Inspection on 10/11/09 for Clarence House

This inspection was carried out on 10th November 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC 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 House 08/03/10

Clarence House 15/10/08

Clarence House 14/02/08

Clarence House 16/04/07

Clarence House 29/08/06

Clarence House 10/04/06

Clarence House 03/11/05

Clarence House 28/04/05

Clarence House 11/01/05

Clarence House 20/10/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Clarence House 42 Warwick New Road Leamington Spa CV32 6AA Lead Inspector Sandra Wade Key Unannounced Inspection 10th November 2009 09:00 DS0000040534.V377620.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Clarence House DS0000040534.V377620.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Clarence House DS0000040534.V377620.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clarence House Address 42 Warwick New Road Leamington Spa CV32 6AA 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) 01926 832826 01926 882677 svsrbn@aol.com Dr Jeyaratha Sivasoruban Mr Kanagasabai Sivasoruban Manager post vacant Care Home 21 Category(ies) of Dementia (5), Old age, not falling within any registration, with number other category (21) of places Clarence House DS0000040534.V377620.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 21 Dementia (DE) 5 The maximum number of service users who can be accommodated is: 21 14th February 2008 2. Date of last inspection Brief Description of the Service: Clarence House is a large Victorian property that was converted from a hotel to a care home in 1984. The home has parking to the front with a ramped access into the building. There is a garden at the rear of the home which can be viewed from the conservatory. The home is situated less than a mile from the town centre with all major facilities readily accessible. The home provides care for 21 older people including five people with dementia care needs. The accommodation is arranged on three floors, there is a passenger lift and a chair lift to ensure accessibility. On the ground floor there is a communal lounge and dining room plus a conservatory which has a hairdressing sink that can be used by a visiting hairdresser. Also on the ground floor there are four single bedrooms and one double bedroom. On the first floor and mezzanine floors, there are seven single and one double bedroom. On the top floor there are a further three bedrooms, one of which is a double room with an en suite. There is one shower room and various bathrooms but these do not have assisted facilities such as a hoist to support people in getting into the bath. Some of the toilets are not accessible by wheelchairs and have limited space for staff to give support. Commodes are made available in rooms as required. At the time of this inspection the fees stipulated in the Service User Guide were £383 to £465. Fees do not cover personal laundry, newspapers, overseas Clarence House DS0000040534.V377620.R01.S.doc Version 5.2 Page 5 telephone calls, hairdressing, chiropody, dry cleaning, dentistry, optical treatment or specialist equipment. Fees are subject to change and should therefore be confirmed with the service. Clarence House DS0000040534.V377620.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that people who use the service experience poor outcomes The last key inspection to this service was on 15 October 2008. The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This unannounced inspection took place between 9.00am and 8pm. Two people who were staying at the home were ‘case tracked’. The case tracking process involves establishing an individual’s experience of staying at the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. A completed Annual Quality Assurance Assessment (AQAA) was received from the service prior to the inspection detailing information about the care and services provided. Information contained within this document has been included within this report where appropriate. Records examined during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, accident records, complaint records, maintenance records, records of money managed by the home and medication records. A period of time was spent in the communal areas of the home to observe what it may be like for people living in the home. Both breakfast and lunchtimes were also observed. A tour of the home was undertaken to view specific areas and establish the layout and décor of the building. What the service does well: People receive an assessment of their needs prior to staying at the home to ensure their needs can be met. The home has an Activity Co-ordinator to help provide social activities to people living in the home. Clarence House DS0000040534.V377620.R01.S.doc Version 5.2 Page 7 Comment cards received from six relatives showed that five felt the service “always” supports people to live the life they choose and one felt they “usually” did. New staff undertake comprehensive induction training to ensure they can care for people effectively. More than half of the care staff have completed a National Vocational Qualification level II in Care. Achieving the Award should enable staff to identify and respond appropriately to people’s needs. Positive comments have been received about the home and staff including “has a very caring attitude to all residents and will oblige if a relative has a request”, “good carers” “the home really cares for X, X is healthier, fitter and cleaner that X has ever been before”. A relative stated “the carers are wonderful and I am quite satisfied with the care”. What has improved since the last inspection? What they could do better: Care plans must to be developed for each assessed care need and be regularly evaluated to ensure any changes in people’s health are identified and responded to. The provider must ensure that the home has a registered manager so that people can be confident the care home is being managed in their best interests. Clarence House DS0000040534.V377620.R01.S.doc Version 5.2 Page 8 The person managing the care home must apply to be registered with the Care Quality Commission as it is an offence to carry on a care home without being appropriately registered. The service needs to demonstrate that people are being provided with a varied, appealing and wholesome diet. This includes those people provided with liquidized meals which should be appealing in terms of texture, flavour and appearance so that people can enjoy them. Systems in place for the management of complaints must be improved by keeping records of any complaints received as well as outcomes so that people can be confident these are being managed appropriately. The Service User Guide needs to be produced in a format which allows people to access the information easily. This guide needs to contain all of the information required to help people make informed decisions on whether to stay. Some areas of the environment are in need of attention. This includes the repair or replacement of some of the furniture provided by the home for use in people’s bedrooms, ensuring water taps work effectively and replacement of marked and stained carpets. The provider told us that he is planning to replace a number of carpets, however this should be completed as soon as possible so that the home is in good order. A review of bathroom and toilet facilities should be undertaken to ensure these are accessible, suitable and sufficient to meet the needs and choices of people living in the home. Staff recruitment records need to be clear and include start dates and references requested and received. This is so people can be confident there are robust procedures in place to protect them. Staff training records need to be appropriately detailed or supported with training certificates to demonstrate each member of staff has completed training as required to care for people safely. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 9 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 House DS0000040534.V377620.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3 were assessed. People using the service experience good quality outcomes in this area. People have access to some information about the home and have their needs assessed before they decide whether the home can meet their needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People who may be interested in living in the home are provided with some information about the service but this is limited. The Service User Guide contained a Statement of Terms and Conditions for the Home including the fees but there was no sample contract or a copy of our summary inspection report. This means that people may not have all the information they need to make an informed decision on whether to stay. The Service User Guide had been produced in a variety of small print fonts which could make it difficult for some people to read. Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 11 The provider had clearly recognised that the Service User Guide needs to be improved as it was stated in the AQAA: “A new Service User Guide with better visual representation is being proposed. It will provide better information as to how the needs are going to be met. It will also include more information about the staff that will be looking after the service user. Additional information will be made available about our staff selection”. The provider explained that the new Service User Guide was in the process of being agreed before being printed. It was confirmed that a Service User Guide was currently being made available for people who decide to stay and a brochure containing pictures and details of the home is given to people who visit. We were told that this information could be made available in audio tape if requested. Comment cards received from relatives of people living in the home showed that three people felt they “always” get enough information about the care service to help them make decisions and three people felt they “usually” did. People are invited to visit the home before they decide to stay. The AQAA states: “We use a comprehensive assessment tool to obtain a full picture about the resident as possible. “We….. encourage the prospective resident to spend time at the home normally after the initial assessment to gain an idea about the home”. One person told us they had visited the home for a day before they decided to stay. Records viewed for two people showed that the manager had undertaken an assessment of their needs prior to them coming to the home. One of these assessments was not dated to confirm this was completed prior to them coming to stay. The manager had recorded the date in the diary when she had visited this person and told us the assessment would have been completed on this date. Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10 were assessed. People using the service experience adequate quality outcomes in this area. Not everyone can be confident that they will have a care plan or that staff will have access to the information they need to meet people’s needs. People are treated respectfully but they cannot be confident their privacy and dignity will be promoted and maintained. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The AQAA completed by the provider states “Our Care plans are improving as more and more details are being included. Our medicine management has also improved including record keeping”. “We keep comprehensive records relating to all aspect of personal care including monthly weight charts, bath records, chiropodist visit, dental visits, audiology visits”. Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 13 We found that people were wearing clean clothes, their hair was combed and their nails were trimmed and clean. Comment cards received by us from six relatives showed that that all felt the service was providing the care and support that they expected and had agreed. Comments included: “has a very caring attitude to all residents and will oblige if a relative has a request”. “treat X like an individual and show X a lot of empathy”, “the home really cares for X … X is healthier, fitter and cleaner that X has ever been before, X’s health matters are attended to regularly”. We looked at the care files of people identified for case tracking. On viewing care records we found the care plans in one care file were in a standardised format and were easy to follow but in another they were still using care plans that had been devised for the person when they were living at their previous accommodation. Only two care plans for mobility and a health condition had been newly developed. This person had been in Clarence House for several months and an assessment of their needs had been undertaken before they came to the home. It was therefore not clear why new care plans had not been developed in line with the needs identified on the assessment. Records did not show that this person’s needs had been evaluated since they had come to the home. It was therefore difficult to identify the changes in the health of the person to make sure they were being appropriately supported by staff. The manager acknowledged that new care plans should have been developed and said this was something she was in the process of doing. The manager told us that all other care plans had been updated. Daily records had been completed for this person and identified they had developed a sore area and broken skin. It was not clear from the daily records whether this person continued to have this sore area although staff were reporting that they were applying cream to the skin. There was no care plan in place for skin or pressure sores to give clear direction to staff on how this should be managed. It was not evident this had been discussed with the GP. On checking the medication records there was no cream prescribed for this person to show that the GP was aware of this sore area and had agreed what cream should be used to treat it. On viewing the person’s bedroom a pot of cream was found but it was not evident this had been prescribed for them as this part of the label had been removed. Staff were unable to give an explanation for this. A pressure sore risk assessment had been completed which confirmed this person was at high risk of developing pressure areas but which also stated the person had “healthy skin”. This had not been evaluated since September 2009. We asked staff about the person skin and no concerns were mentioned they only confirmed full ‘personal care’ was being given. Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 14 Since the last inspection the manager has taken action to develop a short term care plan format for people diagnosed as having a health care need that requires ‘short term’ care. The sample care plan looked at was for a chest infection. This was detailed and appropriate with clear staff actions to be taken to support the person. The manager said this format was being introduced for all short term health care conditions and staff would be provided with training on how to use these effectively. A person who had diabetes had a care plan detailing the symptoms associated with this and the staff actions required to manage them. The care plan was not dated to show when this had been developed and there were no indications that this had been evaluated to see if any changes to the support or condition had been identified. The GP’s notes showed there had been several communications with the home in relation to controlling the blood sugar levels for this person. There had been changes in medicine, changes to dosages and changes in the way the way blood sugar levels were to be monitored. None of this information had been reflected in the care plan. Staff explained that they would take a blood sugar reading if they felt the person was displaying symptoms of concern but there was no clear directive as to when they should seek medical advice or assistance. It was not evident that staff had agreed an acceptable range of readings with the GP for this person so that they knew when further specialist assistance should be sought. There was a blood sugar reading written in the care plan which the manager indicated was considered an ‘acceptable’ standardised reading for everyone and which was included in all diabetic care plans. We audited the medicines of two people involved in case tracking by comparing the quantity in stock against the signatures on the medicine administration records (MAR). We found the administration of medicines was generally being managed well. Medicines were being appropriately stored and dispensed from a medicine trolley that was secured to the wall when not in use. All medicines checked had the correct amount of medicines received, administered and remaining demonstrating these had been given as prescribed. Staff explained that only those people who were trained in medication were able to administer medicines to people in the home. We found that there were very few people with prescribed creams despite creams being available in people’s rooms. Some of the creams found were out of date meaning that even if they were being used they may not have been effective. Where staff consider creams are needed for people this should be referred to the GP so that they can prescribe an appropriate cream for the health condition and advise how often it should be used. Failure to do this could result in the person’s health condition not being managed effectively. Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 15 There were no people on controlled drugs so no audit was completed in this respect. People living in the home were observed to be treated with respect by staff who were friendly and supportive whilst also encouraging them to be independent. For example staff supported people to walk from the lounge to the dining room at a pace suited to their needs as opposed to using a wheelchair. Staff assisted people to the toilets or bedrooms to deliver any personal care. During the tour of the home it was found that several rooms had large windows which were overlooked by other houses or the main road. Many people had commodes in their rooms which staff confirmed were being used. There were no blinds or alternative methods to protect people’s privacy and dignity when curtains were open. The provider said he had discussed the use of net curtains with the fire service who had advised they were not ideal in terms of fire safety. The manager agreed that people’s privacy was being compromised in some rooms. Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15 were assessed. People using the service experience adequate quality outcomes in this area. People are not always offered alternatives at meal times and although there are some social activities these may not always be suited to individual needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There was a relaxed atmosphere in the home for most of the day although at one time both the television and music was on in the lounge at the same time. Some people chose to sit and watch television and others wandered up and down the lounge. Some attempted to go outside through the door from the lounge but due to the cold weather were encouraged by staff to stay within the home. The AQAA states that people have: “daily stimulus from our activities lady consisting of quizzes, games, sing-a-long, as well as exercises and physical activity, movement to music, craft, painting and card making etc twice a week”. Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 17 There is an Activity Co-ordinator who is employed to work from Monday to Thursday from 10.30 to 1.30pm each day. During this time she undertakes various activities with people in the home. Staff explained this included quizzes, reminiscence, armchair exercises, ‘catchball’ and drawing. They also said that they have some outside providers that visit the home to undertake a mobility class and movement to music. A crafting class is also held on Thursday mornings. Records are kept of social activities that people participate in and on the day of inspection a game of skittles took place in the lounge. The manager said that on Fridays when the activity co-ordinator is not working they take people on outside visit such as to the shops. One person asked about outside visits said “they offered to take me out for a meal” but said they mostly watched television or read the newspaper. When asked about social activities provided they said “not much really”. Another person who participated in a board game said “not much else really is here”. One person was observed to be less able to participate in some activities. We established that they did not always have the opportunity to receive social stimulation in other ways such as hand massages. It was suggested that many of the activities provided “go over their head” so they sit and observe. Comment cards received from six relatives showed that five felt the service “always” supports people to live the life they choose. One person felt they “usually” did. At lunch time people were given the choice of two hot meals, Shepherds Pie or Faggots with vegetables and gravy. The meals looked appetising and some people chose to have their meals in the dining room and others in the lounge with a small overchair table. Staff were seen to assist some people to eat in a sensitive manner and without rushing them. One of the liquidised meals had all the food items liquidised together as opposed to being liquidised separately. This prevents the person from being able to taste each food item individually to enhance their enjoyment of the meal and also prevents the meal from looking appetising. This was discussed with the cook on duty with a view to this being reviewed. Menus seen did not indicate that choices are being provided consistently and records of meals chosen by people were not being kept. This means people cannot be confident they will be offered choices or receive a varied and nutritious diet. People spoken to said of the food “its quite good” “its passable” and indicated there is “not really” a choice. Adapted crockery was in use to help those people who may have difficulties eating to be more independent in eating their meals. Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 18 The kitchen looked clean and organised. Both full fat and semi skimmed milk was available to allow people choices as well as ensure those people with specific nutritional needs could be offered food with a higher calorie content. Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. People using the service experience adequate quality outcomes in this area. People cannot be confident that complaints are taken seriously We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The AQAA states “over the past 12 months, two families have made an informal comment and one family member had raised a formal complaint. The informal complaint/comment has been around 1) Decoration and Fittings in The Room 2) Staffing (Over Certain Periods we have used agency staff to supplement our staff to cover holidays and sickness) This has been acted upon in a timely manner. The home has a complaints procedure in place but this does not include contact details for the Care quality Commission or the Local Authority which would give people the opportunity to raise any concerns with external agencies. The provider stated that they had received around ‘five’ complaints and these were linked to the laundry service. These were not recorded in a complaints register and those complaints identified in the AQAA were also not recorded in a complaints register. This means people cannot be confident that complaints Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 20 are appropriately investigated and acted upon within agreed timescales. This issue was raised at the last inspection of the service and remains outstanding. The provider said that problems with the laundry had been resolved because they now had a ‘back up’ drier and washing machine should the laundry equipment fail. We have received one complaint in relation to this service. This was in relation to unpleasant odours from the toilets off the lounge area and transportation of pads through the home creating unpleasant odours. We found that there is a sliding door from the lounge to the toilet area in addition to the doors on each of the toilets to try and eliminate any odours from entering the lounge. It was however evident that this continues to be a problem in the home as these toilets are the most convenient for people to use on a regular basis. Comment cards received by us showed that all relatives were aware of how to make a complaint about the care provided if they needed to and all staff comment cards received showed they knew how to respond to any concerns raised. The AQAA states the following in the section headed “what we could do better”. “The opportunity for raising complaints and comments should be increased. Some families may feel embarrassed to raise a complaint. We found during the inspection that a door was locked on the fire escape route on the top floor. This places people at risk and is not considered a safe practice. Further details are contained within the health and safety section of this report. A policy on how to manage allegations of abuse is in place but this did not clearly indicate the names and telephone numbers of people that would need to be contacted in the event of an allegation of abuse. The training schedule showed that all staff had completed training on the protection of adults on the same day in 2009. The provider said this was achieved by training staff in short blocks of time throughout the day. Staff spoken to confirmed they had completed training in abuse and were aware of who they needed to report it to. This included the manager and us. Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 21 and 26 were assessed. People using the service experience adequate quality outcomes in this area. Whilst some areas of the home are pleasant and decorated to satisfactory standards, other areas are in need of attention to ensure people live in a clean, safe, accessible and homely environment that is suited to their individual needs and preferences. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The AQAA states: “A substantial part of the home has been refurbished and all of the carpets within the home have been renewed (Lounge Area replaced in 2004, 2006 due for replacement in Oct-2009). The kitchen complete refurbishment 2005-2007. Some of the residents have personalised their rooms with their own belongings, furniture cushions, quilt covers photographs etc. Since the last inspection radiators have been suitably covered”. Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 22 We found there is a dining room and communal lounge on the ground floor which are separated by glass doors. At the far end of the lounge there is a small kitchenette where staff can prepare drinks for people. The lounge has a variety of seating including several leather sofas. These areas were decorated to a satisfactory standard. We observed the new radiator covers fitted to help prevent the risk of burns to people should they fall or lean against them. On undertaking a tour of the home we found several of the carpets in bedrooms and corridors to be stained and marked and one of the commodes in a bedroom was dirty. Commodes checked in other rooms were found to be clean. The provider said the carpets were all due for renewal before Christmas and this had been delayed due to other works taking place in the home. Some of the bedrooms viewed were clean and decorated to satisfactory standards but others were in need of attention. People had brought in some of their own possessions such as pictures and ornaments to make them more homely. Some of the furniture in bedrooms was broken or worn this included sets of drawers with missing knobs/handles which could make it difficult for people to open them. A sink unit was worn and water damaged around the door and top of the unit, this had resulted in rough edges which an older person could catch and damage their skin. In one person’s room we found the cold water tap did not work, in another room hot and cold water taps were operating the wrong way round eg the tap indicated as ‘hot’ was the ‘cold’ water tap. This could add to the confusion for those people with dementia. The wash hand basin in one room did not have a plug and the person would not therefore be able to have a wash in their room. Some of the rooms have ensuite facilities, those that do not, have wash-hand basins and commodes if required. Communal toilets are available but some of these are limited in space which would restrict staff being able to provide support if required. Many of the toilets seen did not have raised toilet seats to help assist people in using them although they did have hand rails. All communal toilets and bathrooms did have liquid soap and paper towels to help maintain good hygiene although several bathroom areas had toiletries in them that were not named. This suggests these are being used communally which is not considered to be good practice in relation to infection control. There is one shower room which staff confirmed they use for most people because this is easily accessible. The bathrooms in the home do not have Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 23 assisted facilities to enable people to be hoisted into the bath. This means choices for a bath or shower are limited as only those able to step into the bath would be able to use them. The provider said he has plans to develop a new bathroom with a specialist bath to enable people to have a choice. The laundry is situated in the basement of the home. There is one room where all dirty laundry is delivered to be washed and ironed. Gloves and aprons were available to staff to help maintain good hygiene. There was a separate room where the clean and ironed laundry is sorted onto hangers or placed into named baskets. In the main laundry room there were four large bins with yellow bags in them around the washing machine and drier areas. Staff said that these were being used to put their dirty gloves in. It was unclear why so many were needed which cluttered the space and was limiting the access to the sink unit being used by staff. The sink unit was dirty and in need of cleaning. Staff said they used this to wash their hands as well as for filling and emptying the mop buckets used for the floor in the toilets, kitchen and dining room. A separate hand-wash sink is available in the laundry to help staff maintain good hygiene practices which the manager said had been fitted since the last inspection. It was not clear why staff were also using the large sink being used for “dirty” tasks which does not promote good infection control practice. One person spoken to said that the laundry was “better managed since got laundry lady”. Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30 were assessed. People using the service experience adequate quality outcomes in this area. People do not always benefit from being offered alternative meal and liquidised food is not appetising. Activities are available and meet the needs of some of the people who use the service. Activities may not enable people with a diagnosis of dementia to further enhance or retain mental capacity. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The AQAA states: “We generally have good staffing ratio; normally there is one senior carer supported by three care staff on the morning shift (7:00am2:00pm) and one senior carer supported by two care staff in the afternoon Shift (1:45pm-9:00pm). The manager told us there were 20 people living in the home on the day of inspection and that they aim to have four care assistants on duty during the morning and three in the afternoon. At night they have two carers on duty. The manager said they always have a senior carer on each shift. The manager said she was working in a supernumerary capacity. Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 25 Duty rotas seen confirmed that these numbers were being achieved. The manager explained that she devises a schedule each week which shows tasks that staff are to complete each day. This includes the completion of the laundry. Staff spoken to said that they felt there were sufficient staff on duty and confirmed they were able to complete all of the tasks allocated to them without this having an impact on people’s care. The manager confirmed there are two staff employed to complete cleaning tasks, one weekend cleaner and one who works from Monday to Friday. She also advised that there is a chef and kitchen assistant who provide catering support to the home. These staff were not included on the duty rotas therefore people cannot be confident there are sufficient numbers of designated staff available to meet their needs. Duty rotas only held the staff member’s first name which can present problems if a staff audit needs to be completed retrospectively. People spoken to were complimentary of the staff one person said “staff look after me very well”, another said staff were “very good” and stated “there is quite a range of nationalities” which they indicated was a good talking point with them. A relative stated “the carers are wonderful and I am quite satisfied with the care”. Comment cards received from six relatives show that five out of six feel staff “always” have the right skills and experience to look after people properly. One person has stated they “usually” do. All have stated that they feel the service responds to the differing needs of people. Records confirmed that new staff had been attending induction training based on the Skills for Care Common Induction Standards. This training helps staff to build up their competencies over a period of time so that they can deliver effective care to people. A statutory training schedule seen for all staff confirmed that staff had completed Food Hygiene, Health and Safety and Moving and Handling training al on the same day in January 2009. All staff had completed fire training on another day in January 2009. The provider said that training had actually been done over two days and all staff had achieved this training by completing it in blocks over this time. Certificates were not available to evidence this training had been completed for each individual member of staff. This will need to be pursued with the training provider so that the home can demonstrate all staff are up-to-date with statutory training. In addition to statutory training some staff had completed training in dementia care in 2008. Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 26 The AQAA states: “All but two of the staff have completed a minimum of NVQ-2 while one staff is undergoing NVQ-2, four of the staff are undergoing NVQ-3. We found on viewing the training schedule that the majority of staff have achieved a National Vocational Qualification (NVQ) II in Care which means the home are exceeding the standard of 50 . This training enables staff to identify needs and respond appropriately to these needs. We looked at the personnel files of two recently recruited staff to confirm that recruitment practices were suitably robust to protect people living in the home. It was not clear from the records when the two new staff members had started to work at the home. The provider stated a date that was prior to the Criminal Records Bureau (CRB) check being received. The provider said that both staff were attending training prior to commencing work at the home and this was confirmed on training certificates viewed. One person had two written references but another had only one written reference. The manager said that a second reference had been requested but there was no evidence of this being requested on the file. Clear employment records must be in place and include: start dates, who references were sought from and when they were received so that people can be confident staff recruitment practices are carried out in their best interests. Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35 and 38 were assessed. People using the service experience poor quality outcomes in this area. People cannot be confident that the service is managed in their best interests. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The AQAA states: “The present management team is committed to implement what ever action that is necessary to improve the standards within the home. Progress and Improvements, in areas of record keeping and Careplan has continued through out 2008 and 2009”. “The manager designate is a qualified first level nurse having nearly Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 28 completed the NVQ-4 in Social Care and Management. She will be put forward for registration over the next few weeks. When she assumes full management control, most of the issues which has surrounded the home for the past few years will have been addressed”. We were told by the owner during the last inspection that he was managing the home and it was his intention to apply to us to become registered as the manager. This has not happened. During this inspection we were told that it is now the owner’s intention to register the “clinical manager” as the manager of the home. The manager has been working in this role for two years and has failed to apply for registration. Urgent action must be taken to ensure an application for registration is submitted by the manager to the Care Quality Commission as failure to do so is an offence and may lead to prosecution. People using the service need to be confident that the service is being managed by someone who is appropriately qualified and experienced to manage a registered care service and who will ensure the service is being managed in their best interests. Whilst the inspection has identified some improvements which have been carried out since our last visit there are still areas that need to be addressed and which are necessary to improve the quality of care afforded the people who use the service. During the last few years this service has been awarded either an adequate or poor quality rating. The people who use this service should have good quality outcomes and the provider must therefore take appropriate action to improve outcomes and to reduce any potential risks to people who use the service. We asked if any quality monitoring or satisfaction surveys had been undertaken with people who use the service or their representatives to determine what people feel about the care and services they receive. We were told this has not been done. A meeting with residents and relatives took place at the home in January 2009 and notes of the meeting showed the home intends to hold meetings twice a year. These notes discussed a number of issues including: an allegation against a member of staff in regards to their conduct in the home and the outcome of this, fire and evacuation, changes that have happened in the home on care planning, medicine management and creating a “platform” for involving the next of kin more in the home. A second meeting had not been held after six months as stated in the notes. We were told that it is planned for surveys to be undertaken. This demonstrates a lack of commitment by the home to follow through with what was agreed and does not provide people with a forum to voice their views. We looked at how people’s money is managed by the home. The AQAA stated: “The management of residents finance has been improved and we are Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 29 progressing towards a system where we pay for some of the services like hairdressing, chiropody and invoice the residents at the end of the month”. Monies belonging to a some people were held by the home for safekeeping. Receipts were available for financial transactions undertaken on their behalf but these were not well managed. For example receipts of purchases made for different people were all held all together and kept individually. In order to facilitate any request for access to records or to enable an internal audit which is necessary to ensure people are not placed at risk of financial abuse, details of all expenditure including receipts should be held separately for each individual. Some people are charged ten pounds for toiletries. The manager told us that this was being done every three months for some people who were using these. We could not determine a clear procedure around how this was being managed. It was not clear what the ten pounds covered and there were no clear records around this arrangement. Purchasing toiletries in this way may be considered ‘institutional’ care. Support should be person centred and where possible people should be encouraged to choose and purchase their own toiletries. If unable to do so they should be supported by a carer who knows the person and who is familiar with their needs. The Service User Guide did not include information about how fees are organised and charged for anyone not providing their own toiletries. Information made available to people must be clear so that they are aware of what is included in the fees and what is excluded. This will reduce the risk of any confusion at a later date. A review of health and safety records was undertaken to confirm checks were being carried out. The AQAA indicated that all health and safety checks had been done within the required dates. Records showed a Legionnella water check had recently been carried out. Electrical wiring records indicated some work was required. There were no records in place to confirm these works had been completed. It was agreed the service would fax this information to us but this has not been received to-date. During the tour of the home we found that the fire exit door on the top floor was locked with key. The manager explained this was to prevent a person on this floor from wandering and falling down the stairs. The practice of locking a fire door leading to an escape route may place people at unnecessary risk. We also found another locked door with a key on the stairway although this was not indicated to be a fire escape route. The home were advised to undertake a risk assessment and take prompt action to review these practices and to contact with the fire service and request a review of the home’s fire precautions and fire safety procedures. Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 30 A risk assessment for the person who might go out of the fire door or fall down the stairs had not been carried out and so an alternative had not been considered. Door wedges were observed in some rooms, the use of internal door wedges may not be safe as this prevents the door from closing should there be a fire and could place people at risk of harm. People choosing to have their doors open should have a suitable device fitted which when the fire alarm is activated will automatically close the door and prevent the spread of fire and any toxic fumes. Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 31 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X 2 X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 1 X 1 1 Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 32 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. Standard OP7 Regulation 15 Requirement Each person must have a care plan which details their needs and shows how these needs are to be met. Care plans must also be regularly reviewed and updated. This is so that staff have access to the information they need to meet peoples needs and care needs are being met in accordance with what has been agree. Action must be taken to ensure people with skin conditions are referred to an appropriate clinician for advice. Timescale for action 31/01/10 2. OP9 13 31/12/09 3. OP16 17 This is so that appropriate medicines, creams or lotions can be made available to treat these conditions as required. 31/01/10 A record of complaints must be held and include the following: • the date the complaint was received • the nature of the complaint • the outcome of any investigation DS0000040534.V377620.R01.S.doc Version 5.3 Page 33 Clarence House 4. OP31 This is so that people can be confident complaints will be taken seriously and responded to appropriately. Section 11 The person carrying on the 31/01/10 Care management of the care home Standards must apply to be registered as to Act 2000 carry on managing a registered care service without having been registered with the Care Quality Commission is an offence which may lead to prosecution. This is so people can be confident the service is being managed by a suitably competent and qualified person and that the service is being managed in their best interests. Detailed and accurate records must be held and maintained for items purchased for and on behalf of people who use the service. This is so people can be confident their monies are being safeguarded and being managed in their best interests. The fire service must be consulted to determine whether all practices associated with fire safety in the home are safe. This includes checking the staff practice of locking the door leading to the fire escape route on the top floor and whether this practice should cease. This is to ensure the safety of people who use the service is not compromised. 5. OP35 17 31/01/10 6. OP38 23 14/12/09 Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 34 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The Service User Guide should contain all of the required information and be made available to people who may be interested in staying at the home so that they can make an informed decision on whether to stay. Actions should be taken to ensure those people whose rooms that are overlooked by other properties and the main road are consulted about suitable screening at windows to protect their privacy and dignity. Any actions taken will need to be demonstrated. Action should be taken to broaden the range of social activities to meet the needs of all people living in the home. This includes ensuring those people who are less able to participate in current activities provided receive suitable social stimulation to help promote their wellbeing. The service should be organised to maximise people’s choice where possible. This includes choices of meals, baths/showers etc. Records need to demonstrate how choices are managed to promoted the wellbeing of people living in the home. The home need to demonstrate that people are being provided with a varied, appealing and wholesome diet. This includes liquidized meals which should be appealing in terms of texture, flavour and appearance so that people can enjoy them. Action needs to be taken to ensure people live in a well maintained environment. This includes attention to broken drawers, damaged cabinets, hot/cold taps operating effectively and completion of the replacement programme for stained and marked carpets. Some attention should be given to the current washing, bathing and toilet facilities in the home. This includes plugs being available in wash-hand basins, taps operating correctly and ensuring toilet raisers are available where DS0000040534.V377620.R01.S.doc Version 5.3 Page 35 2. OP10 3. OP12 4. OP14 5. OP15 6. OP19 7. OP21 Clarence House these might help to support people. A review should also be undertaken of current toilet facilities to ensure where possible these are accessible for people who use the service. 8. OP26 The ‘clutter’ in the laundry areas should be removed to improve accessibility for staff in completing the laundry safely and effectively. These areas should also be kept in a clean condition to promote good hygiene practices. Duty rotas should contain details of all people working in the home so that it is clear there are sufficient staff to support the needs of people. Recruitment records need to clearly demonstrate the recruitment process carried out. This includes recorded start dates and two written references for each person. Where staff have commenced training prior to the receipt of CRB’s, there needs to be clear records in place demonstrating where the training has been undertaken and the dates this has been provided. Completion of statutory training for each member of staff needs to be demonstrated such as the provision of a training certificate showing dates and training completed. A suitable system for reviewing and improving the quality of care provided should be implemented to demonstrate that the home is being run in the best interests of those living in the home. 9. OP27 10. OP29 11. OP30 12. OP33 Clarence House DS0000040534.V377620.R01.S.doc Version 5.3 Page 36 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.westmidlands@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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