms have en suite facilities and are fitted with privacy locks, lockable storage space and are well furnished. Comments form relatives included, ‘the home is always clean and fresh, well done! Nice to see fresh flowers in the home every day’. Staffing levels are calculated according to the number of residents and level of need and staffing levels are generally good. The management have arrangements in place to cover staff shortages due to unanticipated absence. Quality assurance processes are in place and the organisation is currently developing a corporate quality assurance strategy to be implemented in the near future. Safe working practices are ensured by staff having the right training, quality assurance practices, individual and general risk assessments, management of accidents and incidents accidents and fire safety procedures. What has improved since the last inspection?
Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 8 All residents now have risk assessments in place for the prevention of falls. The individual plans of care have been reviewed to make sure that staff have the right instructions about the management of life threatening conditions and that appropriate referrals are made to the General Practitioner. Individual plans of care now show that residents psychological health is monitored and that the right guidance and support is obtained. The Activity coordinators hours have been increased and staff files have been reviewed. The environment has been further developed to include a nine bedded extension, which has been well integrated into the existing building. Other developments include ongoing redecoration of some of the existing bedrooms and redecoration of the kitchen. There is evidence that the communal areas are being adapted to suit the residents needs and preferences with the dining rooms now being located on the ground floor and a further sitting room being planned for the first floor. Other improvements include the installation of specialist bathing facilities to meet the needs of residents with a high level of physical disability. Further improvements are being made to the exterior of the premises including landscaping of the grounds and a shaded sun terrace. Staffing levels have been reviewed following the increase in numbers of residents for which the home is registered and recruitment is ongoing. Staff files have been reviewed to ensure that staff have the right checks in place to make sure that residents are protected form abuse and staff training records have been computerised to ensure that staff have the right training and that it is renewed at the right time. The Acting Manager confirmed that an application for registration of the manager has been submitted to the Commission in February this year. However the Commission has not received this. The Acting Manager has agreed to resubmit the application as soon as possible and to send by recorded delivery. The security of the main entrance has been reviewed as a result a key pad system has been installed which enables relatives and staff to have easy access and to prevent intruders from gaining access. Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 9 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 10 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 Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 11 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs are appropriately assessed prior to moving into the home, ensuring that their care needs can be met. EVIDENCE: The Statement of Purpose has recently been reviewed to accommodate information about the new extension and the addition of nine more beds. The Statement of Purpose is provided to prospective, new and existing residents and is also available in the main entrance. The Acting Manager confirmed that documentation such as the Service Users Guide and Statement of Purpose could be produced in large print if necessary.
Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 12 Current residents are all white European with a good command of the English language, however information could be provided in other languages and formats should the need arise. Residents confirmed that they had information about the home before they moved in and all relatives commented that they also had received enough information about the home before their relative was admitted. The Acting Manager confirmed that all residents have up to date contracts in place and the response to residents comment cards confirmed that most residents were aware that they had a contract. Individual plans of care evidenced that all residents have comprehensive preadmission assessments conducted by appropriately qualified and experienced staff. These assessments ensure that the service is able to meet the resident’s health, personal and social care needs and form the basis for the development of detailed individual plans of care. Individual plans of care also evidence that copies of care management assessments are also obtained when these have been conducted. New admissions are managed well, staff spoken to confirmed that residents and their representatives are able to visit the home, spend the day there and have a meal prior to deciding if they would like to live there. There was one admission on the day of the inspection, staff were on hand to greet the new resident and spent time helping him to select one of the vacant rooms most suitable for his individual needs. They also took time to help him to settle in and provide information such as the Service Users Guide, newsletter and the activities programme. The Acting Manager is mindful of the need to provide information to residents in suitable formats according to their needs and there was some evidence that this was being developed in the form of large print with pictorial formats for the activities programme. The service does not provide intermediate care. Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 13 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have an individual plan of care, which demonstrates that their health, personal, and social care needs are met. Residents are supported to manage their own medication where appropriate and accurate medication records are made by well trained and competent staff, which helps to ensure that medication is given safely and correctly. EVIDENCE: The preadmission assessments provide the core information about the residents needs and forms the basis of the individual plans of care. Following admission these are further developed to include information about residents
Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 14 needs, including their routines and preferences. At present there is little documented evidence that these are developed with the active involvement of the residents or their representative. This was discussed with the Acting Manager who has agreed to involve the resident or their representative wherever possible. Individual plans of care contain comprehensive and detailed instruction to staff about how the residents health, personal and social care needs of the residents are to be met. All residents now have risk assessments in place for the prevention of falls that specify the risks involved and include some of the controls necessary to reduce and manage the risk. In addition residents have risk assessments in place for the safe use of bedrails. The Acting Manager has agreed to review the risk assessments to ensure that these are in line with the current best practice guidelines. Individual plans of care evidence regular and timely review, however there is little evidence of the residents, or their representatives involvement of the review. This was discussed with the Acting Manager who has agreed to address this. There is evidence that residents health care is managed well, resulting in good outcomes for residents. The service has enable ten residents within the last twelve months who were originally admitted on a permanent basis to recover and move to more independent living arrangements. There is currently no discharge policy in place, however the Acting Manager has agreed to develop this to ensure appropriate arrangements are made to ensure a smooth transition. All residents are assessed for the risks of pressure and there was evidence that these are regularly reviewed. Residents have access to appropriate pressure relieving equipment and the incidence of pressure ulcers is low. Where residents cannot be weighed appropriate arrangement are in place to ensure that the residents are monitored based on current best practice. All residents are assessed for their nutritional risk and there was evidence that those at risk have access to appropriate specialists such as the dietician. The management of residents with a high level of nursing needs is good, care plans contain detailed and specific information about the management of specific interventions such as Percutaneous Endoscopic Gastrostomy Feeding, these are based on current best practice and the daily records and charts provide a clear audit trail that the care is given as directed. All residents have appropriate continence assessments and movement and handling assessments in place and these are kept under review, appropriate aids and equipment is available.
Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 15 There is now evidence that residents psychological health is monitored and that appropriate support and referral is provided when required. The staff work closely with the Community Psychiatric Nursing Service. Residents have access to a range of health care specialists such as general practitioners, consultants, opticians, chiropodists and specialist nurses such as community psychiatric nurses. All residents confirmed that staff listened and acted on what they said and that they usually received the care and support that they required. There were some specific comments from both residents and relatives that indicated that resident’s care was not always delivered as required. However on discussion with residents, relatives and staff it was established that these incidents were occasional and due to unforeseen circumstances such as staff sickness. Other variations in the delivery of care were due to the wishes or the condition of the resident. Individual plans of care evidence that when things do go wrong the management take the right steps to address the shortfalls. All relatives commented that they were kept up to date with important issues. One commented that they would like to have regular reviews with staff about their relatives care. The pharmacist inspector looked at medication records, medication, and storage arrangements. Medication is managed well, medication records were accurate, complete and up to date with information relating to medication included in residents individual plans. However handwritten medication administration records were not always signed, dated and witnessed. Residents are encouraged and supported to be independent and take responsibility for administering their own medication. One resident was being given additional support by staff to ensure that they could continue administering their own medication for as long as possible. When medication is administered via Percutaneous Endoscopic Gastrostomy tubes there is information available to confirm that the GP authorised administration by that route. However there is nothing to confirm that professional advice had been sought to ensure that individual medications were safe to give in that way. Medication is generally stored safely and securely however fridge temperature records showed that the fridge had consistently been above the recommended temperature. Eye drops that should be stored in the fridge were in a trolley and the fridge was being used to store clinical samples next to medication. Dates of opening were recorded on medication with a reduced expiry once opened however the dates had been exceeded by over two weeks for some eye drops.
Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 16 Privacy and dignity is managed well, staff were seen to treat residents with respect and to refer to them by their preferred form of address. Residents were well presented and had access to their personal property and aids to maintain their independence. Personal care is delivered in private and were seen to knock and await permission prior to entering residents personal accommodation. Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities and meals are both managed well, are creative and provide daily interest for people living in the home. EVIDENCE: Daily life and social activity is managed well, individual plans of care indicated that residents routines were flexible and varied according to their needs and wishes. Since the last inspection the hours of the activity coordinators have been increased to ensure that the planning of social activity is more proactive. The staff are enthusiastic about their role, mindful of the varying needs of residents and consult with individuals to ensure that equality and diversity is maintained. One relative commented ‘Staff respect my relatives opinions and encourage him when he is reluctant to socialise’. Younger residents are consulted and activities developed according to their needs. Residents who cannot or do not wish to attend the group activities are supported individually
Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 18 by appropriate means including hand massage, aromatherapy, access to music and companionship. Staff are keen consult other specialists such as the community psychiatric nurse and occupational therapists for guidance where it is required. A variety of group entertainments are provided including in house activities such as games, visiting entertainers, social activities and outings. Residents are currently involved in producing the artwork to be included in a calendar. One relative commented ‘The activities programme is very good with lots of different activities going on’. Activities are publicised and circulated to each resident, the information is available in large print and pictorial format. All residents who responded to the questionnaire commented that there were activities that they could participate in. One resident commented that they were sometimes unable to participate in the activities because there was not enough staff to take him down stairs to the activities in his wheelchair. This was discussed with staff who confirmed that there had been occasions when this had occurred however these were rare and due to unforeseen circumstances. Care plans contained specific information regarding individual resident’s wishes to be taken downstairs to the lounge to participate. Residents are supported to maintain links with the local community by going on outings and shopping trips and are able to receive their chosen visitors in private should they wish to do so. Visitors were seen to be coming and going freely. Residents are supported to maintain their autonomy and choice in their daily lives examples include choosing how and where to spend their time, choice of food, organising the layout of their room to meet their needs, the provision of additional fixtures and fittings, including access to satellite television. Residents are able to bring in their personal possessions. The service aims to promote equality and diversity and has developed policies and procedures to support this. There is evidence that care is person centred and that the service is able to meet the needs of individuals. Information submitted with the pre inspection documentation indicates that there is a formal menu in place and that arrangements are in place for residents to contribute to the menu planning and select their preferences from the menu on a daily basis. The menu indicates that residents have access to a varied and balanced diet with alternatives at each meal. Fresh fruit and fluids are available throughout the day. Most residents stated that they usually liked the food provided. Some of the residents commented that the food could be cold when served in their own rooms. This was discussed with the Acting Manager who confirmed that there had been some problems regarding this, however following recent changes to the environment more residents were now choosing to use the downstairs dining room, which is nearer to the kitchen and reduces the risk of food
Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 19 cooling. She confirmed that consideration had been given to the use thermos dishes, however this has not been introduced because of the risks of burns and scalds to residents. The lunchtime service was viewed, with particular reference to the food being served in resident’s rooms. Hot meals were served on heated plates and were appropriately covered to retain the temperature and prevent contamination. No more than two residents were served at one time to reduce the risk of food cooling; management continue to monitor the situation. Meals appeared of adequate proportion, well presented, with soft diets being appropriately pureed. Residents requiring support were supported appropriately and with sensitivity. Staff and residents commented that the teatime service could be improved regarding the choice of sandwiches. Residents confirmed that they were aware that there was an alternative hot savoury alternative usually available should they wish to choose it, however comments indicated that they would also prefer to have the option of a light, cold alternative to the sandwiches. One of the relatives commented ‘The home make wonderful cakes for residents tea and generally provide wholesome food and a very good variety’. Another commented ‘The menu seems good and portions reasonable’. Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 20 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive procedures for handling complaints and abuse are in place ensuring residents are fully protected. EVIDENCE: The service has a clear and appropriate complaints policy, which is included in the Statement of Purpose and Service Users Guide. Additionally a copy of the complaints policy is displayed in the main entrance. The Acting Manager confirmed that information about the complaints policy could be made available in alternative formats such as large print and other languages should this be required. The complaints file was viewed and evidenced that complaints are managed appropriately, when things go wrong the management take the right action to prevent a reoccurrence. The file demonstrated that complaints are fully investigated and that a full written response is provided to the complainant within an appropriate time frame. Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 21 The Acting Manager confirmed that she had an open door policy and that she was available to speak to residents or their relatives during working hours and also that she could be contacted through he mobile phone at other times. Comment cards indicated that most residents knew who to speak to if they were unhappy and that they knew how to complain. All of the relatives who responded confirmed that they knew how to complain. Following a Requirement made at the last key inspection all staff files have now been reviewed and evidence appropriate Criminal Records Bureau Clearances and references for new, existing, self employed and volunteer staff are now in place. There has been one potential Safeguarding Adults incident during the last twelve months, the Local Authority Guidelines for the Safeguarding Adults were followed and a full investigation was conducted. The findings indicated that the staff member had acted in an emergency in the best interests of the residents and within his sphere of competence. Protocols and procedures have been developed to support staff in the event of reoccurrence. Staff spoken to were clear about their responsibilities in the Safeguarding of Adults. Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 22 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The standard of the environment is excellent, providing residents with a safe, comfortable and flexible place to live. EVIDENCE: The premises are suitable for their stated purpose, being purpose built and well laid out, rooms are spacious light, well ventilated, heated, clean and hygienic. Since the last key inspection there has been an extension to the home comprising a further nine single rooms. Other developments include the
Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 23 ongoing redecoration of some of the existing bedrooms and redecoration of the kitchen. There is evidence that the communal areas are being adapted to suit the residents needs and preferences with the dining rooms now being located on the ground floor and a further sitting room being planned for the first floor. Other improvements include the installation of specialist bathing facilities to meet the needs of residents with a high level of physical disability. There is evidence that residents have a choice of room to suit their individual needs and preferences and that they are consulted about the layout, fixtures and fittings. All rooms have en suite facilities and are fitted with privacy locks, lockable storage space and are well furnished. Most residents confirmed that the home was always clean and fresh. Relatives comments confirmed this and indicated that there had been improvements made to the standard of the environment such as redecoration of the corridors and replacement carpets. Improvements are being made to the exterior of the premises including landscaping of the grounds and a shaded sun terrace. No hazards were identified. Comments form relatives included, ‘the home is always clean and fresh, well done! Nice to see fresh flowers in the home every day’. Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 24 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 17, 19 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home employs appropriate numbers of inducted and well trained staff to ensure that residents are in safe hands and that their needs are met. EVIDENCE: Staffing levels are calculated according to the residents assessed dependency and in accordance with the Department of Health recommendations. Current levels exceed these recommendations and include two registered nurses and nine care staff during the morning, two registered nurses and seven carers in the afternoons and two registered nurses with four carers at night. The Acting Manager has reviewed existing staffing levels to accommodate the increased number of residents that the service is now registered for and is currently recruiting staff to increase the numbers on each shift by two staff. Nursing and Care staff are supported by adequate levels of staff to support the social and domestic needs of residents such as the catering, housekeeping and maintenance.
Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 25 The staffing mix is consistent with the resident’s gender and ethnicity. Most residents commented that staff were usually available when they were needed, however a number of comments referred to incidents where the home had been short staffed. This was discussed with the Acting Manager and other senior staff who confirmed that there had been occasional incidents where the service had been short staffed due to unforeseen circumstances. When staffing levels are compromised by staff sickness arrangements are in place to obtain extra staff either by staff working extra shifts or by the use of agency staff and that these arrangements are put in place as soon as possible. The layout of the home and the level of dependency of the residents does mean that staff may not be not highly visible at all times. The Acting Manager has agreed to review the working and communication arrangements to ensure that there is a system where the person in charge of the shift can be easily identified and located by visitors to the home. Staff training records have now been computerised which demonstrates that staff have access to appropriate mandatory training, which is regularly updated; such as Induction, Movement and Handling, Fire Safety, First Aid, Health and Safety, Basic Food Hygiene and Safe Administration of Medication. In addition staff have access to additional training which is provided in order for them to meet the existing and developing needs of residents including Safeguarding Adults, Dementia care parts 1 & 2, Continence and Catheterisation training, Enteral Feeding training and the Management of Terminal Illness. Further training is scheduled for the near future and includes Nutrition for Life and Visual Impairment training and training about specific medical conditions. 82 of care staff have National Vocational Qualification in Care level 2 or above which exceeds the Department of health target of 50 . Staff files have been reviewed since the last key inspection and are now in good order. They contain evidence that recruitment is managed appropriately and that staff have access to appropriate information such as the Nursing and Midwifery Council best practice guidelines and professional codes of conduct. Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 26 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate leadership, guidance and direction means that the home is managed in the best interests of residents. EVIDENCE: A Requirement was made at the last random inspection for the Acting Manager to submit an application for registration with the Commission. This was discussed with the Acting Manager who confirmed that the required information and application had been submitted to the Commission in February this year. However this has not been received by the Commission and may therefore have been lost in the post. The Acting Manager has agreed to
Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 27 resubmit the information as soon as possible and to send it by recorded delivery. The Acting Manager confirmed that quality assurance procedures were in place within the home and include regular surveys of residents and visitors views of the home. In addition there is a suggestion box in the main reception areas with comment forms available for use. Regular audits are conducted of the care plans, medication systems, first aid equipment, health and safety audits and environmental audits. The Service provider is currently developing a corporate quality assurance strategy, which is due to be implemented in the near future. The service does not hold any money for residents. Staff files evidenced that staff supervision is conducted in a regular and timely fashion. Relatives comments include ‘The home is on the whole very well run’ and ‘ the home is of a high standard to others that we have visited, both as a family and in our professional capacity’. Safe working practices are ensured by appropriate mandatory training, quality assurance practices, individual and general risk assessments, management of accidents and incidents accidents, fire safety procedures. Following a Requirement made at the last key inspection a security system has been installed to the main entrances to ensure that unwanted intruders are unable to gain access. Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 29 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard OP9 OP9 Good Practice Recommendations Handwritten medication administration records should be signed, dated and also signed by a witness to reduce the chance of errors. Where medication is administered via a Percutaneous Endoscopic Gastrostomy tube the advice of a pharmacist should be sought to ensure that individual medication is being given safely. Storage arrangements should be reviewed to ensure that storage temperatures are appropriate, clinical samples are not stored with medication and that medication is disposed of when the recommended expiry date has been exceeded to ensure that medication in use has not deteriorated or become contaminated. 3 OP9 Claremont Parkway Nursing & Residential Home DS0000066165.V337769.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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