Inspection on 15/07/08 for Clarence Park Nursing Home

This inspection was carried out on 15th July 2008.

CSCI found this care home to be providing an Adequate service.

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 Park Nursing Home 23/08/07

Clarence Park Nursing Home 11/07/06

Clarence Park Nursing Home 05/12/05

Clarence Park Nursing Home 01/07/05

Clarence Park Nursing Home 25/11/04

Clarence Park Nursing Home 21/09/04

Clarence Park Nursing Home 29/03/04

Clarence Park Nursing Home 15/09/03

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

CARE HOMES FOR OLDER PEOPLE Clarence Park Nursing Home 7 / 9 Clarence Road North Weston Super Mare North Somerset BS23 4AT Lead Inspector Patricia Hellier Unannounced Inspection 15th July 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Clarence Park Nursing Home DS0000040907.V365902.R02.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. Clarence Park Nursing Home DS0000040907.V365902.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clarence Park Nursing Home Address 7 / 9 Clarence Road North Weston Super Mare North Somerset BS23 4AT 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) 01934 629374 01934 626207 sally@notarohomes.co.uk www.notarohomes.co.uk N Notaro Homes Limited Mrs Sally Bernadette Brotherton Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Clarence Park Nursing Home DS0000040907.V365902.R02.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 with nursing- Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category- Code OP The maximum number of service users who can be accommodated is 50. 23rd August 2007 Date of last inspection Brief Description of the Service: Clarence Park comprises of two houses joined together and extended and has been well adapted as a home providing 50 beds for residents requiring nursing care. It is situated close to the seafront in Weston super Mare and opposite Clarence Park. Local shops and amenities are close by and the town centre is just under a mile away. The building and décor is of a high standard providing a comfortable and homely environment. Inside, the home is well laid out, level throughout with ramps and lifts giving access to the upper floors. Twenty-one of the single, and all four of the shared bedrooms have en suite facilities. There is a small garden at the front, and the rear has been laid as patio around a central water feature. All rooms have a call bell system. There is a large open dining area and two comfortable lounges. Provision is made within the home for a variety of activities and outings that also enable close links with the local community to be maintained. The provider makes information available through a company leaflet and service specific booklet about the home. CSCI reports are displayed in the entrance to the home and available for all to read. The fess range from £550 - £700 per week with additional charges being made for hairdressing, chiropody, newspapers, escorts, toiletries, use of minibus and social therapy entrance fees. This information was provided in July 2008. Clarence Park Nursing Home DS0000040907.V365902.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key inspection took place over 11.5 hours on two days. The Registered Manager, Mrs Brotherton, was present throughout. An expert by experience accompanied the inspector and spent three hours in the home, talking with residents about their experiences of living there, and joining in with the daily routine of the home to experience it for herself. The results of her findings are incorporated in this report. Before the inspection the information about the home was received from the file held in the office, surveys received from ten people who use the service, two relatives, two members of staff and two Health Care professionals. The last two inspection reports were reviewed, together with the completed Annual Quality Assurance Assessment (AQAA) form, from the provider. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We (The Commission) also reviewed all correspondence and regulatory activity since the last Key inspection. The accumulated evidence for this report comes from the above and also fieldwork that included discussions with 24 residents, four relatives, and six staff. Practices were observed and documents relating to care, recruitment and health and safety were reviewed. Of the 10 resident surveys sent all were returned. The replies indicated that their care needs are met by responsive staff, and they are provided with what they need. Comments from residents were “The staff are very caring and the place immaculate”; “the person in charge of activities is excellent.” Areas of concern were relating to the meals with comments “meals have gone downhill recently”. Of the 10 relatives surveys sent two were returned and all felt that their relatives were well cared for by competent staff. Comments from relatives were “Staff are friendly and caring”. “Office staff are always approachable and helpful”. “The home is constantly asking for suggestions and making small changes to improve life for the residents”. All relatives felt they were kept up to date with information regarding their relatives’ health and well being. There were no comments of concern. Most residents and staff spoken with told us the home is good and the staff seek to help them as they can. Comments received were “it is homely and Clarence Park Nursing Home DS0000040907.V365902.R02.S.doc Version 5.2 Page 6 comfortable”. “We try to provide care that takes account of residents’ wishes and preferences”. Four of the residents spoken with were not totally happy with the care received. Comments received were “it’s the little things that are missing”. “Language is a problem sometimes and misunderstandings arise”. Staff are not always so gentle – some can be rough”. Three members of staff told us that staff do not always work well together and this can have an effect on care provision for residents. What the service does well: What has improved since the last inspection? Since the last inspection the manager and staff have worked hard to implement a person centred approach to care provision, seeking to meet needs individually. Most residents spoken with felt that there choices and preferences were discussed and implemented, in as far as staffing levels allowed. An emphasis on training in the last year has provided staff with greater knowledge and skills to meet residents’ needs. Clarence Park Nursing Home DS0000040907.V365902.R02.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. The summary of this inspection report can be made available in other formats on request. Clarence Park Nursing Home DS0000040907.V365902.R02.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 Clarence Park Nursing Home DS0000040907.V365902.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose and Service User Guide is comprehensive and provides prospective residents with information to make an informed choice. The home’s assessment process is not always thorough to ensure that it is able to meet residents’ needs. Prospective residents and relatives are encouraged to visit the home to assess suitability. EVIDENCE: Residents are provided with a Service User Guide containing the Statement of Purpose and information required to ensure they, or their relatives, have access to relevant information at all times. On day one of the inspection the Statement of Purpose did not include all the required elements of information to ensure residents and their relatives have comprehensive information. The manager took immediate action and rectified the omissions, thus ensuring that all prospective residents are provided with comprehensive information about the home. Clarence Park Nursing Home DS0000040907.V365902.R02.S.doc Version 5.2 Page 10 Resident files inspected showed that all privately funded residents receive a contract of Conditions of Admission and Terms of Business, and those who are publicly funded receive a copy of the Terms and Conditions document which forms a contract of agreement. The contract documents supply residents with clear information about the breakdown of fees, outlining the contributions to be made and by whom, to make up the weekly chargeable amount. Care needs are met through a person centred assessment process. One of the three files inspected did not contain a pre admission assessment, and the assessments in the other two files had gaps in documentation, potentially missing key information about prospective residents needs. The assessment documentation format includes all the elements listed in the standard. One resident who had been recently admitted said that the care was “good.” “The staff are attentive when they have the time, kind and caring and help me as I need”. Social services care plans had been obtained where relevant. Care practices observed showed that staff were aware of the residents needs as stated in their assessments. Prospective residents are encouraged to visit the home and assess the quality and facilities of the home for themselves. While one recently admitted resident had not been able to do this, their relatives confirmed that they had visited and been given an opportunity to see the home, meet the staff, and discuss any queries with the staff and management. Clarence Park Nursing Home DS0000040907.V365902.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents do not always benefit from care plans that are person centred, as gaps information and communication do not enable staff to fully meet residents’ health and social care needs. The system in place for the management of medicines is satisfactory. Kind and caring staff do not always maintain respect and dignity. EVIDENCE: Individual records are kept for each of the residents and include details of personal preferences and interests, reflecting a person centred approach. Three care plans were inspected and all reflected clearly, current identified health and social care needs. Clear actions to meet identified needs were not always recorded. Regular evaluation was noted to ensure provision of appropriate care for residents. Relative involvement was seen in two of the care plans inspected in relation to consent for the use of bedrails. One care plan had been signed by the Clarence Park Nursing Home DS0000040907.V365902.R02.S.doc Version 5.2 Page 12 resident. When spoken with residents were unaware of their care plans and said their care needs had not been discussed with them. Staff told us that care plans are reviewed sometimes with the residents. In the three care plans inspected there was clear and informative information about choices and preferences for daily life and food. Two care plans contained good information about the individuals’ life history, family and contacts. The information also described the person’s hobbies, sociability and preferred activities to enable staff to provide person centred care. All care plans contained well-formulated risk assessments for Manual Handling, Falls, Nutrition and for pressure areas. In one care plan good practice was seen with the nutritional risk assessment being supplemented by a support flow chart and oral assessment, from which actions to minimise the risk had been described in the care plan. Not all staff interviewed were fully conversant with these needs and actions. Thus it is not clear that the resident would always receive adequate nutrition in the best manner suited to their condition. Wounds and pressure sores are not always well managed. In one of the files a record of the wounds with good descriptions were present, with clear records of management and appropriate treatment. In a second file there was no record of a pressure sore that was described as “deep” in the daily notes and no plan of care as to how this sore or wound was to be managed. Staff when spoken with told us that this person is noted to have fragile skin and thus prone to pressure sores. There was no clear understanding of how best to mange this persons risk and the current wound for the benefit of the resident. Pressure relieving equipment was seen in use in a number of areas in the home. and staff were able to describe the principles of pressure relief management for the benefit of residents. In discussion with staff care we were told that some care plans are “out of date” and “there is confusion as to who uses them”. From these discussion it was clear that care plans are not working tools to assist staff to be sure they are meeting all the residents’ needs in the best way for them. Staff told us that communication is a problem and that “more communication between staff about residents’ needs and changes to their condition is needed” to provide consistent care for residents. Daily records were up to date, written in a respectful manner and included both physical and psychosocial needs. Feedback from residents and relatives was mainly good with a number of residents saying “I am happy living here and well cared for”. Two residents told us that care is not always as they would like and they “just have to let the staff get on as they want”. Another resident told us “they do their best” Two residents and one relative told us that they feel staff can be rough when moving and helping them. Care plans contained moving and handling Clarence Park Nursing Home DS0000040907.V365902.R02.S.doc Version 5.2 Page 13 assessments and clear instructions as to how best to assist residents, in a person centred manner. One resident said, “some staff quite recently have been rough in handling me”. Another resident said, “I do not always feel confident when being hoisted”. A relative told us that sometimes they want to call out and say, “be careful what you are doing”. In respect of hydration needs of residents we did not see any glasses of water about the home, and no residents were observed with a drink accessible to them throughout the day. We did not see drinks being offered to residents except morning coffee and afternoon tea. The expert by experience who joined residents for lunch had to ask for a drink of water with her meal. Two care records containing fluid charts were seen and these had gaps of three or more hours between entries of fluid offered or taken. Residents’ would benefit from a larger fluid intake given the findings of current research in the care of older people. Four episodes of poor practice that showed disregard for the dignity of the individual were observed during the day. E.g. • When a resident was being hoisted in a communal area. • A carer was observed ramming the door with the footplates of a resident’s wheelchair to open the door. • In the lower lounge two residents in recliner chairs had tea poured out for them without consultation or comment, and left on a table where they could not reach it. None of these residents had access to a call bell. • A resident was observed without their call bell and half falling out of the chair in their room. One resident spoken with told us about their call bell “they give it to me when they think of it”. Comments received from residents who returned surveys, told us “the staff are very caring and helpful”. “They are always attentive”. “The home is better than most in the town but has deteriorated recently”. One resident spoken with told us “it is the little things that are missing”. Two of the resident’s spoken with expressed concerns about the length of time it takes for call bells to be answered. One person told us “sometimes it takes an age when you need the toilet”. Other care practices observed showed caring interactions and good communication skills from staff. Choices and preferences were observed being discussed and offered. All residents were neatly dressed, and attention had been paid to hair and nail care. Detailed conversations with nine of the residents confirmed a satisfactory standard of nursing and personal care. Two residents said, “ it’s comfortable” another resident said, “people are very kind, we are looked after”. Clarence Park Nursing Home DS0000040907.V365902.R02.S.doc Version 5.2 Page 14 Both relatives who returned surveys said they felt “the home communicated well with them” and their relatives were cared for by “friendly and caring staff”. Visits by the dentist, chiropodist and optician were recorded in all of the care plans inspected demonstrating an holistic approach to care to ensure the health and well being of residents. The management of medicines was satisfactory and good practice was observed in the dispensing and disposal of medication, during the lunchtime period. Medication Record Sheets (MAR) showed no gaps and clearly recorded when medication had been refused or omitted for some reason. Hand transcribed prescriptions were seen on the Medication Administration Records and these had been signed by two members of staff when written, thus providing the recommended safeguard for residents. The medications fridge was locked and temperatures recorded had been higher than recommended for fifteen days and no action had been taken to rectify this, thus not providing for the safe storage of medicines. The home has an Equality and Diversity policy that recognises the cultural and social needs and differences that are present in society. The staff team is international and has experience of equality and diversity issues. Both management and staff demonstrated clear knowledge and desire to meet cultural and diversity needs of residents as and when they should arise. One relative commented, “there are all nationalities here and they get on well”. Two members of staff two relatives told us “language is a problem and communication is sometimes difficult”. Clarence Park Nursing Home DS0000040907.V365902.R02.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from routines, and menus, that are flexible to meet their needs. A variety of activities is offered, and resident’s right to choice and control over their lives is well respected, and encouraged. Friendly staff always welcome relatives and visitors. EVIDENCE: Many residents commented on the atmosphere of the home. One person described it as nicely informal, and residents’ felt that their visitors are also helped to feel relaxed and at home. An excellent range of activities is provided with posters displaying information of forthcoming events in the front hall and on the notice board in the lower lounge. Two residents said, “there is something on every day of the week if you want it”. Special activities are arranged at varying points of the year. All residents spoken with enjoy the outings arranged at varying times in the year. Records inspected and displays in the home showed evidence of the many activities residents can take part in. Clarence Park Nursing Home DS0000040907.V365902.R02.S.doc Version 5.2 Page 16 Residents said they were able to arrange their day as they saw fit. Spiritual needs are catered for and local clergy visit as requested. Relatives were seen popping in during the course of the inspection and being welcomed by staff. One relative said, “I feel quite happy coming here and the staff are very good to me”. Comments made by relatives indicated they were made welcome; “there is always a warm welcome when I visit”. A friendly banter was evident between staff and residents throughout the inspection. Residents spoken with said that the ‘food is good on the whole’. However in the survey feedback we were told “meals have gone downhill recently”. Menus showed a varied, balanced and nutritious diet. The meal on the day of inspection reflected this and tasted “very good”. The dining room is homely and tables well presented to enhance the experience for residents. Resident who require assistance with their meals are sat in separate area of the dining room and were observed being assisted by staff individually. We also observed adaptive cutlery and plate guards in use to assist residents to eat their meal independently. A choice of meal is offered and likes and dislikes catered for. At lunchtime choices of both main course and desert were seen being offered, and meals tailored to resident’s preferences for their enjoyment. Clarence Park Nursing Home DS0000040907.V365902.R02.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident that they are listened to and their requests acted upon. Staff have a clear understanding about how to safeguard residents from abuse, but do not always put it into practice. EVIDENCE: The home has a comprehensive complaints procedure and all residents have a copy of it. There have been two complaints since the last inspection, of which one was upheld, and the other is still under investigation. The complaint investigation showed a clear focus on the outcome for the resident and meeting their needs. Residents stated that if they were not happy about anything they would speak to the manager and felt that she would act on it in the best interests of the resident. In the survey responses from relatives we are told “the home is constantly asking for suggestions and making small changes to improve life for the residents”. Residents said that the manager and staff are very approachable and they would always raise any concerns with them. Staff and residents spoken to, say the manager is very approachable and understanding. One resident said “I’ve nothing to complain about”. A system for keeping clear records of complaints received with actions taken and outcomes, is available. Clarence Park Nursing Home DS0000040907.V365902.R02.S.doc Version 5.2 Page 18 In the comments book we saw the following entries “lovely atmosphere – plenty of staff”. “Greatly impressed by the management, professionalism and friendliness of the manager and staff”. “The family are all delighted with the way our relative was looked after”. In the AQAA we are told “we actively encourage residents to be politically active if they wish and facilitate the use of a postal vote or take them to the polling station if they wish”. None of the residents spoken with could remember voting in any elections. A comprehensive policy and procedure for responding to allegations of abuse is available, together with the Local Adult Protection (No Secrets in North Somerset) guidelines. The home also has a Whislteblowing policy and staff said they would report any concerns to the manager. Staff said they had never seen any signs of abuse in the home, although two members of staff told us “some residents are scared of certain carers”. Staff interviewed demonstrated a good understanding of what abuse is and the actions they would take if they should see it. They seemed unaware that, their by actions or forgetfulness, albeit due to being busy or staff shortages, they may be perpetrating this in a mild way to the detriment of residents e.g. forgetting to give a resident their call bell, or not positioning it correctly for the resident to reach and use. Staff said they have received training in the recognition and handling of abusive situations for the safeguarding of residents. This was verified during inspection of training records. Care plans inspected showed that consent for the use of bedrails had been obtained from some residents, or their relatives, thus safeguarding choice. There was no evidence that residents sat in recliner chairs, which they could not operate, had been consulted or their liberties considered under the Mental Capacity Act 2005. It is recommended that policy guidance is sought and implemented to safeguard residents. All residents spoken with said ‘the staff are kind and do their best’. Clarence Park Nursing Home DS0000040907.V365902.R02.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with homely, safe and comfortable surroundings. Residents’ benefit from a clean and well presented home which has suitable equipment to maximise resident independence. Robust Infection Control practices are followed for residents’ protection. EVIDENCE: The home is nicely decorated and well maintained with a welcoming atmosphere, and made comfortable with homely communal spaces. Staff have worked hard to reduce the impact the size of the home may have on residents by making it welcoming. Residents’ rooms are personalised and comfortable. All rooms are provided with en-suite facilities. The décor, fixtures and fittings are in good order in the main. Clarence Park Nursing Home DS0000040907.V365902.R02.S.doc Version 5.2 Page 20 During a tour of the building a number of fire doors were observed to be wedged open, thus not being able to operate by closing should the fire alarm be sounded. A number of fire doors did not close flush to the frame to provide the safeguards necessary in the event of a fire. The manager took immediate action to rectify these issues and the maintenance man was seen repairing and adjusting fire doors a few hours later. Maintenance and refurbishment plans and records are kept, to ensure the homes’ environment is maintained at a good standard for the comfort of residents. There are plenty of toilets within easy access of all communal rooms, for the comfort of residents. The home has grab rails situated at relevant points and a shaft lift that is easily used to assist resident mobility, and aid independence within the home. The home was clean and free from offensive odours throughout. The laundry facilities were well organised. Staff interviewed and observed demonstrated good understanding of Infection control procedures and practices, and maintained a clean and hygienic environment. The home has good facilities for ensuring that staff can maintain good hand washing practices between caring for residents. Clarence Park Nursing Home DS0000040907.V365902.R02.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents do not always benefit from staffing levels that are adequate to meet their needs. The procedures for the recruitment of staff are satisfactory and provide the safeguards required for residents’ protection. Residents do not always benefit from staff with appropriate training to enable them to provide safe and knowledgeable care to residents. EVIDENCE: The staffing rotas for the two weeks prior to the inspection were reviewed. Staffing levels appear to provide sufficient care staff to meet residents’ needs. A good team of ancillary staff supports them. In the AQAA we are told “we provide staffing levels that meet the dependencies of the residents”. Survey responses and comments received from residents and staff told us that there are at times staff shortages that negatively affect the care provision and lifestyle for residents. Two members of staff told us “it is not staff shortages that affect care but staff who cut corners”. In discussion with residents they told us “the staff are good and always there when you need them.” Other comments received were “you sometimes have to wait a while when you ring the bell”. In discussion with the manager she informed us that staffing levels had been increased recently to meet the increased dependency needs of residents. Staff when interviewed told us “the Clarence Park Nursing Home DS0000040907.V365902.R02.S.doc Version 5.2 Page 22 home is very heavy; there could be more staff”. “More staff to be able to provide individual care”. A number of residents spoken to during the inspection told us “more staff are needed, they are very busy”. Call bells were answered promptly during the inspection. A few of the staff team employed at the home are from overseas. Residents and staff told us, “they try to fit into the team; however there are some language difficulties”. In discussion with the manager we were told that overseas staff are assisted through a college course to improve their language skills. Two employees from overseas verified this. From discussions with staff and observation of practice we noted staff do not always work well as a team for the benefit and care of residents. The home currently has 50 of staff with a National Vocational Qualification (NVQ). This should ensure that staff have the skills and knowledge to care for the residents in a safe and competent manner. Some care practices observed did not reflect this e.g. lack of communication with more dependent residents. Recruitment procedures in the main ensure all the necessary safeguards are in place prior to employment of staff, thus safeguarding resident from potential risk. Two recruitment files were inspected. In both files a Criminal Record Bureau (CRB) or PoVA first check had been received prior to the commencement of work to ensure the protection of residents. In one file while three references had been obtained, the only reference that had been signed was from a family relative. The reference from the previous employer had not been signed for accountability purposes and thus the protection of the residents. Evidence was seen of staff induction in the file of one new member of staff to ensure they have the skills and knowledge to care for residents appropriately. When interviewed we were told that the induction “was helpful and covered all the things I needed to know”. The home has provided some in house mandatory training in the last year. The manager told us “a new training coordinator has been appointed and training is now getting under way”. A training programme covering mandatory areas was seen for the coming months. Two staff told us “it is difficult to get to training due to staffing levels”. Three staff told us they have received training in “manual handling, health and safety and fire procedures”. Training files inspected verified training had been provided and attended. Feedback from staff surveys told us “more training opportunities would be helpful”. Clinical staff have not received update training in specialist areas e.g. wound care to ensure they have the knowledge of the latest best practice guidance for the benefit of residents. . The manager told us that specialist training would be accessed from the PCT when the information was available. Clarence Park Nursing Home DS0000040907.V365902.R02.S.doc Version 5.2 Page 23 Residents tell us that they feel “the staff have an understanding of their needs and how to meet them. Clarence Park Nursing Home DS0000040907.V365902.R02.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager provides clear leadership and guidance to staff to ensure residents receive consistent care in a safe environment. Residents can be confident that management processes ensure consultation with them, their families and visiting professionals to ensure they have say in the running of the home. Resident’s can be confident that monies held for them by the home are well managed. Health and safety issues are monitored in the home to ensure that issues are identified and addressed where they arise. EVIDENCE: The manager is a qualified nurse with experience in management and has gained her Registered Manger Award qualification. She gives clear leadership, Clarence Park Nursing Home DS0000040907.V365902.R02.S.doc Version 5.2 Page 25 guidance and direction to staff, and residents feel she is approachable and seeks to ensure all their needs are met. Residents told us that the manager is “approachable and seems to be around a lot”. Two residents told us that she is “professional and kind and seems to know what she is doing”. All six staff interviewed stated that they felt well supported by an approachable manager. Policies, and practice guidance, are provided in the home. These ensure staff are provided with current good practice advice for the benefits of residents. . Staff are aware of the policy folder and can access it as needed. Systems are in place for people using the service, visitors and relatives to comment on the running of the home, and ongoing audits of aspects of the homes quality are completed. The results are fed back to residents and relatives at meetings, where they are discussed and used to inform the ongoing service provision. Surveys for this year had not been completed, but in the comments book we saw the following entries “lovely atmosphere – plenty of staff”. “Greatly impressed by the management, professionalism and friendliness of the manager and staff”. “The family are all delighted with the way our relative was looked after”. Supervision for staff has not been provided regularly over the last year. The manager has implemented a system in which supervision is cascaded down through the organisational structure, thus ensuring no one person is overburdened. Staff interviewed said they had received supervision once or twice this year. Records inspected showed that issues relating to resident care, personal and professional development, and the aims and objectives of the home had been discussed and actions planned to address issues raised for the benefit of resident care The Notaro group maintains a secure system for safeguarding residents’ finances. The home stores records securely and uses them in accordance with the Data Protection Act 1998. Information in some care records inspected was incomplete. Records should be accurately maintained to ensure clear information for the provision of knowledgeable and consistent care to residents. Records inspected indicated regular safety and fire checks are carried out. Staff spoken to confirmed that fire instruction and drills had taken place. Not all staff have received fire training within the prerequisite timescales. This must be provided for the safety of residents. Records indicating regular maintenance to gas and water systems were seen, together with servicing records for all equipment. Recommendations raised by these professionals are responded to in a timely manner for the safety of residents. Clarence Park Nursing Home DS0000040907.V365902.R02.S.doc Version 5.2 Page 26 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 3 2 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 2 3 Clarence Park Nursing Home DS0000040907.V365902.R02.S.doc Version 5.2 Page 27 NO Are there any outstanding requirements from the last inspection? 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 OP3 Regulation 14.1 Requirement The registered person must ensure that all prospective residents’ needs are assessed and documented prior to taking up residency. The registered person must ensure that all identified risks to residents’ health have clearly described actions as to how these risks are to be minimised for the safety and well being of the residents. The registered person must ensure that the home is run in a manner that respects the privacy and dignity of residents. This relates to moving residents in communal areas, and taking wheelchairs through doorways The registered provider must provide more robust safeguarding training to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. This refers to call bells being out of reach. DS0000040907.V365902.R02.S.doc Timescale for action 03/10/08 2. OP8 13.4(c) 16/10/08 3. OP10 12.4(a) 30/09/08 4. OP18 13.6 30/09/08 Clarence Park Nursing Home Version 5.2 Page 28 5. OP30 18.1(c) Specialist training provision must 16/11/08 be provided to ensure staff have the specific skills and knowledge to meet resident’s needs. E.g. wound care and management 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 OP3 Good Practice Recommendations To document the outcome of the assessment process as to how the home can /cannot meet their needs. To provide written confirmation of decision for clarity for prospective residents and their families. 2. OP7 To improve communication systems, both written and verbal to ensure that all changes in care needs are known to staff and continuity of care provision is maintained for the well being of residents. The registered manager should keep staffing levels under review to consistently meet the needs of people using the service. To ensure that appropriate and regular supervision is provided to ensure knowledgeable and competent staff can meet residents’ needs. To ensure that all written records are maintained up to date with full relevant information for the benefit of residents’ care. 3. OP27 4. OP36 5. OP37 Clarence Park Nursing Home DS0000040907.V365902.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Clarence Park Nursing Home DS0000040907.V365902.R02.S.doc Version 5.2 Page 30 - 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. 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