Inspection on 08/03/10 for Clarence House

This inspection was carried out on 8th March 2010.

CQC found this care home to be providing an Poor service.

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

Other inspections for this house

Clarence House 10/11/09

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

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Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Random inspection report Care homes for older people Name: Address: Clarence House 42 Warwick New Road Leamington Spa CV32 6AA zero star poor service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sandra Wade Date: 0 8 0 3 2 0 1 0 Information about the care home Name of care home: Address: Clarence House 42 Warwick New Road Leamington Spa CV32 6AA 01926832826 01926882677 svsrbn@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Kanagasabai Sivasoruban,Dr Jeyaratha Sivasoruban care home 21 Number of places (if applicable): Under 65 Over 65 0 21 dementia old age, not falling within any other category Conditions of registration: 5 0 The maximum number of service users who can be accommodated is: 21 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 Date of last inspection Brief description of the care home 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 and garden at the rear. There is a ramped access to the front door. 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 with needs such as physical disability, sensory loss and general frailty. In Care Homes for Older People Page 2 of 12 Brief description of the care home addition care can be provided for up to five people with dementia care needs The accommodation is arranged on three floors, there is a shaft-lift and a chair lift to ensure accessibility. On the ground floor there are two communal lounges with a dining room situated between them. 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. A bathroom with bath chair is situated on the top floor for those who may need assistance into the bath and there are also accessible showers available. Care Homes for Older People Page 3 of 12 What we found: This random unannounced inspection was undertaken to check compliance with the requirements made during a key inspection to the home on 10 November 2009. We visited the home on Monday 8 March 2010 between 9.30am and 5.20pm. The manager and provider were both present for the duration of our visit. The service was required by 14.12.2009 to:Consult with the fire service to determine whether all practices associated with fire safety in the home were safe and to check the staff practice of locking the door leading to the fire escape route on the top floor and whether this practice should cease. The Improvement Plan forwarded to us from the provider following our last inspection to the home stated:- A fire risk assessment is in place for the home where the potential fire source has been identified. The practice of locking the half guard door with keys has now ceased with the alternative of a keyless lock being fitted. We were told that the provider had been contacted by the fire service following our last inspection. The fire service had highlighted areas for improvement in the home including changing the locking mechanisms of the fire doors. During our visit we observed that the locks to all fire doors had been changed to allow people to safely exit the building if required. The provider confirmed they were due to receive another visit from the fire service to check that all areas identified for improvement are actioned. We were told by the provider that the person nearest the door that used to be locked was not at risk of falling down the stairs as the person did not use these stairs. The requirement to consult with the fire service has been met. The service was required by 31.12.2010 to: Ensure people with skin conditions are referred to an appropriate clinician for advice. The Improvement Plan forwarded to us following the last inspection to the home stated: All residents identified as being at high risk of pressure sores have creams prescribed by their GPs as part of the management plan. We asked the manager and provider if there were any people in the home with skin conditions such as pressure sores, ulcers or rashes and were told that nobody in the home currently had any skin problems. We were also told that there was nobody who needed to see the district nurse for support with any skin conditions. The provider advised that people who are using creams on their skin have had these prescribed by the GP and individualised records are held in peoples rooms to document when these are being applied. Those people whose care needs were reviewed by us had not been prescribed any creams. Care Homes for Older People Page 4 of 12 This requirement has been met as there were no people with skin conditions and we were told appropriate actions had been taken to ensure suitable creams were prescribed by the GP for those people who needed them. This will however continue to be monitored during further inspections to the home. The service was required by 31.1.2010 to:Ensure each person has a care plan which details their needs and shows how these needs are to be met and also show they are being regularly reviewed and updated. Keep a record of complaints to include the date the complaint was received, the nature of the complaint, the outcome of any investigation. Maintain detailed and accurate records of items purchased on behalf of people who use the service. Ensure the person carrying on the management of the care home applies to be registered with the Care Quality Commission. Care Plans The provider told us in an improvement plan that was completed following the last inspection that The care plans that are in force at present, some have very detailed information and others less detailed information. We have since the inspection resorted to our own template which includes full details of all aspects of care provided. The care plans are reviewed periodically, (monthly in some cases, longer in others (depending how the needs change). The National Minimum Standards for Care Homes for Older People stipulate that the service users plan is reviewed by care staff in the home at least once a month. We looked at the care files for three people living in the home. We were told that one person had been reluctant for staff to assist them with personal care and had on occasions been aggressive towards staff. The care file contained a care plan for cognition and behaviour. The care plan explained that cognition was the higher mental process of knowing such as to perceive, recognise and judge. The person was judged to have a moderate to reasonable function. The care plan also explained what the person could do for themselves. The care plan stated that the person did not like crowded and a noisy environment or intrusion into their personal space. It was explained that this could be a trigger for challenging behaviour. The care plan viewed gave very limited information about what this persons behaviour was like on a daily basis and how staff should approach the person and manage this. Records stated that the person had the right to refuse staff intervention for some aspects of personal care but did not state what aspects and what staff should do if the person refused personal care. There were also no instructions for staff to monitor this behaviour or where they should record this. We asked staff where they would record challenging behaviour incidents, one member of staff pointed out the risk assessment and daily record sheet. Another member of staff had completed a sheet on the file named Care Homes for Older People Page 5 of 12 incident reports. If staff are completing this information in different areas this could prevent staff from obtaining a clear picture of the persons behaviour and could result in an inconsistent approach to care. Staff told us that they had to approach the person in a certain way if they wanted the person to do something and had to make sure they did not give instructions. The daily records seen contained a code to state if the persons mood was happy or sombre but there were no indications as to what this persons behaviour was like on a daily basis. It was not possible to tell whether the persons challenging behaviour had improved, remained the same or deteriorated. This information is important when reviewing care so that any changes to staff support can be determined. We looked at the care plan for personal care. This stated that the person had a history of self neglect and requires a shower twice a week. A showering/bathing record showed that the person had only had one shower in February and none in March due to refusing them. We found that daily records were being completed on three different forms. Information on some of these forms was not accurate or was conflicting so it was difficult to determine that the persons personal care needs were being met. One daily report stated all care needs met as opposed to explaining how staff had supported the person during the day to demonstrate this. Some records such as the daily task sheets contained the words self. Staff were asked what was meant by this and they explained that the person would have dressed and washed themselves. We asked how they could be sure that this is the case when the person had a history of self neglect. One member of staff said that the night staff mostly recorded this information so they were not sure, another staff member said x looks like x is self caring, does comb their hair . We asked when the persons skin was last checked to make sure this was intact and had no sore areas, staff were unable to confirm this. Another record showed that the person had washed their own hair on three consecutive days. The provider confirmed this was a recording error and the person would not have done this. Another record showed that the person had attended to their own nail care on two consecutive days but it was clear from observing the persons nails this was not the case. One member of staff said x refuses to have a manicure or pedicure done. We found that what staff told us was not reflected in the records. For example one member of staff stated that the person would let them assist them with a wash four or five times a week. Daily records did not show this to be the case Staff spoken to stated that both the persons behaviour and co-operation for personal care had improved since they had been in the home. Care plan reviews did not reflect any improvements. It was not evident a care plan review had been completed one month following the persons stay as stipulated in the care standards and the second months review stated no changes. It was not clear from review records what staff had actually reviewed. Care plan reviews should reflect any changes in the person that have been identified as well as any changes to staff support required. This is to ensure the persons care needs can be met effectively. Two further care plans were reviewed and we were told that each of these people had a Care Homes for Older People Page 6 of 12 diagnosis of diabetes. The first care plan file contained no care plan for the management of diabetes and the risks associated with both low and high blood sugar levels. We therefore could not identify that this care need was being managed appropriately. In the second care plan the summary section did not indicate that the person had diabetes. There was a care plan in place for this but we found it was not up-to-date. We established this by reading additional information in the file, speaking to staff and the person who had diabetes. We found records that indicated the persons medication had changed so that it was tablet controlled as opposed to insulin. We were told that the arrangements for the blood sugar monitoring had changed in that this was now being managed from the GP surgery. We found the care plan reviews did not identify these changes as well as the change in staff support required. In addition to this we also found that other information in the care plan was not up-todate. For example the care plan stated that the person used a frame to assist them with mobility but both staff and the person said they did not use a frame. The care plan said the person slept well but was known to wander. Staff told us the person slept well at night and did not wander. The medication list on the persons file did not include more recently prescribed medicines. The persons eating and drinking review did not reflect that they had lost weight over a period of time, there were also no actions detailed to suggest they may need a review of their nutritional needs. This requirement was therefore not met. Complaints A new complaints record had been developed as well as a new updated procedure for the management of complaints. The new procedure required staff to record the date, nature and outcome of the complaint. The manager, showed us a complaint that had been received recently, this had not been recorded onto the new records but the manager advised us that she intended to do this. This requirement was met. Financial Records The Improvement Plan completed by the provider following our last inspection stated: All items purchased on behalf of the individuals by the home will be invoiced by the home on an item by item basis at cost price. During our visit the records of two peoples money were checked. We found that records were being maintained of any transactions that had been carried out on behalf of people and receipts had been maintained. The manager said that people were currently not being charged for toiletries until they could meet with families or advocates to agree how they would prefer to pay for these. The provider said an invoicing system is proposed to Care Homes for Older People Page 7 of 12 be implemented. This will be followed up further during our next inspection to the home. This requirement was met. Manager Registration The improvement plan forwarded to us from the home following the last inspection stated that registration was postponed due to x maternity leave. The home has undertaken an elaborate improvement plan including a new office on the top floor. This has had an impact on the management. We reminded the provider during our visit of the importance of making sure requirement timescales are complied with. The provider stated that the completion of the new office on the top floor as well as the absence of the manager due to maternity leave had delayed this. We were previously advised that the proposed manager had been in post since August 2009. We had requested an application for registration to be made and this was delayed hence a requirement being given during the last inspection to the home. The provider told us that the manager application was forwarded to the Commission on 22 February 2010 which we were able to confirm. This was however returned to the manager as one of the employment checks needed validating. A commitment was given by the manager for this to be completed the day after our visit so that the full application could be returned to us for processing. The outstanding requirement has been met in regards to submitting an application to us. However as this was returned, we are still awaiting re-submission of the manager application with all supporting documentation so that the registration process can commence. A new requirement has therefore been issued to this effect. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 12 following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 9 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 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. 31/01/2010 Care Homes for Older People Page 10 of 12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 31 he person carrying on the management of the care home must submit an application for registration along with all the required supporting documentation. (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. 31/05/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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