Inspection on 23/10/08 for Clarendon Care Home

This inspection was carried out on 23rd October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Clarendon Care Home 25/10/07

Clarendon Care Home 29/03/07

Clarendon Care Home 02/03/06

Clarendon Care Home 21/07/05

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 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Clarendon Care Home 64/66 Clarendon Road Southsea Hampshire PO5 2JZ     The quality rating for this care home is:   one star adequate service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anita Tengnah     Date: 2 3 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Clarendon Care Home 64/66 Clarendon Road Southsea Hampshire PO5 2JZ 02392824644 02392824644 siliviapaton@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Silvia Paton Type of registration: Number of places registered: Mrs Alice Dunbar care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 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 the garden has been replaced with a tarmac surface, which is level. 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. 0 0 Over 65 20 20 Care Homes for Older People Page 4 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced inspection visit was carried out on 23rd October 2008. The visit was carried out over one day and lasted for six and a half hours. As part of our inspection process we sent out the Annual Quality Assurance Assessment (AQAA). This gives us information about the service and was completed and returned to us. During our visit we looked around the building and spoke to five service users and staff. We also looked at care and staff records and observed the staff practices as part of our visit. The registered manager assisted us with the visit. We used information that we have received from the AQAA. We sent out service users surveys to the service, we have not received any returned surveys at the time of writing this report. Care Homes for Older People Page 5 of 27 Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a good pre-assessment process in place and people are assessed prior to moving into the service. The home does not provide intermediate care. Evidence: We looked at the pre assessment records of two service users who had been recently admitted to the service as part of case tracking. There was a detailed assessment for one of the service users who had been admitted the previous day. As part of the admission process, the sevice user had visited the home and had spent a day at the service. A care managers assessment was also available in the record that we looked at. The manager reported that the service users and their familes are offered the Care Homes for Older People Page 9 of 27 Evidence: opportunity and encouraged to visit the home and information such as the statement of purpose was made avaialable to them. The manager was developing a new brochure for the service. The assessments record seen contained detail of the persons abilities of daily living, a list of their medication. History of recent falls, mobilty and diet were also included. The comments we received from the service users were positive and one of them stated that they had settled in well and had made a new friend already. The manager stated that the home did provide short respite care. The home however did not provide intermediate care. Care Homes for Older People Page 10 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans and record of care was satsifactory. However some of the assessments need further development. The service users access to health care is well managed. The management of the service users medication was adequate , however records of all prescribed medication given must be recorded. The service users were treated with respect. However the use of their personal bedrooms as communal, does not respect their autonomy and privacy. Evidence: We looked at the care plans of four of the service users as part of case tracking. We chose these as they had different care needs and support needed. We found that the care plans had good details of the persons needs and some assessments were completed. There was evidence that the service users needs were regularly reviewed Care Homes for Older People Page 11 of 27 Evidence: and monitored, to ensure that any changing needs are recognised and appropriate plan of action put in place. As discussed at the time of the visit, assessments such as moving and handling and pressure risks assessments must be developed to ensure that all needs are assessed and appropriate care plans put in place. This is in particular for people requiring assisted baths so that staff have the correct information to provide care safely. The manager stated that the service users were fairly independent and required minimal help, however this would be developed for all the service users as a baseline for providing care. This must include fall risk assessment for those with recent history of falls and action plan put in place. We noted that the health of the service users were monitored and they were referred to external professionals as needed. The manager reported that they had good relationship and support from the surgeries that served the home and other health care professionals such as the community psychiatric nurse and the district nurses. The GP was available on request as required. Positive comments were received from health care professionals regarding the care that people were receiving at the home. On the day of the visit one of the service users was attending the local hospital for treatment and was accompanied by a health care professional. It was evident from interaction observed and comments received that the service maintained good relationship with the external health care professionals. We looked at the medication managed by the service on behalf of the service users. The home was using the Monitored Dosage System (MDS). A record of medication received was recorded on the Medication Administration Record (MAR ) sheets as required. The manager reported that only the carers who had completed medicine management training were responsible for the service users medication. There was no service user administering their own medicine at the time of the visit. A sample of the MAR record was looked at as part of the inspection. Records of medication administered were maintained. We noted that one of the service users did not receive their prescribed medication for one of the morning doses. This included diabetic medication that they must receive and this is detrimental to their health and well being. This was brought to the attention of the manager who said she would be investigating this. Staff did not record variable dosages as needed and this must also be addressed. Any medication transcribed on to the MAR sheets did not have two signatures. The manager said that this would be put in place. Care Homes for Older People Page 12 of 27 Evidence: We found that medication was stored securely and discussion was undertaken with the manager regarding the safekeeping of the key for the medicine cupboard. We observed that the controlled drug (CD) cupboard did not meet with the current regulation. The registered person must ensure that the home has a CD cupboard which complies with the Misuse of Drugs (Safe Custody) Regulations 1973. The service users, relatives and observation of practice indicated that the service users were treated with respect and the staff spoke to them in a respectful manner. All the six service users that we spoke to said that they liked living at the home and the staff were very kind and helpful. We observed that one of the service users occupied shared room at the home was used as a hairdressing facility on the day of the visit. This practice impinges on the service users private accommodation and their personal space. This was brought to the attention of the manager and must be addressed to ensure that private accommodation is not used as communal space. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is some activities available to the service users, however this would benefit from further development and information available to the service users. The service users are supported to maintain contacts with their families and friends. The service users are offered varied meals that meet with their satisfaction. Evidence: The manager stated that there is a varied programme of activities that the carers undertook in the afternoon. The five service users we spoke to said they watched television in the mornings usually and there are some games and singing in the afternoons. The manager told us about a tea party that they had earlier on in the week. Some of the activities that the service users had provided included trips to the seaside, lee on solent for ice cream, fish and chips at one of the local eateries. One of the service users was out with her husband and staff said that she went out weekly and has her hair one while she is out. Another service user who is partially sighted has talking book that her daughter brings and she told us that she enjoyed. Care Homes for Older People Page 14 of 27 Evidence: The hairdresser was also visiting on the day of the visit and the service users said that they looked forward to having their hair done. One of the service users went out with her daughter to the church every Sunday and another service user attended the salvation army meetings at regular intervals. A record of activities undertaken should be recorded in the personal records and an activity programme developed in order to inform practice and made available to the service users and their relatives. The home has an open visiting policy and records of visitors as maintained at the service indicated that there was no restriction in visiting. People spoken with said that they were always welcomed when they visited. Some of the comments included that there is a very polite and friendly staff making the new resident feel at home. Another comment was that this was an exceptionally friendly home. Other comments were: This is a warm friendly place. Residents are always made welcomed and the residents appeared well looked after. We observed the lunchtime meal and found that the service users were offered choices regarding the meals that they received. The care records contained details of their food likes and dislikes and the chef said that she was also aware of these and a record of food taken was maintained. The meals appeared well balanced and appetizing. Meals were nicely presented and people were offered assistance as required. We observed that all the service users had hot and cold drinks available to them throughout the day. Jugs of juice were replenished and carers were observed to encourage the service users with their fluids. All the six people we spoke to said that the food was very good and they could ask for something else if they did not like what was offered. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaint process is good and people are confident in approaching the staff with any concerns. the process of making referral to safeguarding is satisfactory. The updated procedures should be put in place to inform practice. Evidence: The home has a complaint procedure that the manager stated is available to the service users. A copy was displayed at the service we noted that this needs updating with the current details of the commission, the manager confirmed she would be putting in place. The service maintained a log of concerns and complaints received. There has been one complaint that was referred to the safeguarding team. This was not upheld. We found that there was a number of compliments and thank you letters that showed people were satisfied with the care. The service users we spoke to said that they were happy and did not have anything to complain about. The staff and manager were aware of the process of making safeguarding referral to social services as required. As discussed the manager must ensure that the home accessess the current safeguarding procedures and staff are updated with their Care Homes for Older People Page 16 of 27 Evidence: contents. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users are provided with a warm and homely accommodation. However process of promoting the service users privacy needs to be in place. The infection control procedues were satisfactory. The laundry flooring is in poor state of repair and pose infection control risk to the service users. Evidence: We walked around the building and looked at a number of the sevice users bedrooms as part of this visit. The home was clean and homely and there was no adverse odour when we visited. We found that the service users bedrooms were highly personalised that showed that people are supported to bring in items of personal belongings when they moved in. The service users spoken with said that they liked their rooms and some of them preferred to spend time in their rooms. The shared rooms had curtain on a track to maintain the privacy and dignity of people. We noted that the curtains did not surround the bed area and should be looked into. Call bells were available in the bedrooms we looked at and in the communal areas. There is an ongoing refurbishment programme in place and some of these included a Care Homes for Older People Page 18 of 27 Evidence: new chair lift, furniture, fridge freezer , tables and lampshades and two new beds arrived on the day of the visit. As previously reported in the other section, the use of their personal bedrooms as the hairdressing facilty does not respect their autonomy and privacy. We also observed that the locks in a number of the bedrooms we tested at random were not working. We brought this to the managers attention and need to ensure that appropriate locks are available in their private accommodation as needed. The home has a laundry room and the staff reported that all the service users laundry was undertaken internally. The laundry room was fitted with washing machine and drier. The manager confirmed that there was a sluicing facility on the washer. The laundry room is accessible and close to the newly refurbished garden area. We found that there were some items of hazardous substance that were unlocked in the laundry and these were removed. The manager stated that they plan to have a locked cupboard in the laundry to ensure that these materials are maintained safely. Information and equipment such as gloves and aprons were available and staff practices observed showed that they were aware of these and follwed these procedures. We observed that the laundry room flooring was in poor state of repair and was not impermeable and easily cleaned, as part of infection control procedures. The manager reported that this would be discussed with the provider and addressed. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is adequate staff to meet the current needs of people accommodated. The training programme is in place and staff are supported to access training and maintain their skills. The recruitment process is satisfactory and checks are completed for staff. Evidence: We looked at a sample of the duty roster and this showed that there are two carers on each shift and this included night duty when there are two awake carers. Comments we have received indicated that there were adequate staff to meet the service users needs. However comments were that sometimes it can be very busy in particular in the evening when the carers are also responsible for the preparation of tea time meals. The manager stated that both the provider and herself are both hands on and support the carers. The home has an ongoing training programme in place and the staff we spoke to said that they are supported to access training. There is an induction process and the manager confirmed that this met with the Skills for Care guidelines. Care Homes for Older People Page 20 of 27 Evidence: We looked at the recruitment records for three staff who had been recently recruited. All the staff completed an application form and checks such as Criminal Record Bureau (CRB) and POVA first were completed prior to them starting work. The manager reported that appropriate references from the previous employers was sought, as part of the recruitment process. Two of the staff records showed that one of the carers had two references in place, the other carer had only one reference. We were unable to locate any reference for the third staff member in her record. The manager confirmed the following day that these had been found. We have since received evidence of these as sent to us by the manager. There is a training programme and recent training included fire safety, moving and handling, infection control, dementia care,first aid and medication. The manager reported that five carers had been booked for moving and handling training in November 08. The manager confirmed that only carers who had completed medication training can administer medication at the service. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a manager who is highly regarded and has clear lines of accountability for the service. The financial interests of the service users are safeguarded through good accounting. The process of seeking the service users views is well managed and ensures that the home is run in their best interests. There is a satisfactory procedure in place to ensure the health and safety of the service users is promoted. However the safekeeping of hazardous substance must be addressed. Evidence: The service has a registered manager who has completed her National Vocational Qualification (NVQ) 4 in care and the registetred managers award. She undertook Care Homes for Older People Page 22 of 27 Evidence: regular updates to maintain her skills and the service users spoke highly of the manager.The manager reported that she had developed good relationship with the provider and was supported in her role. It was evident from the comments received that the manager maintained good relationships with external healthcare professionals and staff at the service. There is an audit system in place and included regular residents meetings. Positive comments were received regarding the care that people were receiving at the service. The manager stated that the home did not manage any of the service users personal allowances. Receipts and invoices were maintained of transactions. Invoices for items such as chiropopdy and hairdressing were raised monthly and sent to people who were responsible for these. Information that we have received indicated that there is an ongoing programme in place for the regular servicing of equipment. These included fire safety equipments, weekly fire alarm testing, emergency lighting and fire risk assessment. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R 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, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 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, Care Homes 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 9 13 The registered person must ensure that arrangements are in place for the safe administration of medication. So that the service users are receive their prescribed medication as required. 10/12/2008 2 19 12 The registered person must ensure that the home is conducted in a manner that respects the privacy and dignity of the service users. So that they can be assured that their private accommodation is not used as a communal facility and impinge upon their privacy. 10/12/2008 3 26 13 The registered person must ensure that unnecessary risks to the health and safety of the service users are identified and as far as possible eliminated. 10/12/2008 Care Homes for Older People Page 25 of 27 So that they can be sure that all areas of the home including the laundry is managed safely. 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 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!