Inspection on 21/07/05 for Clarendon Care Home

This inspection was carried out on 21st July 2005.

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

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

Other inspections for this house

Clarendon Care Home 23/10/08

Clarendon Care Home 25/10/07

Clarendon Care Home 29/03/07

Clarendon Care Home 02/03/06

Clarendon Care Home 20/12/04

Clarendon Care Home 27/09/04

Clarendon Care Home 20/02/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Clarendon Care Home 64/66 Clarendon Road Southsea Portsmouth PO5 2JZ Lead Inspector Clare Jahn Unannounced 21 July 2005 10:00 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 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. Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Clarendon Care Home Address 64/66 Clarendon Road Southsea Portsmouth PO5 2JZ 023 9282 4644 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Alice Dunbar Care Home 20 Category(ies) of Old age - 20 registration, with number Dementia - 20 of places Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 20 December 2004 Brief Description of the Service: Clarendon Rest Home is a large property situated within reasonable walking distance of the town centre of Southsea, and within a few minutes walk of the seafront and pier.Accommodation provided is by way of eight single bedrooms, one of which has an en-suite facility and six double bedrooms, four of which have an en-suite facility. Day space within the home is provided for by way of two lounges and a separate dining room. Outside there is an attractive garden, which consists mostly of patio area, with flower borders and planting boxes.The home is registered to accommodate twenty elderly persons, of either sex, in need of residential care due to old age and related mental health problems. Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was undertaken over one day. Considering clients abilities the inspector spoke with seven service users, five staff members including the manager and deputy manager, visiting relatives and a healthcare professional. The clients were observed making full use of the facilities, taking their meals, and enjoying having their hair done. Letters in respect of the service were also viewed and staff were spoken with individually and observed throughout the day providing support to the clients. A tour of the premises was undertaken. What the service does well: What has improved since the last inspection? New carpets have been laid throughout the communal areas and in a number of rooms. A full review of the fire escape routes and fire door access and security has also been undertaken by the Hampshire Fire service and clear exit notices displayed. The home has been beautifully maintained and the décor is in a very good condition. Some rooms have been refurbished with new curtains. The manager has purchased a new wide screen television for the residents lounge. The deputy manager has been updating the homes current policies and procedures and has implemented new staff supervision and training matrix and application form. Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 6 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. Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5, Clients and their relatives are provided with up to date information but adequate pre-assessment information is not sought prior to admission. Terms and conditions of residency demonstrate client agreement. EVIDENCE: The home provides a detailed statement of purpose and service user’s guide, both of which are very informative, clearly stating the aims and objectives of the home and the services provided. A copy is available for the service users and their families or representatives and copies were seen held on each service users file. Residents spoken with were unable to recall the documents held on their files but they were freely available and accessible. A review of the assessment process identified that a full pre-assessment is not being completed on all occasions. Relatives spoken with did confirm trial visits are undertaken and the home had letters to demonstrate that there is currently a waiting period for vacancies. All terms contracts were in place and confirmed to have been discussed. One relative described the reasons for choosing the home and was very complimentary to the standard and philosophy of the home. The home was Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 9 described as a home were the service users aren’t just “Looked after” but are “Cared for”. The inspector had the opportunity to observe relatives visiting family members and all were made welcome by the staff that were observed interacting with residents throughout the day in a polite respectful and dignified manner. Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10, The care plans continue to improve but further expansion is needed for the risk associated with pressure sores, nutrition and manual handling. The service users must be protected by the homes current procedure for the administration of medications, which needs further review by the pharmaceutical supplier to ensure a safe standard is maintained. EVIDENCE: Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 11 The care plan documents were viewed and demonstrated that the relevant information had been collated and individual care plans were available for each service user. Additional risk assessments have been developed and records show that these are regularly monitored and amended to reflect the changing needs of the service users. The care plans are presented in an orderly fashion, which staff confirmed they could readily access the relevant information. It was discussed that the current assessments need to be expanded to include an up to date risk assessment in pressure sores and nutrition. Residents were identified during discussion as being at risk. The deputy manager was eager to discuss with the inspector changes to the current system so as to improve the record keeping and service user assessments in conjunction with work being undertaken for her registered managers award. Since the last inspection daily records are now completed on each service user by the staff initiating the care and staff confirmed their knowledge of the care plan and daily record documents. The inspector was later shown the home’s nomad system for the administration of medication, which is delivered on a weekly basis. The registered manager explained that the senior care staff are responsible for the administration of the medication to the service users, however all staff receive the appropriate training in the safe handling and administration of medication which is supported by the home’s records. At the time of the inspection there were no service users that were able to take responsibility for their own medication, however the manager said she is aware of the necessity to develop the appropriate risk assessments in such cases. There was only one area requiring some further attention by the pharmaceutical supplier when there were inconsistencies in the correct time allocations of boxed medications. Visiting healthcare practitioners spoken with were very complimentary regarding the standard of care at the home. One visiting district nurse complimented the home on how they closely monitored residents for changes and concerns regarding their health and reported it appropriately. Staff were described as courteous and helpful and the home described as “The best one around”. The manager was requested to review the manual handling risk assessment and procedure for one service user and ensure that health and safety guidelines were adhered to for the safety and wellbeing of the staff and resident. Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Service users, staff and relatives are very satisfied with the homes provision for activities, meals and the opportunities given for relatives to visit. EVIDENCE: Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 13 Staff confirmed that visiting libraries bring a variety of books adapted for special needs and described what events the service user also enjoy which included day trips and drives in the minibus, and enjoy finishing their day out with a visit to the fish and chip shop on most occasions paid for by the manager. Staff also confirmed that there is also a monthly in-house church service and visits made by an activity co-ordinator from The PATEY day centre (Alzheimer’s Society) who visits regularly to undertake service user related activities such as reminiscence therapy. A group discussion with residents identified that there does not appear to be any restrictions regarding the times for going to bed and getting up, and the service users are able to choose when and where they prefer to take their meals. Residents told the inspector that they were satisfied with the events of their daily lives and did not have any suggestions to how to improve the homes activities and stated, “I think we do have a choice of what we do”. On the morning of the inspection the inspector observed a lady being helped from her room to the dining room for some breakfast at about 11.00am and the inspector was informed she preferred to get up later. One resident said that she chooses what she wants to wear but said ” staff will help you select and sort out your clothes.” Visitors were seen being welcomed to the home throughout the day by staff. The home’s visitors book was signed by the inspector on arrival and available to all visitors. Staff said that service users are encouraged to bring their own personal possessions into the home with them and an individual inventory is developed and signed in confirmation of this. Inventories were available on the residents file and rooms visited were personalised. Kitchen staff said that the staff and residents discuss and plan the menu for the following week, which proves to be popular with the service users who like to offer their opinions and be involved with the decisions. The records seen showed an assortment of choice and variation and the inspector discussed with the cook the need for an audit trail of all food provided as such a selection was provided. The comments received from the service users were very favourable and complimentary of the food provided from both residents and relatives. The inspector witnessed a relaxed mealtime where service users choices and preferences were respected and catered for. Staff were observed supporting the residents throughout the day and during mealtimes, offering drinks and seeking their choice of snacks and giving assistance in a discreet and professional manner. One resident informed the inspector “We don’t ever get told what we ‘re having” and the staff informed the inspector that the manager was known to go to the shop to get a specific food item for someone if they requested it. Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17,18 There have been no concerns in respect of the service and the manager aims to further improve and expand the monitoring of the opinions of persons using the care home as part of quality assurance practice. EVIDENCE: The inspector greeted and made herself available to all residents, staff, relatives and visiting healthcare professionals on the day of the inspection. No complaints were received and all feedback given in respect of the home was very complimentary. The manager said that the home’s quality assurance procedure would be expanded to ensure the opinions of all persons using the service can be sought and this will be looked at on the next visit. No complaints have been received in respect of the service. All procedures previously inspected were demonstrated and remain in place. Staff verbally confirmed knowledge of the whistle-blowing procedure when asked. Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,23,26, The home is well maintained and clean throughout but a review of the infection control procedures is necessary. Specific needs assessment and matching of the clients physical disabilities are required when assuring suitability of a client to this environment. EVIDENCE: Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 16 The manager accompanied the inspector on a tour of the building. The rooms were warm, clean and tidy throughout. The home had been maintained to a high standard and is tastefully decorated, and the furnishings and fittings are of a good quality and condition. Service users were seen to be making use of the communal areas around the home. New carpets have been fitted to some bedrooms and through out the corridors and communal areas. Areas for concern were; • There are five steps down to the dining room and no stair lift. • There is no stair lift to the top two bedrooms on the right side of the house and to one room on the other side of the Home. • There is no stair lift down stairs on left side of the Home to the lower three bedrooms. • The Home is not accessible at the front by wheelchair users The manager is aware that because of the layout of the home very specific matching of the clients needs and mobility has to be undertaken prior to admission and this was confirmed again on this visit. Previously it was agreed with the manager that all service users must be mobile and able to access all communal areas. There are a number of rooms that are not suitable for service users with reduced mobility. It was also identified that two service users sharing room 18 on the lower floor of the second house have a direct access from the kitchen and patio area going through their room to the corridor. Since the last visit a fire officer has reviewed this area and all nominated fire exits have been fitted with appropriate locks and fire route escape signs posted throughout. One of the service users who has occupied this room for more than eight years has commented how nice the room was with all the people passing through and that she would feel isolated if people were not allowed to come via her room. The use of the room is with her permission. It was agreed that when the current service users vacate this room a review of the area would need to be considered with the Commission due to its location, access and lack of natural light. Future buildings or registration for the Home will require this to be looked at and possibly an alternative access made. The manager discussed plans and demonstrated a catalogue of new dining furniture that they are hoping to purchase. Residents and relatives spoken to were very complimentary of the homes décor. Two of the residents referred specifically to how clean the home was. On discussion with staff it was evident that an on going daily, maintenance book is not maintained for small maintenance requests, i.e. changing bulbs etc. Staff do not therefore formally report defects. The manager said a log would be commenced. Discussion with staff also identified those procedures for the handling of soiled waste needs review. It could not be established that the current laundry procedures are in line with current universal precaution guidelines, as the staff do not use red bags. Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29,30 The homes recruitment procedure meets the standard but the process for recording employment history needs further expansion. The home provides adequate basic training for staff and staff are supervised and supported. EVIDENCE: Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 18 The manager has recruited an experienced, senior care worker who is currently undertaking her NVQ 4 in management, with a view to her undertaking the manager’s role. The registered manager does not hold a formal management qualification and said the deputy manager will be submitting an application to register as the manager. Records and discussions with staff identified that over 50 of staff employed hold a national vocational qualification in care or the equivalent. The deputy manager discussed and demonstrated a training information sheet she has recently put together detailing practice for the care of people with dementia, which was informative and specific to the needs of the client group. Staff and records confirmed relevant training has been on-going and staff have received regular supervision and performance assessments. Staff records contain the appropriate references and existing files have now been further developed and hold the relevant proof of identity to comply with the standard. The manager and deputy manager discussed the need to start to implement a newly devised application form, as the current form seen does not adequately reflect the details necessary for a full employment history. Staff confirmed that all new staff receive the appropriate training during their induction period, which is normally six weeks, and are supervised in their duties until such times, as they are deemed confident and competent in their roles. Completed inductions were available for viewing by the inspector. Records and staff confirm that regular Fire Training sessions conducted by an approved trainer has been undertaken and held in the home every six months. The manager was able to demonstrate a TOPPS Induction programme and stated that these have now been introduced for new staff. Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32 The staff are not formally consulted and included in the running of the home on a regular basis but are supervised. The home does not operate a formal quality assurance programme. EVIDENCE: Discussion and records indicate that staff meetings are not held regularly. Staff and relatives did state that they had regular opportunity to speak with the manager, staff and deputy manager on an informal basis as required as they are always around the home. Some relatives said they found this level of opportunity to discuss issues satisfactory and said that they would address any issues they had as they arose. The registered manager has developed a quality monitoring system in accordance with Regulation 26, and these have been undertaken regularly and forwarded to the Commission. Discussion with the manager identified that previous plans to implement a quality assurance questionnaire and survey has not yet been fully undertaken and is still not fully operational. Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 20 The deputy manager explained the current system for all staff to receive formal supervision at least six times a year and records indicated this is being undertaken as described. A sample of the home’s fire book, accident book, portable electrical testing certificate, food hygiene certificates, fire certificates, Legionella sampling certificate and electrical wiring certificate were reviewed and all were in date. The deputy manager showed the inspector the updated selection of the homes policies and procedures written in conjunction with the national minimum standards, which the home purchases to ensure compliancy. The deputy manager said the policies and procedures are adjusted to suit the homes individual environment. The service certificate for the stair lift was viewed and the portable appliances have all had their safety checks. Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 2 3 3 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 3 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 3 x x x 3 x x 2 STAFFING Standard No Score 27 x 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 2 2 x x 3 x 3 Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 22 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. 2. Standard 31 26 Regulation 9(1) 13(3) 16(2) 14(1) Requirement The manager of the home must undertake/hold the appropriate management qualifications. The home must seek appropriate infection control advice for the handling /cleaning of soiled laundry. A preadmission assessment as described in standard 3 must be undertaken on all residents prior to admission.All admission documentation must be completed within five working days. Risk assessments undertaken must be expanded to include nutrition ,pressure sores and appropriate manual handling There must be a process for seeking the views of the residents ,relatives and others regularly as part of a quality assurance procedure. Timescale for action 30.10.05 30.10.05 3. 3 30.10.05 4. 7 13(4) 12(1) 13(1) 24(1) 30.10.05 5. 33 30.10.05 6. Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 23 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 Good Practice Recommendations Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 24 Commission for Social Care Inspection 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Clarendon Care Home H55-H03 S39959 Clarendon V225455 010805.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!