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Inspection on 21/09/06 for Claremount House Nursing Home

Also see our care home review for Claremount House Nursing Home for more information

This inspection was carried out on 21st September 2006.

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

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

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

What the care home does well

What has improved since the last inspection?

The manager Roy Bennett has confirmed his position and the company have also appointed an experienced clinical manager. Care plans have continued to improve.

What the care home could do better:

A revised statement of purpose would give current and prospective residents up-to-date information about the home, its management and services available. Adult protection policies and procedures need to be clarified and confirmed to all staff, to make sure that residents get the protection they need. Bathing facilities that allow residents to bathe independently or with minimal assistance should be reinstated on the top floor. The numbers of staff with an NVQ level 2 qualification must increase. The manager must make an application to the Commission for Social Care Inspection for registration.

CARE HOMES FOR OLDER PEOPLE Claremount House Nursing Home Claremount Road Claremount Halifax West Yorkshire HX3 6AN Lead Inspector Sughra Nazir Unannounced Inspection 10:20 21 September 2006 st 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 Claremount House Nursing Home DS0000001047.V298219.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. Claremount House Nursing Home DS0000001047.V298219.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Claremount House Nursing Home Address Claremount Road Claremount Halifax West Yorkshire HX3 6AN 01422 331121 01422 367289 claremount.house@craegmoor.co.uk 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 Care Homes (No 2) Ltd Care Home 22 Category(ies) of Dementia - over 65 years of age (22), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (22) Claremount House Nursing Home DS0000001047.V298219.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Elderly service users over 60 years of age Can accommodate a maximum of 2 services users aged 55 to 65 years, category MD and DE. Can accommodate one named service user under 65 years of age, category DE. 17th February 2006 Date of last inspection Brief Description of the Service: Claremount House is registered to provide nursing and personal care for up to 22 older people with mental health needs. The establishment is situated in the Claremount district of Halifax with easy public transport links to the town centre. The establishment is generally well maintained with all bedrooms being for single occupancy and spacious communal areas. A safe and secure attractive garden area is available for the use of the residents. Fees range from £700 to £895 per week dependant on the level of need. A copy of the previous inspection report is made available on request. Claremount House Nursing Home DS0000001047.V298219.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) will be inspecting homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. All regulated services will have at least one key inspection between April 2006 and June 2007. This is a major evaluation of the quality of a service and any risk it might present. It focuses on the outcomes for people using it. All the key National Minimum Standards are assessed and evidence gathered is used to assess outcomes experienced by residents. On occasions it may be necessary to carry out additional site visits, some visits may focus on a specific areas and are known as random inspections. This was the first key inspection of this home for the 2006 to 2007 period. Due to the number and nature of requirements outstanding from previous inspections the indicative quality rating for this home was adequate. The manager is not registered with the Commission. The visit to the home was carried out by one inspector who took 8 hours to gather information by looking at files and speaking to the residents, the manager and staff before giving the manager detailed feedback. Prior to the visit 2 pre-inspection questionnaires were sent out to the manager for completion. Neither was returned. Surveys were sent to the home for completion by residents and relatives. To date, ten responses have been received from relatives or visitors. Ten survey forms have also been received from service users. Any comments made in the surveys or during the site visit are included in the report. Claremount House Nursing Home DS0000001047.V298219.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: A revised statement of purpose would give current and prospective residents up-to-date information about the home, its management and services available. Adult protection policies and procedures need to be clarified and confirmed to all staff, to make sure that residents get the protection they need. Bathing facilities that allow residents to bathe independently or with minimal assistance should be reinstated on the top floor. The numbers of staff with an NVQ level 2 qualification must increase. The manager must make an application to the Commission for Social Care Inspection for registration. Claremount House Nursing Home DS0000001047.V298219.R01.S.doc Version 5.2 Page 7 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. Claremount House Nursing Home DS0000001047.V298219.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 Claremount House Nursing Home DS0000001047.V298219.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 The quality in this outcome area is adequate. This judgement has been based on available evidence including a visit to this service. Pre-admission processes are good. Current and prospective service users do not have all the information they need to make sure the home will meet their needs EVIDENCE: There is a statement of purpose displayed in the home but this does not contain up-to-date information about management arrangements, and the improved facilities available at the home for example the snoozelum and the millennium garden Preadmission processes are detailed. The clinical manager has negotiated new protocols with referring hospitals to make sure the home gets all the information they need. Detailed assessments were seen on file. The home does not provide intermediate care. Claremount House Nursing Home DS0000001047.V298219.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8.9 and 10 The quality in this outcome area is good. This judgement has been based on available evidence including a visit to this service. Care plans are detailed and based on comprehensive assessments of need. Care practice is respectful. EVIDENCE: A number of care plans were reviewed during the inspection. All had a good level of detail. Care plans review forms have been implemented and the standard of documentation is improving. Some entries were difficult to read. One care plan seen showed very good attention to the cultural and religious needs of the service user. This included references such as • To be dressed according to cultural needs • Female staff to attend to hygiene and dressing • Religious diet food prepared separately • Staff to be aware of religious festivals • Relatives to provide some intimate care. This is good practice Claremount House Nursing Home DS0000001047.V298219.R01.S.doc Version 5.2 Page 11 Service users’ interests and abilities are assessed and an individual activity plan devised. It was agreed that where call bells have been placed out of reach, there would be written confirmation on file and alternative measures for ensuring the residents’ welfare would be agreed and recorded. The home continues to use a cassette system, supplied by a local pharmacy, for the administration of medication. The medication is securely and appropriately stored, and records examined were completed accurately. The qualified nursing staff are responsible for handling medication in accordance with NMC guidelines. Care practice was observed throughout the day and residents were treated with respect and dignity. One survey response from a relative said their relative received “ excellent care at Claremount House” and that the family feel extremely fortunate that their loved one is cared for so well. End of life and death and dying wishes are recorded on individual care plans. Claremount House Nursing Home DS0000001047.V298219.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 14 and 15 The quality in this outcome area is adequate. This judgement has been based on available evidence including a visit to this service. Service users’ preferences are identified and daily routines are flexible to enable social and emotional needs to be met. Minor improvements are needed to ensure that mealtimes and activities meet assessed needs. EVIDENCE: Service users have access to a snoozelum room. Staff were also seen applying hand cream and giving hand massages this had a very calming effect on the residents. Music was playing unobtrusively throughout the day. The manager spoke about a collection of old movies on dvd and plans to introduce a plasma tv screen to create a tv lounge. Residents have access to a very pleasant garden. Some assist with gardening tasks. There is a wide range of activities for relatives and family carers including a relatives support group called the Blossom Again project and 6 weekly meetings. The home has organised trips for relatives such as a boat trip. There is very good contact with relatives, families and friends. Claremount House Nursing Home DS0000001047.V298219.R01.S.doc Version 5.2 Page 13 Some choice is offered at mealtimes and residents can decide whether or not to participate in activities. Lunchtime was observed at the home. Residents were assisted into the dining room from 11.35am, lunch was served after 12pm. A couple of residents became anxious during the lunchtime period this was handled well. It was suggested that the move to the dining room could be closer to lunchtime or that some activity could take place to occupy residents during the wait. It was also suggested that a blind in the dining room would increase the comfort of diners using the room in bright sunlight. Residents had access to a range of crockery including lidded beakers this helps to maintain independent eating. Staff providing assistance did so discretely. One member of care staff was holding a resident’s hand to reassure them throughout the meal. This is good practice. Choice was offered at the table. Portion sizes were very similar and could be varied to meet individual need. Residents did not all have drinks; this included those who had been identified as needing additional fluids. Claremount House Nursing Home DS0000001047.V298219.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality in this outcome area is adequate. This judgement has been based on available evidence including a visit to this service. Service users are protected from abuse but some improvement is needed to make sure staff are aware of their responsibilities. EVIDENCE: The complaints procedure is normally displayed in the reception area. Two of the 12 survey cards returned stated that respondents were unaware of the complaints procedure. The home reports that no complaints have been received since the last inspection. A record of complaints is kept. The company has polices and procedures in place to respond to allegations of abuse. These do not make reference to local arrangements. One recent example shows that care staff did not immediately act upon an allegation and that the home’s management do not have access to consistent advice from the company. The arrangements must be clarified and confirmed to all staff. Induction records seen show that staff receive good training on recognising the signs of abuse. Claremount House Nursing Home DS0000001047.V298219.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 26 The quality in this outcome area is adequate. This judgement has been based on available evidence including a visit to this service. Residents have access to secure and well-maintained facilities. An assisted bath needs replacing. EVIDENCE: The lounge and communal areas of the home are in good order. All areas of the home seen were found to be clean. The programme of refurbishment includes updating residents’ bedrooms. It was suggested that more pictorial or photographic signage is introduced to aid orientation. An assisted bath has been removed from the top floor and has not been replaced. This reduces the number of facilities available to residents. Bathing facilities that allow residents to bathe independently or with minimal assistance should be reinstated on the top floor Some call bells have been placed out of reach where these are unsuitable for residents because of the nature of their difficulties. Claremount House Nursing Home DS0000001047.V298219.R01.S.doc Version 5.2 Page 16 Personal toiletries were seen in the assisted shower room and the manager was asked to remind all staff that this is not good practice. One relative said that the items sent for laundry are “always pressed and smell nice.” Claremount House Nursing Home DS0000001047.V298219.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The quality in this outcome area is good. This judgement has been based on available evidence including a visit to this service. Staff are trained and available in such numbers to meet service users needs. Recruitment practices are robust. EVIDENCE: A relative in their survey response said “ this is a well-run home plenty of staff who do a good job. “ There is a commitment to training within the establishment, with a programme of in house training. Staff have access to training in dementia care. Staff files examined indicated that thorough recruitment practices are in place. There was evidence of two written references, proof of identity, an application form and a POVA and CRB disclosure within the files. 3 out of 14 care staff hold an NVQ (National Vocational Qualification) at level 2. 6 others are enrolled on the course. Claremount House Nursing Home DS0000001047.V298219.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 The quality in this outcome area is adequate. This judgement has been based on available evidence including a visit to this service. Management staff provide good leadership and encourage a positive ethos and philosophy of care. However the home is operating without a registered manager. EVIDENCE: The home’s manager and Clinical manager work well together. There is clear leadership. The manager must make application to the Commission for registration. The home is run in the best interests of service users and there is very good communication with relatives. The home has an administrator and recordkeeping is good. Health and safety checks are maintained in line with company requirements. Claremount House Nursing Home DS0000001047.V298219.R01.S.doc Version 5.2 Page 19 Claremount House Nursing Home DS0000001047.V298219.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 2 X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Claremount House Nursing Home DS0000001047.V298219.R01.S.doc Version 5.2 Page 21 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 OP1 Regulation 4 Requirement The Statement of Purpose and Service User Guide to be revised to reflect the current management arrangements within the home. Previous timescale of 31st March 2006 is unmet. Timescale for action 31/12/06 2 3 4. OP18 OP21 OP28 13 23 18 Adult protection procedures must 31/12/06 be made clear to all staff. The registered person must 31/03/07 ensure that the assisted bath is replaced on the top floor. 50 of care staff must be 30/04/07 qualified to NVQ II. Previous timescale of 30th June 2006 is unmet An application to be submitted to the CSCI for registration of the manager. Previous timescale of 30th April 2006 is unmet. 31/01/07 5. OP31 9 Claremount House Nursing Home DS0000001047.V298219.R01.S.doc Version 5.2 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Claremount House Nursing Home DS0000001047.V298219.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Claremount House Nursing Home DS0000001047.V298219.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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