Inspection on 05/06/07 for Clarendon Hall Care Home

This inspection was carried out on 5th June 2007.

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

Other inspections for this house

Clarendon Hall Care Home 22/05/08

Clarendon Hall Care Home 18/05/06

Clarendon Hall Care Home 02/02/06

Clarendon Hall Care Home 08/08/05

Clarendon Hall Care Home 28/10/04

Clarendon Hall Care Home 12/05/04

Clarendon Hall Care Home 15/03/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

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

CARE HOMES FOR OLDER PEOPLE Clarendon Hall Care Home 19 Church Avenue Humberston Grimsby North East Lincs DN36 4DA Lead Inspector Eileen Engelmann Key Unannounced Inspection 5th June 2007 09:30 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 Clarendon Hall Care Home DS0000002779.V341514.R01.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. Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clarendon Hall Care Home Address 19 Church Avenue Humberston Grimsby North East Lincs DN36 4DA 01472 210249 01472 210365 clarendonhall@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Limited 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) Muriel Broadhurst Care Home 52 Category(ies) of Old age, not falling within any other category registration, with number (52), Physical disability (46), Physical disability of places over 65 years of age (46) Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th May 2006 Brief Description of the Service: Clarendon Hall is a 52-bedded establishment for older people and physically disabled, both under and over 65 years of age. The home is purpose built and is owned by the Southern Cross group of homes. The accommodation is provided over 2 floors and is accessed by a passenger lift and various settings of stairs. There are some en-suite rooms and also a number of bathrooms and toilets, all within easy access to communal areas. There are a variety of sitting rooms and several dining areas, which are also used by the activities person. All garden areas are accessible for wheelchair users. The management team split the home into a unit for very ill service users and those who are more able, but each person can have access to the entire home, if they should so wish. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home, and copies are on display in the entrance hall of the home. The latest inspection report for the home is available from the manager on request. Information given by the manager within the Pre-Inspection Questionnaire indicates the home charges fees from £329.00 to £497.00 per week plus the nursing band fees where applicable. Residents will pay additional costs for optional extras such as activities, hairdressing, private chiropody treatment, toiletries and newspapers/magazines and staff escort duties. Information on the specific charges for these is available from the manager. Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit was carried out with the manager, staff and residents of Clarendon Hall. The visit took place over 1 day and included a tour of the premises, examination of staff and resident files and records relating to the service. Informal chats took place with some of the staff on duty and a number of the residents and relatives; their comments have been included in this report. Information was gathered from a number of different sources before the inspector visited the home. Questionnaires were sent out to a selection of staff, relatives and residents and their written response to these was poor. The inspector received 4 back from relatives (19 ), 1 from staff (5 ) and 6 from residents (29 ). The manager completed a pre-inspection questionnaire and returned this to the Commission within the given timescale. Since the last key inspection visit in May 2006 there have been two additional visits to follow up the progress being made by the home to meet the requirements and recommendations from the key inspection report. The additional visits took place in December 2006 and March 2007. From May 2006 to June 2007 there have been three separate issues of concern raised with the Commission by visiting professionals around the care being given to the residents. The owner of the home investigated these issues and changes to practice were made to make sure that residents receive the correct care to meet their needs. One formal complaint was made to the Commission by a visiting professional around poor care in the home. The owner of the home was asked to investigate and issues were identified around staffing numbers and staff competence. The home acted promptly to increase staffing and address the areas of staff recruitment and staff competency. Additional senior management support was provided for the home and admissions of new residents were carefully screened to ensure their needs could be met before placement was offered. At this visit (June 2007) it was seen that the additional management support has been reduced and is expected to cease shortly, as the registered manager feels able to resume the responsibilities of her role. One safeguarding of adults referral has been made in 2007 around concerns over the care of a resident. After discussion with the safeguarding of adults team from the Social Services, the operations manager investigated the issue and additional staff training around moving and handling was initiated. Since the last visit in March 2007 the manager and staff have worked extremely hard to improve the documentation within the home, staff practices have got better and the service has moved forward and been brought up to Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 6 date. A number of requirements and recommendations made at the March 07 visit have now been met and work is progressing to achieve others. What the service does well: What has improved since the last inspection? What they could do better: The person who owns the home must make the statement of purpose and service user guide better by putting more information into it. People living in the home said that the staff are very good at talking to them and they felt comfortable talking about the service and their needs. Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 7 The person in charge of the home must make sure she gets information about what care and support people who would like to come into the home need, before she makes the decision that the home can look after them. The people who are looking to come into the home will then know that they have chosen the right place to live in. The people working in the home do not always write down what care each person living in the home needs to make their life and health better. They should be talking to the residents more to find out what they like and how they want to be looked after. This helps the residents to have choice in how they are cared for and helps them stay as independent as possible. People who are working in the home have to be given training around keeping people safe from harm, this helps them understand how to look after individuals and speak up if they think anything is wrong. The person who owns the home must make sure the people living in the home have nice rooms to stay in and that anything that is broken or worn out is replaced with something new. The people who own the home must make sure that bedroom doors are fitted with locks and people who live in the home are given keys (if they are able to look after them), so people can keep their belongings safe and their privacy and dignity is respected. Information gathered from the people who live in the home, the people who visit them and those who help look after their health, must be put together into a report and this should be published so anyone with an interest in the home can see what the people using the service think about it. The inspector would like to thank everyone who completed a questionnaire and/or took the time to talk to her during this visit. Your comments and input have been a valuable source of information, which has helped create this report. 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 Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 8 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 6. People who use the 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 homes needs assessment process is inadequate and does not give individuals full written assurance that their needs can be met, prior to their coming into the home. EVIDENCE: Prospective residents who are interested in coming to live in the home are provided with a good choice of information about the service and its facilities. Information packs contain a brochure of the home including photographs and pictures, a copy of the company’s newsletter giving updates on events taking place and the service user guide available in clear print or an audio format. The statement of purpose and the service user guide need some amendments to the information within them to meet the criteria of Regulations 4 and 5 of the Care Standards Act 2000 and Care Standards Act 2000 (Establishments and Agencies)(Miscellaneous Amendments) Regulations 2006. Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 11 • • • • • • The statement of purpose says that the home has no deputy manager; however since this was written someone has been appointed to this post and her details should be put into the document. The range of needs does not mention the fact that the home can accommodate individuals under the age of 65 with physical disabilities or older people with physical disabilities. The responsible individual must make sure the statement of purpose clearly sets out who the home is able to look after and how they intend to do this. The service user guide does not include any information on the physically disabled category of care and how it will meet the needs of younger adults. The responsible individual must make sure this information is put into the documents. There is no fee information in the service user guide about the cost of staying in the home or the additional costs for extra services. The responsible individual must make sure this information is put into the documents. The service user guide must contain a copy of the homes terms and conditions (other than those relating to fees) in respect of the provision to residents of accommodation (including the provision of food), personal care and nursing care. The service user guide must contain a copy of the inspection report. The care files and associated documents for four residents were looked at as part of this visit. In the financial section of these, three out of the four individuals had a contract supplied by either the funding authority or the home (for self-funding individuals). A number of residents within the home are selffunding and their files show that information about fees and fee increases is sent out to the person responsible for each individuals finances and sufficient notice of changes to the prices is given in writing. One person who has been in the home for around five weeks does not have a contract or statement of terms and conditions, even though the Funding Authority has sent in a letter stating what fees they are paying for the individual. This is not acceptable practice and the responsible individual must make sure that everyone in the home is provided with this documentation. In the terms and conditions there is a break down of costs of additional extras, but this does not include the costs of staff who escort residents to medical appointments. As the service user guide says there is a cost attached to this service, the charges must be included in the section for additional costs. In the last report (March 07) a requirement was made for the responsible individual to ensure they have sufficient information about care needs of residents before the point of admission. Information from this visit indicates the requirement has not been met and will remain on this report. Of the four files looked at one was for a resident who was recently admitted to the home. No care needs assessment has been obtained from the funding authority for this individual although staff have carried out their own Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 12 assessment and produced a working care plan. Discussion with the manager resulted in her telephoning the Social Services Team and asking for a copy of the assessment as soon as possible. This is not acceptable practice and the responsible individual must make sure that improvements are made to this area of management. The statement of purpose says that the manager will formally write to prospective residents to make an offer of placement as part of the admission procedure. There is no evidence in the files looked at that this is taking place. The responsible individual should make sure that the homes policies and procedures are being followed. Since the visits in December 2006 and March 2007 the manager has made sure that staff attend training and development sessions to improve their knowledge and skills. This has resulted in a more positive attitude from the staff and comments from the surveys show that residents and relatives have noticed an improvement in the care practices and service. Individuals said the care and support from the staff is getting better and ‘staff consistency is proving to be a success, making Clarendon Hall an excellent place to live’. Information from the Pre-Inspection Questionnaire and discussion with the residents indicates that the majority of residents are of white/British nationality; the home does accept residents from other countries, including those with specific cultural or diverse needs. Everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community; and placements are also open to individuals from other areas. The home employs five staff members from overseas. Discussion with the staff indicates they work well together as a team and they consider their support to each other as a main strength in the progress being made to improve resident care. Residents are able to make a limited choice of staff gender when deciding who they would like to deliver their care, as the home has four male care staff as well as the female members. The manager said that she would discuss this with prospective residents during the assessment process. The staff’s training files and the training matrix show that the home has an Induction package for all new staff to go through before starting work and that the home has a training programme in place. Information from the files and matrix indicates that the majority of staff are up to date with their mandatory safe working practice training, and the manager said she is looking into providing training in more specialised subjects linked to conditions of old age. The home does not accept intermediate care placements so standard six is not applicable to the service provided. Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 13 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 and 11. People who use the 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 quality of the record keeping for care plans must be improved to ensure the needs of the residents are met and their health and safety protected. Improvements must be made to the end of life care within the home to make sure residents wishes and choices are respected and they are able to die with dignity. EVIDENCE: A number of requirements have been made in the past few reports (May 06, December 06 and March 07) to improve the care plans. The responsible individual has been asked to • Ensure that risk assessment documentation is in place to support the use of “bucket style” chairs (timescale given of 01/05/07). This has been met at this visit. • Ensure that all service users assessed needs have appropriate care plans to address them. Previous timescale 30/06/06,15/01/07and 01/05/07 were not met. It was seen at this visit that this is partly met, but some parts of the care plans could be developed further. Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 14 • Ensure that the nursing staff working at the home follows care plans, developed for service users by district nursing teams. It was seen at this visit that the staff are working closely with the community nurses to improve care and that this requirement is now met. Individual care plans are in place for all residents and set out the health and personal care needs identified for each person. Four of the plans looked at have been evaluated on a monthly basis and any changes to the care being given is documented and implemented by the staff. Risk assessments were seen to cover pressure sores, nutrition, moving/handling and activities of daily living. The funding authorities are carrying out yearly reviews of the care plans and the minutes of these meetings show that residents have input to this process (where possible), and family/representatives are also invited to the reviews with the resident’s permission. Residents or their representative have signed the care plans at the point of their being written to show they agree with the content, however there is little evidence that residents are consulted on a regular basis about their care, especially when staff are completing the monthly evaluations. This was discussed with the manager and she said she would look at how staff could use a variety of different and creative methods to help people using the service to contribute to their own care plan. Areas of the care plans that need to improve include those within the headings of sexuality and death and dying. Staff are not using their knowledge of equality and diversity to complete these properly. Individuals have a right to express their preferences, wishes and choices about their life, care and expectations for the future, and these are not being represented in these areas of care. The manager should ensure that staff take part in equality and diversity training and use this knowledge when admitting people into the home and completing or updating their care plans. In the last report (March 07) requirements were made for the responsible individual to • Ensure that staff (in the residential unit) are competent in recognising and reporting abnormalities in blood pressure recordings if they are to continue this practice. Given timescale was 01/05/07. Discussion with the staff indicates that training has not taken place, but the nurses are willing to show the residential staff how to undertake this procedure. The requirement will remain on this report. • Ensure that all service users receive appropriate support with their nutritional needs. Given timescale of 19/12/06. At this visit it was seen that this has been partially met. It was noted that some nutritional records in the residents’ rooms had not been completed for the day of this visit even though it was midday when the inspector was walking around the home. The home has a set of sit-on weighing scales and scales that can be used with a hoist to ensure that everyone can have their weights checked and recorded Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 15 as part of their risk assessment process. Staff are now weighing people living in the home on a monthly basis: individuals have nutritional risk assessments in their care plans, which are being reviewed regularly, and dietician advice is being sought if there are concerns about anyone’s nutritional health. One complaint and two concerns have been raised in the past months about the number of residents who have pressure sores in the home and whose care was not found to be acceptable by the tissue viability nurse. Since December 2006 the responsible individual has made sure that qualified staff have undergone training around their competency levels and skills, and the tissue viability nurse is working closely with the staff to improve wound care. The tissue viability nurse is providing training for the staff and is carrying out quarterly visits to check documentation and care. The pressure care charts in the bedrooms are being completed daily, but the inspector was concerned to see that between the handover of night to day staff there is a wait of over three hours before residents are being turned. This is not acceptable practice and the responsible individual must look at how this can be addressed. Two residents have use of Care flex chairs, which are water filled and provide pressure relief by staff adjusting the angle of tilt. Throughout the building residents are provided with specialist nursing beds, pressure relieving mattresses and seat cushions to aid staff in maintaining the comfort and wellbeing of the residents. Over the past twelve months there have been a number of residents who have received small skin tears or bruising during care practices. The operations manager has carried out investigations into these, and staff training in moving and handling has been implemented more frequently. The manager should make sure that she looks carefully at the accident reports and checks the cause of the accident to see if there are any pattern to the incidents such as equipment use or care practices that are putting residents at risk of harm. The home has been visited by the ‘Prevention of Falls’ team from the community who have assessed the residents and are going to provide training for staff to use a piece of equipment designed to improve individuals’ balance. Two residents said that they have good access to their GP’s, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Responses to the surveys indicated that the residents and relatives are satisfied with the level of medical support given to the people living at the home. Relatives commented that ‘the care provided for my mum is extremely good, she says she is very happy with the staff’ and ‘staff care is excellent, they even visited our relative in hospital’. The home uses Boots the Chemist as their pharmacy supplier and has a ‘pop out’ system of medication, plus some boxes and bottles where medication is not suitable for putting into the heat-sealed system. There are two sides to Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 16 the home, one for nursing care residents and one for mainly residential care residents. At the last visit in March 2007 a requirement was made • The responsible person must ensure that Temazepam medication is stored appropriately. Checks of the controlled medication cupboard showed that stock levels were correct and a register is kept, however the Temazepam tablets are not kept in this cupboard because the blister packs are too big. No action has been taken by the manager to arrange for the Temazepam to be provided in boxes or bottles and therefore the requirement will remain on this report. Checks of the medication records showed that overall these are well maintained and kept up to date. The qualified staff are auditing the records daily at handover to ensure documentation is well managed and this has resulted in noticeable improvements to this area of care practice. Residents living in the home say they are well looked after and feel like they are part of one big family. Two individuals spoken to said ‘we are made comfortable at all times and the staff look after all our needs’. Comments received from the residents and relatives indicated that they have noticed the improvements to care practices and in the staff attitudes since the last visit. Individuals said the atmosphere within the home is positive and more up beat, staff are working together better and act as a team, which means that care is more consistent and to a higher standard. Relatives were very positive about the home meeting the needs of their family members. One person said ‘the staff really care for the people living in the home, they keep you up to date with any problems, telephone you when needed and make us welcome every time we visit’. The home is looking after some residents who have a terminal illness and information in their care plans is not very good regarding their palliative care and information about their wishes and choices around end of life care. The inspector discussed the use of an End of Life Care Programme within the home and a useful source of reference is the Introductory Guide to end of life care in care homes provided by the NHS. This can be obtained from www.endoflifecare.nhs.uk. Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 17 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 and 15. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents are provided with choice and diversity in the activities and meals provided by the home. Individual wishes and needs are catered for and people have the option of where, when and how they participate in both eating and leisure activities. Improvements are needed to staff practices around offering help and assistance to residents who cannot maintain their own dietary needs, to ensure their health and nutritional wellbeing is met. EVIDENCE: Information from the resident and relative surveys showed that everyone is satisfied with the social activities on offer and individuals felt there was always something they could participate in. One person said ‘the activities are varied and of a high standard. The co-ordinator does an excellent job, but it would be helpful if the home had its own minibus’. A relative commented that ‘my mum prefers to be alone in her room, but enjoys some of the activities on offer. She is always given the choice of joining in’. The activity co-ordinator works five days a week in the home and her records of events taking place are extremely detailed and show who was asked to join Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 18 in and those who did take part. Each resident has their own record for activities and this details what they like and events they enjoyed. Younger residents in the home are able to take part in 1-1 activities and specific events are tailored to their wishes and choices. Where individuals cannot express their own preferences regarding social needs then families are asked to input to the care plan and discuss what they think the individuals would prefer. Residents spoken to during this visit were busy knitting, reading, listening to music or watching television: they are all happy with their daily lives and felt they had enough to keep them occupied. Resident/relative meetings are held every 1-2 months; these are used as an opportunity for individuals to express their ideas of what activities and trips out they want and to give their feedback on events that have taken place. Church visitors come into the home every 2 weeks and residents are encouraged to celebrate Christian events such as Birthdays, Easter and Christmas. Discussion with the residents indicates that they have good contact with their families and friends. Everyone said they are able to see visitors in the lounge or in their own room and they could go out of the home with family or staff would take them into the local town. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly is a good relationship between all parties. Relatives and visitors to the home are very positive about the service and the staff. Written and verbal comments given to the inspector showed a high level of satisfaction. Individuals said that the home helped their relatives/friends stay in touch with them. One person said ‘I am phoned when important things affecting my relative take place’ another commented that ‘ the staff make time for me, answer my questions and help me through what is a difficult time’. Information about advocacy services is on display in the home and discussion with the manager indicated that no one at the home is currently using an advocacy service, although she has arranged for one person to be seen next week by someone who can help with their finances. Two residents spoken to are well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. Residents spoken to are satisfied that they can access their personal allowances when needed. All the residents said that the home encouraged them to bring in small items of furniture and personal possessions to decorate their bedrooms. There are resident meetings where the viewpoints and opinions of those living in the home can be expressed and the management team will listen and take action were needed. Visitors said they are kept informed of any important issues affecting their friend/relative and felt that staff did a good job of supporting people to live the lives they choose. Survey responses about the food served within the home are mixed. Some individuals said ‘the food is very good and diets are well catered for, the Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 19 breakfasts are particularly appreciated’, but others felt ‘the meals can be cold and tasteless: staff do not always take them out on a tray to the bedrooms. The quantity is ample, but the choice of dessert could be more appealing and varied with better choice’. Walking around the home it is apparent that the manager has made some changes to the dining areas. One dining room in the main house is being decorated and there are plans to carpet part of the floor and make a lounge/dining room. Another large dining room has been decorated and is waiting for the border to go onto the wall. This was well used during the lunchtime meal with residents choosing to sit in this area to eat their food. Another lounge in the Lodge area of the home did have dining tables in it at the last inspection. These have now been removed and residents are encouraged to go down to the other two dining areas for their meals. Discussion with the staff indicated that they usually wore plastic aprons when serving meals but today this was not possible, as they had run out of supplies. The manager said these are on order and should be received the next day. Observation of the midday meal showed it to be well prepared and presented on the plates, and the kitchen staff had made an effort to provide soft/pureed diets in an attractive way. Staff were seen to offer assistance to residents who need help with eating and drinking during this meal. Staff are not particularly organised when taking meals out to the residents, this could be why comments about cold meals and a lack of trays in rooms are being made. The responsible individual should consider how the meal times could be improved so meals are always hot, well presented to individuals and staff have an effective routine. It was noted that staff are not always efficient at clearing away dirty cups and crockery from the residents’ rooms: this was commented on in the surveys and observed by the inspector during the day. A number of residents were sat with cold cups of tea/coffee in front of them during this visit. This raised the questions are staff giving individuals assistance with drinking during the day and are residents receiving enough fluids? Nutrition charts in the bedrooms had not been completed by the staff, even though it was midday when they were looked at by the inspector, so how well staff are monitoring the diet and fluid intakes of the residents is also questionable. The responsible individual must ensure that residents’ nutritional needs are being met, with sufficient diet and fluids being given to individuals and assistance offered where needed on an ongoing basis. Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 20 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 and 18. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Staff understanding of the arrangements for protecting residents is not satisfactory, placing residents at possible risk of harm or abuse. EVIDENCE: The home has a complaints policy and procedure that is included in the statement of purpose and service user guide; it is also on display within the home. All of the six resident survey responses showed individuals have a clear understanding about how to make their views and opinions heard and those residents spoken to said ‘we would talk to our key worker or the nurse on duty if we have a problem’. The four relatives who completed a survey said that they felt the home responded appropriately if they raised a concern and minor issues were dealt with quickly. The recommendation from the last report (March 07) that ‘the responsible individual should ensure that all outcomes identified from complaints management are clearly identified and records support they are followed through’, has been met. The home has received fourteen complaints between May 2006 and April 2007; these related to food, care, staff, wheelchair use, medication and hygiene. The Commission for Social Care Inspection has received three concerns and one formal complaint about Clarendon Hall. All have been investigated and Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 21 resolved. The complaints record documents each issue and the subsequent action taken by the manager or staff. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of resident’s money and financial affairs. Staff have undergone training around safeguarding of adults, challenging behaviour and dementia care to help them build their skills and knowledge in this area of care. The information in the staff surveys around adult protection from abuse indicated that some staff may not have taken on board the importance of protecting the residents and that they viewed whistle blowing as ‘grassing up’ colleagues. This was discussed with the manager and it is imperative that the responsible individual ensures that staff understand the importance of reporting any incidents that may put residents at risk of harm. Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 22 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, 22, 24 and 26. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Since the last visit the standard of the environment has improved, providing the residents with an attractive and homely place to live. EVIDENCE: The manager has a record of the ongoing maintenance and renewal programme and this indicates that the provider is committed to improving the facilities and environment within the home. The home is undergoing a period of redecoration and refurbishment with lounges and dining rooms being supplied with new carpets, curtains, furniture and colour schemes. Keypad locks are in the process of being fitted to the laundry, kitchen and nurses offices to increase security and protect residents safety. Walking around the home it is apparent that the domestic staff work hard to keep the building clean, tidy and presentable. There are a few areas of the home that require some attention and these include Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 23 • • • • • • One of the residents’ toilets on the Lodge is leaking and needs repairing. Discussion with the manager indicated that this has been reported and is being attended to . The stairwells at either end of the building are in need of redecoration and cleaning as there were a number of cobwebs hanging from the ceilings and the appearance of these areas did not match the standard of the rest of the home. The extractor fan in the en-suite of Room J on the Lodge is not working and needs repairing or replacing. The bathroom door on the lodge is dented and should be considered for replacement. Armchairs currently stored in the stairwell of the home must be removed as they could be a fire risk. Some bedroom doors are being propped open by inappropriate objects and this could be hazardous if there was a fire. The responsible individual should consider fitting approved and appropriate fire door stops to these rooms. In the last report (March 2007) a recommendation was made for ‘the responsible individual to improve the amount of communal space in the residential unit’. At this visit it was seen that some action has been taken to provide better communal space. The lounge area on the residential unit no longer has dining tables and chairs within it: instead the residents are being encouraged to use one of the dining rooms in the main house. This has opened up the residential lounge, but one visitor commented to the inspector that there were no chairs for him to sit on unless he took one of the resident’s armchairs. The home has lawned and garden areas around the premises, but these are looking overgrown and neglected. One relative said that ‘ the home is an excellent place to live, but an enclosed garden for residents of the Lodge would be advantageous for people returning to mobility’. The responsible individual must ensure the outside areas are in a suitable state for use by the residents, especially as the better weather is here. At the last visit in March 2007 the inspector made two recommendations • The responsible individual should ensure that a referral is made to the Community Occupational Therapist to review the provision of the “Carflex” chair to the service user with physical disabilities. Discussion with the manager indicated that this has been done and the appropriate documentation is in place. • The responsible individual should review the provision and type of moving/ handling equipment in the residential unit. Discussion with the manager indicated this has not taken place and the recommendation will remain on this report. DS0000002779.V341514.R01.S.doc Version 5.2 Page 24 Clarendon Hall Care Home Inspection of the home showed that it has been designed and built to meet the needs of disabled individuals. Doorways to bedrooms, communal space and toilet/bathing facilities are wide enough for wheelchairs, and corridors are spacious and have enough room for people in wheelchairs or with walking frames to pass by comfortably. The home is built on two floors with flat walkways inside and out, providing safe and secure footing for people with limited mobility. Access to the upper floor is by use of staircases or the passenger lifts. Discussion with the staff and manager indicates that there is a wide range of equipment provided to help with the moving and handling of the residents and to encourage their independence within the home. This includes electric hoists, fixed bathing hoists, slide sheets, specialist chairs and handrails. Specialist nursing beds are provided for some individuals to aid staff in caring for the residents and make life more comfortable for those people who spend a lot of time in bed. In the past staff have asked for a stand aid for the residential unit, but to date no action has been taken to assess the need for this or to purchase this equipment: (see recommendation above). Two residents spoken to were very pleased with their individual rooms and said that they had ‘brought in a number of personal possessions to make them feel more homely’. Door locks are not provided for all rooms and some bedrooms do not have lockable drawers for use by the residents to keep valuables or personal possessions safe. The responsible individual must ensure all bedrooms have a lock suited to residents’ capabilities and accessible to staff in an emergency. Residents must be provided with a key unless their risk assessment suggests otherwise. The laundry in the home was having some problems at the time of this visit. Two of the three tumble dryers are broken and, although an engineer has looked at them, the parts are taking some time to arrive. Staff are doing the best that they can, putting linen out on lines to dry outside and taking washed items to a sister home for drying where necessary. One relative commented that ‘I am not always pleased with the laundry service, as clothes are not ironed very well’. Others said ‘the staff work beyond the call of duty, we have nothing but praise for them all’. Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 25 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): 27, 28, 29 and 30. People who use the 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 staff have a good understanding of the residents support needs. This is evident from the positive relationships, which have been formed between the staff and residents. EVIDENCE: At the last visit in March 2007 a requirement was made that asked ‘the responsible person must implement formal systems whereby the levels of care staff required on shift are closely monitored and linked to the dependency of the service users’. Timescales of 15/01/07 and 15/04/07 were given for compliance. It was seen at this visit to be met. The pre-inspection questionnaire contained information on the dependency levels of the residents and the staff rotas show that the main house and the lodge are staffed independently during the day and staffing at night is for the whole home. The Lodge has three staff on duty during the day and there is a total of one nurse and three staff for the home at night. The main house has one nurse and five care staff during the morning and one nurse and four care staff during the afternoon. Observation of the staff showed that the home is busy, but well organised. Information from the pre-inspection questionnaire about the dependency levels of the residents, and information from the staff rotas gathered during the Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 26 inspection, was used with the Residential Staffing Forum Guidance and showed that the home is meeting the recommended guidelines. Staff are using a team approach to care and there is a good working atmosphere at the home. Comments from the relatives and residents praised the staff; one individual said ‘the staff are excellent, they work hard to make the home comfortable for the residents’. There is an induction course for new members of staff, and 32 of the care staff have achieved an NVQ 2 or 3. It was a recommendation in the March 2007 report that 50 of care staff should achieve this qualification and will remain a recommendation in this report. The home provides a mandatory staff-training programme and is beginning to add more specialised training to help staff develop their skills and knowledge around challenging behaviour, dementia, syringe drivers and palliative care. Discussion with the manager indicated that the access to specialist subjects should be more evident over the next 12 months. Staff training has improved since the May 2006 visit and over 85 of care staff have undergone mandatory safe working practice training in Moving and Handling, First Aid, Health and Safety, Food Hygiene, Fire Safety and Medication in the past twelve months. Staff do have access to training around equality, diversity and disability rights and discussion with the manager and operations manager indicated this will be included in the rolling programme of staff training and development. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of four staff files showed that police/Criminal Records Bureau checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Nurses at the home undergo regular registration audits with the Nursing and Midwifery Council to ensure they are able to practice. Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Improvements to the management practices within the home have taken place: these must be sustained to ensure the residents’ health, safety and wellbeing is protected. EVIDENCE: Following the last two inspections (December 06 and March 07) management support was provided for the registered manager; a project manager was seconded from one of the companies other homes in the area; the operations manager and regional manager also visited the home regularly ensuring that senior management was provided daily in the home. The operations manager confirmed that the manager’s induction programme has been revisited; that all senior managers have worked closely with the Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 28 manager to improve her knowledge base and competence and the managing director has also provided the manager with time management training. At the time of this visit the project manager has left the home and managerial support for the registered manager is being reduced. Discussion with the manager indicates that she feels able to carry out her role and responsibilities. There is a new deputy manager in place at the home and she is providing staff with clinical support and assistance. It is important that the management practices of the home continue to move the service forward to achieve the high quality standards of care expected of a care home. The registered manager is a qualified nurse with an active registration with the Nursing and Midwifery Council. She is currently doing her Registered Managers Training and hopes to complete this by the end of August 2007. The company provides their managers with regular training and development sessions to keep their skills and knowledge up to date. Since the last key inspection in May 06 the home has introduced a system of Quality assurance and monitoring. The manager is responsible for completing monthly audits of staff practice and records within the home and the registered individual does spot checks and completes the regulation 26 visits. A copy of the monthly visit is sent to the commission. Meetings for the staff and residents are taking place; minutes are kept and are available for any interested parties to read. Policies and procedures are up dated and reviewed as an ongoing practice and action is being taken to ensure the requirements of the inspection reports are met. Feedback is sought from the residents and relatives through regular meetings and satisfaction questionnaires, although there is no annual development report produced as part of this process to highlight where the service is going or indicate how the management team is addressing any shortfalls in the service. The annual development report must be produced to ensure the service meets the resident’s needs and is run in their best interests, and time was spent with the manager discussing how this could be achieved. The importance of the Commission’s document called Key Lines Of Regulatory Assessment (KLORA) was discussed with the manager, and how it is used in the inspection and report writing process. The home continues to keep up to date financial records for residents’ personal allowances. These records are computerised and detail the transactions undertaken and the money held for each resident, the administrator updates these each week. Information from the manager indicates that the majority of the residents have a family member or representative who looks after their monies and these individuals make sure the Personal Allowances are sent/brought into the home. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 29 Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. There is a need for the manager to closely monitor the causes of any accidents (see standard 8) and record any action taken to reduce the risk of harm to residents. This was a requirement in the last inspection report (March 07) and will remain in this report. Staff have received training in safe working practices and the manager has completed generic risk assessments for a safe environment within the home. The risk assessments should be reviewed by the manager on a regular basis and signed. Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 1 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 X 3 X 2 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes. 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 OP1 Regulation 4, 5, Schedule 1 Requirement The responsible individual must produce an up to date statement of purpose and service users guide. This is so that people looking for a place to live have the right information available to them to help them decide if the home can meet their needs. The responsible individual must make sure that all residents are provided with a statement of terms and conditions or contract for privately funded individuals at the point of moving into the home. This is so individuals are aware of the rules of living in the home, understand the cost attached to the overall care and services to be provided and agree to the payments, which must be made. The terms and conditions must include a break down of all costs for additional services to be paid for over and above those included in the fees. This is so people coming into the home understand what they have to DS0000002779.V341514.R01.S.doc Version 5.2 Page 32 Timescale for action 01/12/07 2. OP2 5 01/09/07 5(bc) Amended regulations 2006 Clarendon Hall Care Home 3. OP3 14(1) pay for the different services available to them. The responsible individual must ensure that all relevant assessment information is obtained and documented prior to admission even when preassessment visits cannot take place. This is so prospective individuals can be confident the home can meet their needs before an offer of placement is made (given timescale of 01/05/07 was not met). 01/09/07 4. OP7 15 (1) The responsible individual must 01/10/07 make sure that the assessed needs of the residents have appropriate care plans to address them. This will ensure that the residents receive the right care to protect their health and wellbeing, and their wishes, choices and rights as individuals are promoted and protected. (Given timescales of 30/06/06, 15/01/07 and 01/05/07 were not met) The responsible individual must ensure staff use a variety of different and creative methods to help people using the service to contribute to their own care plan. So that residents are able to have a say in the decisions made about their lives and play and active role in planning the care and support they receive. The responsible individual must 01/10/07 ensure that staff in the residential unit, are competent in recognising and reporting abnormalities in blood pressure recordings if they are to continue this practice (given timescale of 01/05/07 was not met). 5. OP8 12(1)(a) (b) Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 33 6. OP8 17(1)(a) 7. OP8 12(1) 8. OP9 13(2) The responsible individual must make sure that staff maintain records of nutrition, and take appropriate action where needed. This is so residents’ health and wellbeing are protected and their nutritional needs are met. The responsible individual must make sure that staff are giving correct pressure relief to the residents as set out in their care plans. This is to protect the residents from risk of developing pressure sores. The responsible individual must ensure that Temazepam medication is stored appropriately. This is because it is a controlled drug and must be stored as such to prevent risk of medication errors or abuse. (Given timescale of 01/05/07 was not met) The responsible individual must ensure that residents who are dying receive appropriate care and attention and that their wishes concerning terminal care and arrangements after death are discussed and carried out. This is because individuals have the right to be handled with dignity and respect and their spiritual needs, rites and functions observed. The responsible individual must make sure that residents’ nutritional needs are being met, with sufficient diet and fluids being given to individuals and assistance offered where needed on an ongoing basis. This will protect the residents’ health and wellbeing and make sure they are not hungry or thirsty. DS0000002779.V341514.R01.S.doc 01/10/07 01/09/07 01/09/07 9. OP11 12(1)(4) 01/10/07 10. OP15 12(1) 01/10/07 Clarendon Hall Care Home Version 5.2 Page 34 11. OP18 13(6) The responsible individual must 01/10/07 ensure that staff understand the importance of reporting any incidents that may put residents at risk of harm, and robust procedures for responding to suspicion or evidence of abuse or neglect are used when necessary. This will protect residents from risk of harm and make them feel safe within the home. The responsible individual must make sure that all repairs and renewals as highlighted in this report are carried out. This will enable the residents to live in a safe and well-maintained environment, which meets their needs and the outcomes of the statement of purpose. The responsible person must make sure that the external gardens are suitable for, and are safe for use by, the residents. This will protect their safety and wellbeing and promote their enjoyment of the communal spaces outside of the home. The responsible individual must ensure service users’ private accommodation are fitted with locks suited to service users’ capabilities and accessible to staff in emergencies. This will protect the residents’ rights to privacy and dignity. The responsible individual must ensure service users are provided with keys to their bedrooms, unless a risk assessment suggests otherwise. This will protect the residents’ rights to privacy and dignity and also keep them free as far as possible from hazards to their safety. DS0000002779.V341514.R01.S.doc 12. OP19 23(1)(2) (a) 01/12/07 13. OP20 23(2)(o) 01/10/07 14. OP24 12(4)(a) 01/04/08 15. OP24 13(4)(a)(c) 01/04/08 Clarendon Hall Care Home Version 5.2 Page 35 16. OP33 24(1)(a) (b)(2)(3) The responsible individual must ensure that there is an annual development plan for the home, based on the views and opinions of the residents and which reflects the aims and outcomes for the people using the service. The responsible individual must ensure that appropriate records of management action taken following accidents in the home are maintained. 01/04/08 17. OP38 13(4) 01/10/07 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. 2. Refer to Standard OP3 OP7 Good Practice Recommendations The responsible individual should make sure that prospective residents receive a formal written offer of placement, in line with the homes policies and procedures. The responsible individual should ensure that the frequency of turns provided to service users with high tissue viability needs are consistently identified and recorded. The responsible individual should consider how the meal times could be improved so meals are always hot, well presented to individuals and staff have an effective routine. The bathroom door on the lodge is dented and should be considered for replacement. • Some bedroom doors are being propped open by inappropriate objects and this could be hazardous if there was a fire. The responsible individual should consider fitting approved and appropriate fire door stops to these rooms. The responsible individual should review the provision and type of moving/ handling equipment in the residential unit. DS0000002779.V341514.R01.S.doc Version 5.2 Page 36 3. OP15 4. OP19 • 5. OP22 Clarendon Hall Care Home 6. 7. 8. OP28 OP31 OP38 The responsible individual should ensure that a minimum of 50 of the care staff have completed their NVQ level 2 by the end of April 2008. The responsible individual should ensure that the manager of the home completes her NVQ level 4 in management by the end of August 2007. The generic risk assessments should be reviewed by the manager on a regular basis and signed. Clarendon Hall Care Home DS0000002779.V341514.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. 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