Inspection on 27/04/07 for Clarence Care Home

This inspection was carried out on 27th April 2007.

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

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

Other inspections for this house

Clarence Care Home 08/05/06

Clarence Care Home 21/11/05

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 Key Unannounced Inspection 08:00a 27th April 2007 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 DS0000008746.V335510.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. DS0000008746.V335510.R01.S.doc Version 5.2 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 clarence@mimosahealthcare.com Mimosa Healthcare Group Limited Melanie Harding Care Home 47 Category(ies) of Dementia - over 65 years of age (47) registration, with number of places DS0000008746.V335510.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1 No one falling within category DE(E) may be admitted into Clarence Care Home where there are 47 persons of category DE(E) already Date of last inspection 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. Fees range between £290-£503. Information obtained from the manager on 27/04/07 Service users are expected to pay extra for Hairdressing, Chiropody and Body Massage DS0000008746.V335510.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This inspection took place over 6 and a half daytime hours. The main method of inspection used was called ‘case tracking.’ This involves selecting four residents and looking at the quality of the care they receive by talking to them, examining their care files and discussing how support is offered to them by staff members. Many of the people who live at this home have a very limited ability to understand and communicate. Therefore many judgements in this report are from observation and reading residents’ records and documents. Not all residents who were “case tracked” were spoken with, as either they did not wish to give an opinion about the care provided or they were not available. Other residents were spoken with throughout the inspection process however. Two relatives were spoken with at the inspection. Two members of staff and the manager were spoken with as part of this inspection, documents were read and medication inspected to form an opinion about the quality of the care provided to residents. Prior to completing this visit the inspector assessed the homes previous inspection reports, the service history including complaints and adult protection referrals. The Pre-inspection questionnaire completed by the manager, twenty completed resident’s satisfaction questionnaires and two relatives questionnaires were also received prior to the completion of the inspection report. What the service does well: Outcomes for service users are very good. DS0000008746.V335510.R01.S.doc Version 5.2 Page 6 Their health, personal and social care needs are set out in the individual plan of care. Medication management is satisfactory. Service users feel they are treated with respect and their right to privacy is upheld. Service users maintain contact with family/friends and the community and exercise choice and control over their lives and enjoy their meals. The activities provision appears to meet most service users needs. Service users are confident that their complaints are listened to and said they felt safe. Service users benefit from an accessible, safe and well maintained environment, which is furnished in a homely way and the home is clean, pleasant and hygienic and provides a safe environment for service users to live. Appropriately recruited, trained and supported staff meets service users needs. Service users have the information they need about the home, have a written contract and their needs are fully assessed. Service users are generally safeguarded by the homes, management, accounting and financial procedures in the home. The health and safety and welfare of service users and staff is promoted and protected. Service users and their relatives commended the staff team for their respect and patience and for their engagement and interaction with service users with Dementia. What has improved since the last inspection? The provision of staff training has improved alongside procedures for handling service users finances. Service users are being consulted more about the quality of care provided and the activities provided are more varied and stimulating for service users. DS0000008746.V335510.R01.S.doc Version 5.2 Page 7 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. DS0000008746.V335510.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 DS0000008746.V335510.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 and 3 Quality in this outcome area is good Service users have the information they need about the home, have a written contract and their needs are fully assessed. The home does not provide an intermediate care service. EVIDENCE: Service users and/or relatives sign within the care plan that they have been issued with a copy of the service user guide. Four care plans were examined and contained detailed assessments, which meet the standard. Service users individual and specific needs are identified and staff receive training in Equality and Diversity. Relatives spoken with confirmed that they had accessed the last inspection report when considering the home. DS0000008746.V335510.R01.S.doc Version 5.2 Page 10 It is recommended that information on accessing inspection reports is posted in the home and includes the web site details of the Commission. DS0000008746.V335510.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8. 9 and 10 Quality in this outcome area is adequate Service users health, personal and social care needs are set out in the individual plan of care. Medication management is satisfactory. Service users feel they are treated with respect and their right to privacy is upheld. EVIDENCE: From examination of four service users care plans they were found to be comprehensive, well written and appeared to meet the needs of service users, these had been reviewed monthly. Daily progress notes were well written. The care plans contained a sheet for service users/relatives to indicate how much involvement they prefer in the compilation and review of the care plan, however not all had been completed. This provided minimal evidence of service user/relative involvement and therefore needs to be further developed. Accidents are appropriately recorded and copies kept in individual service users files. Statistics are kept as part of monitoring falls and accidents. It is recommended that a running record is kept of individual service users falls within their care plan and which details and analysis’s the incidents of falls and the action taken to prevent further occurrence of falls. DS0000008746.V335510.R01.S.doc Version 5.2 Page 12 The management of diabetes is well managed but care is needed that care plans contain who is responsible for monitoring of individual blood sugars and that the type of diabetes is fully documented. Two events had occurred earlier in the year, which had identified that some service users were at risk of eating soap, although appropriate action had been taken to minimise this kind of risk to service users, Care plans and risk assessments had not been implemented in relation to two service users who the risk of this type of event was greater. Authorisation for the use of bedrails were in place but it is recommended that service users and their representatives be fully informed of the risks bedrails may present on the documentation for which they are signing agreement to. Care should also be taken that monthly reviews of risk assessments, use all information provided within the care notes for example one review for April 2007 indicated no change in the pressure area risk assessment for one individual but there was evidence in the notes that a pressure area had developed in March 2007 and no care plan had been yet implemented in relation to this. Relatives spoken with commended the care given to their relatives and other service users, commenting that service users needs [Particularly in respect of continence needs] were attended to promptly by staff and that staff find time to sit with service users. One relative commented that the home had taken immediate action in respect of her relative’s requirement of personal care being provided by female staff only. Service users spoken with confirmed that staff treated them with respect and maintained their privacy and dignity. Relatives spoken with confirmed that this was their experience when visiting the home Medication management was assessed as satisfactory. DS0000008746.V335510.R01.S.doc Version 5.2 Page 13 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): 11, 12, 13, 14,15 Quality in this outcome area is good Service users maintain contact with family/friends and the community and exercise choice and control over their lives and enjoy their meals. The activities provision appears to meet most service users needs, but closer assessment of individual needs and preferences should be explored. EVIDENCE: Visitors are welcomed at any reasonable time and a policy for visiting was clearly in place. The home employs an activities co-ordinator and The Alzheimer’s society is involved with the home. There were conflicting contributions from service users, staff and relatives in relation to activities provision. The majority reported that the activities programme suited their needs, others said not and felt they needed more one to one time spent with them on activities. Staff stated that service users were using the garden more now the weather is warmer. Relatives spoken with spoke highly of the activities provision and especially about the weekly coffee morning which they attend and which they stated provides mutual support and contact between other relatives and service DS0000008746.V335510.R01.S.doc Version 5.2 Page 14 users. They added that they wished the coffee morning would be more supported by other relatives. The activities programme is arranged on a monthly cycle and included, Games crafts, bingo, movement to music, reminiscence, gardening reading the newspaper, shopping, nature walks canal trips, excursions and pub lunches. Entertainers visit periodically to sing or play music for the residents. Staff reported that they access priests and church personnel as requested and that all religious festivals are celebrated and that there are no service users currently at Clarence with specific cultural needs. Service users and staff spoken with confirmed that service users could go to bed and get up when they wanted. Several service users reported that the food was most enjoyable and this was supported by the returned questionnaires. There was evidence of records kept for meal option choices and service users spoken with confirmed that they were given a choice of meals. Lunchtime was observed satisfactory practice was observed.. The food seen appeared appetising and nutritious and relatives confirmed this was also the case and one added that her relative had gained weight since moving into the home. Relatives said it would be nice to have the menu displayed. DS0000008746.V335510.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is good Service users are confident that their complaints are listened to and said they felt safe. EVIDENCE: Service users and relatives confirmed that they knew how to make a complaint, should they need to, but relatives could not recall viewing a complaints procedure. The complaints procedure is included in the service user guide but it is recommended that this is posted in various places within the home for people who would not necessarily have access to the service user guide /welcome pack. The full contact details of the Commission For Social Care Inspection must also be accessible There were two complaints recorded by the home since the last inspection. Complaint issues included lack of cleaning of an en-suite and a service users not being provided with a jug of water in their room. The issues had been responded to. One complaint involved a personal issue of the service user and was not a formal complaint against the home. DS0000008746.V335510.R01.S.doc Version 5.2 Page 16 One complaint hade been made to the Commission for Social Care Inspection in July 2006, this was investigated by the Provider and found Not to be Upheld. Staff spoken with were aware of the whistle-blowing policy and that they would report on any poor practice. Training in abuse awareness has been provided for most staff. Further training is being arranged. Relatives praised their observation of staff practice and their positive engagement with service users stating that any distressed service users are supported and assisted to regain their well being and that even when some service users are very challenging staff remain calm and patient. There has been four incidents reported under the Safeguarding Adults protocols in the previous twelve months, which no further action was recommended. Service users finance records were examined and found to be satisfactory. DS0000008746.V335510.R01.S.doc Version 5.2 Page 17 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, 24 and 26 Quality in this outcome area is good 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. Keypads are in place for security. DS0000008746.V335510.R01.S.doc Version 5.2 Page 18 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. The home smelled fresh on the day of the inspection and all areas examined were clean and pleasant throughout. Gloves and paper towels were observed supplied throughout. There were no issues raised in relation to laundry services or infection control procedures. DS0000008746.V335510.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is good Appropriately recruited, trained and supported staff meets service users needs. EVIDENCE: The staffing rota was examined for forty three service users in residence six care staff are rotered for early daytime cover five for the afternoon/evening shift and four staff for nights. The manager works supernumery and catering and housekeeping staff appear sufficient. Additional activities provision is also provided. Care staff were observed to be deployed to lounge and dining areas on the day of the inspection, senior staff were observed overseeing and ensuring reports and medication practices were in hand etc. Updates in training are ongoing and staff reported a good level of training provision. Records supported this. Four staff personnel files were examined. Recruitment practices were on the whole satisfactory with evidence of appropriate checks in place. However the recruitment practices of the home could be improved in relation to reference requests and verification that, these are provided by previous employers The manager reported in the pre inspection information that eighteen staff hold at least NVQ 2 this [70 of staff]. DS0000008746.V335510.R01.S.doc Version 5.2 Page 20 Service users and relatives stated that the staff are wonderful. DS0000008746.V335510.R01.S.doc Version 5.2 Page 21 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, 32, 33, 35 and 38 Quality in this outcome area is good Service users are generally safeguarded by the homes, management, accounting and financial procedures in the home. The health and safety and welfare of service users and staff is promoted and protected. EVIDENCE: The manager has been assessed as suitable for registration recently. The manager is a trained nurse. Staff, relatives and service users reported confidence in the manager. Comments made included that the manager was very approachable and has good contact with service users and relatives. DS0000008746.V335510.R01.S.doc Version 5.2 Page 22 Service user and relatives meetings take place and the manager gives updates on developments and planned action in the home. Relatives and staff confirmed that the manager is open to ideas and will listen to suggestions. Quality monitoring systems are in place, including Regulation 26 visits by the Responsible individual, Audits etc. Service user and relative surveys are prepared and are to be sent out to obtain views about the service. A sample of service users financial records were examined and found to be satisfactory. 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. Servicing contracts for equipment and health and safety checks were otherwise in order and evidence was seen of the five yearly electrical safety check and fire risk assessment. DS0000008746.V335510.R01.S.doc Version 5.2 Page 23 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 x 3 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x 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 3 3 x x x x 3 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 X X 3 DS0000008746.V335510.R01.S.doc Version 5.2 Page 24 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 3 4 5 6 7 Refer to Standard OP1 OP7 OP7 OP7 OP8 OP8 OP8 Good Practice Recommendations Provide information to service users and visitors about how to access copies of previous inspection reports as discussed. Ensure all care plans contain evidence that the service users or their representative are in agreement to their plan of care Ensure care plans contain details about the type of diabetes the person has been diagnosed and how this is to be managed. Where service users present challenging behaviour, a care plan needs to be implemented for staff to follow. Include a running history of events of falls in the individuals care plan for mobility and any action taken to prevent further occurrence Ensure risk assessments and care plans are in place in relation to the risk of soap inhalation. Ensure risk assessments are appropriately evaluated every month to ensure information is not overlooked in relation DS0000008746.V335510.R01.S.doc Version 5.2 Page 25 8 9 10 OP12 OP15 OP29 to development of pressure areas. Look at ways to ensure all service users leisure needs are met taking on board their comments in the report. Display the daily menu where it is accessible to service users and their relatives. More attention should be given to information about referees given by newly recruited staff to ensure that references are obtained from the person’s previous employer wherever possible. DS0000008746.V335510.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 DS0000008746.V335510.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!