Inspection on 21/11/05 for Clarence Care Home

This inspection was carried out on 21st November 2005.

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

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

Other inspections for this house

Clarence Care Home 27/04/07

Clarence Care Home 08/05/06

Clarence Care Home 25/04/05

Clarence Care Home 14/12/04

Clarence Care Home 06/07/04

Clarence Care Home 06/01/04

Similar services:

Cheaney Court Care Home

Chater Lodge

Conifer Lodge

Egerton Lodge Care Home

Edenhurst Care Home

Ernehale Lodge Care Home

Ecton Brook House

Cherry Trees @ Hazel Hill

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Clarence Care Home Huthwaite Road Sutton In Ashfield Nottinghamshire NG17 2GS Lead Inspector Jayne Hilton Unannounced Inspection 21st November 2005 10:00 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 Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 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. Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Clarence Care Home Address Huthwaite Road Sutton In Ashfield Nottinghamshire NG17 2GS 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) 01623 558422 01623 558113 Mimosa Healthcare Group Limited *** Post Vacant *** Care Home 47 Category(ies) of Dementia - over 65 years of age (47) registration, with number of places Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The Manager undertakes training on Adult Protection Issues and the mental health needs of older people within the next twelve months Service users shall be within category DE(E) only (47) Date of last inspection 27th June 2005 Brief Description of the Service: Clarence Care Home is a purpose built two storey home situated outside the centre of Sutton in Ashfield. It provides residential care only for up to 47 service users with Dementia All bedrooms are single with en suite facilities and the home has four lounges and dining rooms available. There is an enclosed garden to the rear accessed by patio doors from the units on the ground floor and plenty of car parking spaces to the side of the building. The home is pet friendly, recently acquiring a pet dog for the service users in addition to the budgies and goldfish already resident in the home. Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit took place on 21st November 2005 for duration of 3.5 hours. The purpose of the visit was assessing the key standards not assessed at the previous inspection carried out over the last inspection year and the progress of requirements set the previous visit. One service user was interviewed and many others were spoken with throughout the inspection. Two staff members were spoken with at this visit. A tour of the premises was undertaken at this visit. A sample of policies were also examined as part of the inspection methodology, a sample of staff personal files and four care plans, the staffing rota, complaints records, a sample of accident records and the pre inspection questionnaire. What the service does well: There is a good care package in place for service users, which identifies the health, personal and social care needs of service users are well addressed. Service users health and safety is safeguarded, by the practices of staff in the home and service users wishes for the end of life are well documented. Service users maintain contact with family/friends and the community and generally exercise choice and control over their lives, however there is still further evidence required that service users are fully in control of their meal options. Service users enjoy their meals. Service users are confident that their complaints are listened to. Service users benefit from an accessible, safe and well maintained environment, which is furnished in a homely way. The home is clean, pleasant and hygienic and provides a safe environment for service users to live. Staffing levels are appropriate to meet service users needs. The manager has applied to be registered under the assessment for fitness process. Service users are generally safeguarded by the homes accounting and financial procedures in the home, but further development is needed. Staff are appropriately supervised but again further development of this would be beneficial to all. Record keeping is generally satisfactory. The health and safety and welfare of service users and staff is generally promoted and protected. Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The above standards were not assessed at this inspection; Standard 3 was assessed in the inspection on 24th April 2005. Standard 6 is not applicable. EVIDENCE: Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, 10,11 There is a good care package in place for service users, which identifies the health, personal and social care needs of service users are generally well addressed. Service users wishes for the end of life are well documented and service users spoken with confirmed their privacy was respected. Some further work is recommended regarding the monitoring and evaluation for challenging behaviour. EVIDENCE: From examination of four service users care plans it was found that the requirement set from standard 8 at the last inspection in relation to the evaluation and history of falls was found to be met. Care plans were found to be well written and appeared to meet the needs of service users, these had been reviewed monthly. Daily progress notes were on the whole well written, however one service user’s daily notes, did not reflect the situation reported by the manager and regarding the GP being called out in relation to the service user presenting challenging behaviour. Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 Page 10 Care plans were in place for other service users who presented challenging behaviour but there was not a system apparent for monitoring and evaluating behaviour and this is recommended. The use of tools such ABC [Antecedent, Behaviour and consequences] would assist in assessing if patterns or triggers of behaviour were evident. A service user spoken with reported that her health care needs were met and prompt referrals were made to the GP when needed. Risk assessments and assessments for mobility, nutrition and tissue viability were in place and reviewed and up to date. Service users signatures are included as part of the care plan process. Good records are kept regarding personal care. The wishes of service users for the end of their life were noted to be, well documented and appropriate policies and procedures are in place for staff to follow regarding caring for a person who is dying or upon death. There were some information sheets in the care plan folders that addressed whether service users wished to be resuscitated in the event of needing CPR. This acts as an advanced statement made by the service user, which states they do not wish to be resuscitated. [DNR]. Service users autonomy must be respected however the inspector advised that these advance directives should be obtained with caution and clear guidance for staff and managers as to who has the ultimate responsibility for the DNR decision [usually a doctor] and regarding service users capacity to make such a decision at the time of admission to the home. Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14, 15 Service users maintain contact with family/friends and the community and generally exercise choice and control over their lives, however there is still further evidence required that service users are fully in control of their meal options. Service users enjoy their meals. EVIDENCE: Visitors are welcomed at any reasonable time and a policy for visiting was clearly in place. The home has employed another activities co-ordinator, which the manager reports that will increase opportunities for service users to go out more into the community. The Alzheimer’s society is involved with the home. A service user confirmed that she could go to bed and get up when she wanted and that she was able to make decisions in her life. She had just received some personal mail, which had been given to her unopened. The service user explained she had her privacy respected at all times and could receive visitors in private including her solicitor if need be. The service user confirmed that she had lockable facilities in her room and a key to her bedroom door. Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 Page 12 A new menu has been devised; this is over a four-week cycle. Several service users reported that the food was most enjoyable, however one service user stated that the meat could be a bit tough. The inspector has been working with the home for many months in enabling choice of menu items for service users and keeping a record of this. Two days menu options were seen, including the day of inspection and a staff member confirmed that service users are asked the day before what option they prefer for the following day. However a service user spoken with said that this practice was not consistent and that no one had asked her for her choice for the days meal. A staff member stated to the service user she had selected a particular meal option and asked if she still required that option or the other. The service user opted for the other item, stating that she would not have selected the first option, as she doesn’t eat salad and said someone else must have chosen for her. The inspector was therefore still not convinced that the meal option system is working effectively and the manager was asked to address this. The meal options provided appeared appetising and nutritious. Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Service users are confident that their complaints are listened to EVIDENCE: A complaints policy is displayed in the home and a response is promised within 5 days. A recommendation is made once again to reflect in the outcome documentation whether the complaint is upheld, not upheld or resolved. It is also recommended that follow ups are made regarding complaints to ensure the service users/relatives continue to be happy that the complaint is resolved and that practice is improved etc. There was one complaint recorded since the last inspection, regarding missing clothing and hearing aid and around issues of a service user not looking smart. The complaint appears to be resolved but doesn’t state the outcome or any follow up A recommendation is made once again to reflect in the outcome documentation whether the complaint is upheld, not upheld or resolved. It is also recommended that follow ups are made regarding complaints to ensure the service users/relatives continue to be happy that the complaint is resolved and that practice is improved etc. A service user confirmed that she knew how to make a complaint and quoted the name of the previous CSCI inspector as evidence. The service user reported that she had no complaints and felt that any would be dealt with appropriately. Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 Page 14 Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 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): 19,20, 21,22 23, 24 25, 26 Service users benefit from an accessible, safe and well maintained environment, which is furnished in a homely way. The home is clean, pleasant and hygienic and provides a safe environment for service users to live. EVIDENCE: A tour of the home was made. The homely environment appeared comfortable and furniture and soft furnishings were in good order and the layout of the home is spacious and service users were observed moving freely within their designated units. The garden area is enclosed. The patio area was level and accessible. Service users bedrooms were noted to be comfortable, personalised and free from hazards and window restrictors were in place throughout. En-suite facilities are provided. Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 Page 16 Keypads are in place for security. Toilet and bathrooms are adequate and suitable for people with disabilities. Hoists and appropriate equipment are provided for transfer of service users with poor mobility Call alarms are sited throughout the home. Lighting is of a domestic style and radiators were noted to be of the low surface type. There was no mal odour present in the home on the day of the inspection and all areas examined were clean and pleasant throughout. A linen trolley was stored in a bathroom, which could pose a risk of cross infection. Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 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, 29 Staffing levels are appropriate to meet service users needs. Recruitment practices were not satisfactory and an immediate requirement set in relation to this. EVIDENCE: The staffing rota was examined for 38 service users in residence 5/ 6 care staff are rotered for daytime cover and 3 /4staff for nights. The manager works supernumery and catering and housekeeping staff appear sufficient. Staffing levels appear to be meeting service users needs, with positive feedback from all a service user spoken with and asked in relation to whether they feel there is sufficient staff to see to peoples’ needs. Staff were observed by the inspector to be calm and unhurried, when carrying out their duties and were seen to be taking time to sit down and speak with service users. A staff member confirmed that staff do make the effort to sit with service users, but stated that there are strict rules about not eating whilst in attendance of service users and regarding staff breaks. The requirements set at the previous inspection in relation to recruitment had been met. This had been confirmed by the inspector working with the home to achieve compliance. Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 Page 18 The acting manager reported that there had been one new staff member employed since she had taken over. This staff member’s file was examined and found not to meet the legislative requirements for overseas staff. There was a police check in place for the staff member’s place of birth, but no CRB or Pova check for this country. Therefore an immediate requirement was issued regarding this and that the staff member must not be allowed to work until the required checks have been carried out. Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 Page 19 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, 35, 36, 37, 38 The manager has applied to be registered under the assessment for fitness process. Service users are generally safeguarded by the homes accounting and financial procedures in the home, but further development is needed. Staff are appropriately supervised but again further development of this would be beneficial to all. Record keeping is generally satisfactory but care plans were not stored securely. The health and safety and welfare of service users and staff is generally promoted and protected. The electrical circuit safety check is overdue and must be carried out promptly. EVIDENCE: Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 Page 20 A new acting manager has been in post for about a month and an application has been submitted to CSCI for registration. The acting manager is a trained nurse. Staff and service users reported confidence in the new manager. It was clear that the manager was still settling in needed time to familiarise herself with the home, staff, service users and expectations of the Care Standards Act 2000, The Care Home Regulations 2001 and the National minimum Standards. A sample of service users financial records were examined and in the main was in order. Valuables kept on behalf of service users in the safe are not currently receipted for and this should be actioned promptly. The system for receipting needs to be improved so that appropriate receipts are attached to the correct record sheet. The administrator and manager confirmed that the accounts are audited periodically and the inspector recommends that this be evidenced on the records. The inspector noted that service users had been charged a £1.00 as a contribution to an entertainment booking, however there was no statement about this expectation in the statement of purpose/service user guide. The registered person is advised to ensure that if service users are to be charged for extras such as entertainment that this is clearly written in the service user guide or contract. The policy in place for staff shopping on behalf of service users needs to clearly indicate it is illegal for staff to benefit from making purchases on service users behalf and the auditing procedures should support this. Staff confirmed that formal supervision takes place, however on examination of staff personal files these are not carried out at least 6 times a year. The format currently in place relies on the staff member to decide the subject criteria and it is recommended that the format is structured around topics for discussion such as all aspects of care practice, philosophy of the care in the home as well as staff training and development needs. Care plans were, observed to be left unattended in the lounge area. Care plans must be kept secure. A visitor’s book is in use. Accident records were examined and found to be in order and cross referenced to care plans. An appropriate accident book was in use. An induction booklet was examined and health and safety topics were clearly covered. The pre inspection questionnaire indicated that the electric circuit test certificate was overdue. There was no evidence at the inspection that this had been renewed. A requirement is therefore set for this to be obtained within four weeks as is now 18 months overdue. Servicing contracts for equipment and health and safety checks were otherwise in order and evidence was seen that the catering staff hold food hygiene certificates. Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 Page 21 Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x x x 2 3 2 2 Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard OP29 OP37 OP38 Regulation 7,9,19 17 16, 23 Requirement Timescale for action 21/11/05 Ensure staff are not employed without the appropriate recruitment checks. Immediate Care plans must be stored 21/12/05 securely Evidence of an up to date electric 21/12/05 circuit test must be submitted to CSCI RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP8OP7 OP15 OP16 OP26 Good Practice Recommendations Ensure the care plans of those service users who present challenging behaviour are current and up to date and that behaviour is appropriately monitored and evaluated. The acting manager should ensure that service users are being given informed meal options Further develop the complaints format to include whether the complaint is upheld or not and follow ups are documented. Towels\and linen stored in bathrooms/toilets present a risk of cross infection. The linen trolley should not be placed in DS0000008746.V253786.R01.S.doc Version 5.0 Page 24 Clarence Care Home any of these rooms. 5. OP35 Improve the financial procedures as described in the report. 1, address the £1.00 charge for entertainment 2, provide receipts for valuables kept on service users behalf 3 further develop the policy for shopping on behalf of service users regarding staff not benefiting from service users purchases. 4,Ensure there is evidence that the financial processes are audited. Formalise the supervision agenda topics for discussion and ensure staff are offered up to six sessions a year. 6. OP36 Clarence Care Home DS0000008746.V253786.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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. 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