Inspection on 09/05/06 for Clarendon House

This inspection was carried out on 9th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 House 20/11/07

Clarendon House 24/11/05

Clarendon House 19/05/05

Clarendon House 09/03/05

Clarendon House 24/11/04

Clarendon House 26/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Clarendon House Carrwood Road Bramhall Stockport Cheshire SK7 3LR Lead Inspector Kathleen Mcall Unannounced Inspection 9th May 2006 10:40 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 House DS0000008548.V290505.R01.S.doc Version 5.1 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 House DS0000008548.V290505.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Clarendon House Address Carrwood Road Bramhall Stockport Cheshire SK7 3LR 0161-488 4107 0161 488 4107 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) Davenport Manor Nursing Home Limited Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 32 OP. Date of last inspection 17th July 2002 Brief Description of the Service: Clarendon House is a residential care home that is registered to provide accommodation for up to 32 older people, including ten residents who have a diagnosis of dementia. Clarendon House is one of two residential care homes owned by the Davenport Manor Nursing Group, the other being Davenport Manor residential care home. The registered providers are Kiran Patel and Mr Dilip Patel. The acting managers are Ms Sally Turner and Mrs Wendy Drabble. Clarendon House is a large Tudor Style residence that is situated on Carwood Road, Bramhall. The home is set back off the road with substantial gardens surrounding the property with access to Bramhall Park. There are no bus routes that run directly to the home. The nearest shops are situated on Bramhall Road or in Bramhall village, which is approximately a five minute drive away from the home. The home has 20 single rooms, ten of which have en-suite facilities and six double rooms that have no en-suite facilities. All rooms have a washbasin. There are two lounges and two dining rooms. There is a passenger lift to assist residents to their bedrooms on the first floor. The home is suitable for wheelchair users. Rooms at Clarendon House can be contracted on a private basis or funded by the local authority. Fees range from £315 for a shared room funded by the local social services department, to £384 plus a £40 top fee. Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place over the course of two days. The inspector met with the registered provider who was visiting the home at the time of the site visit. There have been a number of changes to the management and staff group at the home since the last inspection. The registered manager had resigned from her post as manager of the home. Two acting managers had been appointed with joint responsibility for the dayto-day management of the home. The inspector had a discussion with the registered provider regarding the future management arrangements at the home. The registered provider advised that there were plans to register a new manager. Both the registered manager and the acting managers were aware of the requirements that the home had been given at the previous inspection and of areas that the home must improve on. Both the registered provider and the acting manager were fully committed to improving the service delivery and day to day management of the home for service users and asked that they be given time and support to achieve this. A significant number of long-term staff had terminated their employment and several new members of staff had been employed. A large number of service users expressed regret about care staff leaving and told the inspector that they were adjusting to the changes and getting to know the new care staff. One of the acting managers accompanied the inspector throughout the inspection process. Care plans, assessment documentation, and other records were examined. The inspector spoke with a number of residents and several members of staff who were on duty. Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? Since the last inspection the registered provider had applied to the Commission for Social Care Inspection to vary the homes categories of registration to include up to ten service users with dementia. The homes Statement of Purpose had been updated to reflect these changes. The home has consulted with residents regarding their preferred choice about activities provided at the home and questionnaires have been sent out to residents. The majority of residents were now satisfied with the activities provided. The home has made a number of changes to the way medication is administered and stored within the home and overall there has been a significant improvement in this area. Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality in this outcome area is good. Service users’ care needs were fully assessed before admission and they received sufficient information that informed them about the home. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: At a previous inspection the home had been required to ensure that all prospective and new service users to the home were given a copy of the service user guide. There had been one new service user admitted since the last inspection, who confirmed that she had been given a copy of the service users guide and other information about the home which she said she found useful. Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 10 Since the last inspection the registered provider had applied to the Commission for Social Care Inspection to vary the home’s categories of registration to include up to ten service users with dementia. The home’s Statement of Purpose had been updated to reflect these changes. One new service user had been admitted to the home since the last inspection and a service user had been admitted to the home as an emergency the evening before the site visit. Information held on service users files confirmed that service users had been thoroughly assessed prior to their admission or immediately following their admission as an emergency. Routinely assessments were obtained from social workers and the home completed their own assessment documentation. Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. Care planning and risk assessments remained poor however medication practices at the home had improved. Care staff treated service users respectfully and met their health and care needs. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: At a previous inspection the home had been required to ensure that care plans accurately illustrated how service users needs were being met. The acting managers had begun to review all care plans. There were 27 service users in the home at the time of the site visit, the acting manager said she was aware of the requirement in respect of care plans and that she had taken responsibility for updating all care plans and anticipated that these would be completed very soon. Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 12 The acting manager had put a new system for daily records in place. The quality of information recorded on daily records was good. One carer told the inspector that she liked the new system, ‘it worked well and it was simpler to use’. Similarly, as with risk assessments, the inspector observed that there had been no progress in respect of developing risk assessments. However the acting manager was aware of this requirement and had plans to putt up to date detailed risk assessments in place alongside care plans as they were reviewed. Several service users told the inspector that they were very satisfied with the way in which their health and care needs were met. General Practioners were contacted when needed, as was the chiropodist and hospital appointments were kept with assistance and support from relatives. Service users told the inspector that staff treated them well and with respect at all times. Care staffs practices were observed during the site visit. Care staff treated service users respectfully and spoke appropriately at all times. At the time of the site visit a service users was agitated and distressed. Care staff handled this well, minimising the amount of upset for other service users’. Care staff members interviewed confirmed that they had undertaken relevant training and had updated their moving and handling training. At a previous inspection evidence of poor practice in the storage, recording and administration of medication was found and a number of requirements were issued. At the time of the site visit it was observed that the medication practices at the home had improved considerably. However there was still one area of medication practices that remained outstanding. Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 15. Quality in this outcome area is good. The day-to-day routine of the home including mealtimes was relaxed and informal and met service users needs. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The day-to-day routine of the home was relaxed and informal. At a previous inspection the home had been given a requirement in respect of activities. Service users had complained that there was not enough going on, some service users expressed dissatisfaction with the range of activities on offer at the home and some service users were unhappy with the positioning of the TV in the top lounge as it meant that those service users sat at the top of the room were unable to see the television. Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 14 Since the last inspection consultation had taken place with service users on an individual basis, however no record of this consultation was kept. As a consequence the acting manager was in the process of introducing an activities record which detailed those service users who took part in a planned activities and those who declined and any comments, i.e., enjoyable or not. At the time of the site visit service users were generally more satisfied with the activities provided and the TV in the top lounge had been moved and a loop system fitted. One service user remained dissatisfied and this was fed back to the acting manager. At the time of the visit one member of staff had been given the responsibility of organising activities. A game of bingo had been planned however it was a warm sunny day and several service users and staff chose to sit outside. The home had purchased several new sun parasols and a gazebo. Visitors were welcome to the home and the home maintained contact with the local community, i.e., church visits. Service users were able to see visitors in private. Service users expressed a high level of satisfaction about the meals and quality of food provided at the home. Lunch was the main meal of the day served with fresh vegetables; the teatime meal was a light snack meal. The acting manager had reviewed the arrangements around meal times. The home had two dining room areas, these have been renamed and staff were given specific responsibilities and duties for each area and for managing mealtimes. Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. Service users felt confident that their complaints would be taken seriously and acted upon. Not enough staff had undertaken training in adult protection. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: There had been one anonymous concern made directly to the commission since the last inspection, concerning poor morale amongst staff and inadequate management arrangements at the home, which was unsubstantiated. There have been no complaints made directly to the acting manager or any other member of staff. Service users told the inspector that they knew who to complain to and felt that their complaint would be dealt with in a suitable manner. The home had a procedure for responding to allegations of abuse. Since the last inspection there has been two further adult protection investigations, one of which was inconclusive and one of which was still under investigation at the time of the site visit. Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 16 At a previous inspection the home was required to ensure that all staff had completed training in adult protection. Out of a total of 22 care staff, eleven members of staff had completed such training. Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9, 24 and 26. Quality in this outcome area is good. The home was well maintained and provided comfortable living accommodation for service users. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: There had no physical changes to the home environment since last inspection. Standards of hygiene and cleanliness throughout the home were good. The home provided comfortable accommodation and was free from any unpleasant odours. A number of service users’ rooms were seen, these were also furnished and equipped to a comfortable standard, many had been personalised by the occupants. Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 18 The grounds of the home were well kept and attractive and were used by service users. Staff had completed fire safety training. Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30. Quality in this outcome area is good. The home was sufficiently staffed and recruitment procedures ensured that service users were protected. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The staff group at the home had changed since the last inspection. A significant number of long-term staff had terminated their employment and several new members of staff had been employed. A large number of service users expressed regret about care staff leaving and told the inspector that they were adjusting to the changes and getting to know the new care staff. The new staff group worked alongside established staff at Clarendon. The majority of the new staff were experienced staff from care homes within the company. Care staff interviewed said that they enjoyed working at the home. Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 20 One member of staff complained that she did not think there was always enough staff on duty following lunch. The inspector observed this period of time following lunch and had a further discussion with the member of staff and no difficulties were observed or reported. The acting manager was made aware of the concerns and she agreed to monitor the situation. The home did not use agency staff. Care staff on duty at the time of the inspection said that they had undertaken further training to assist them in their role as carers, which included moving and handling updates, food hygiene, fire training and the safe handling of medicines. Written evidence was provided at the time of the site visit that confirmed the training had taken place. New staff had completed a period of induction and evidence to confirm this was provided at the site visit. Appropriate recruitment procedures had been followed in respect of recently employed care staff. Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is adequate. The home was well managed for service users; however not all staff were appropriately supervised. The health and safety of staff and service users was safeguarded. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Since the last inspection there had been a change to the management arrangements at the home. Two acting managers had been appointed with joint responsibility for the day-to-day management of the home. Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 22 The inspector had a discussion with the registered provider regarding the future management arrangements at the home. The registered provider advised that there were plans to register a new manager. Both the registered provider and the acting managers were fully committed to improving service delivery service users. Since the last inspection the home had sent out questionnaires to service users regarding their views on activities and food provided by the home. There were plans to analyse this information and produce a report of the findings. There were also plans to produce questionnaires for relatives and other stakeholders. The home had reviewed its procedures regarding service users finances since the last inspection. Service users are encouraged to handle their own finances or with support from family or representatives. The home did not manage service users monies, however small amounts of cash were kept for individual service users for day-to-day expenses ie. hairdressing costs. Records of all transactions were kept along with the receipts. Day care staff received regular supervision to support them in their work and records of such meetings were made available at the time of the inspection. However night care staff did not received regular supervision. Staff had updated their training in safe moving and handling procedures, food hygiene and health and safety. A staff member alleged that a problem with the lift had been identified on a recent service. The inspector had a discussion with the acting manager the administrator for the home, who confirmed that action had been taken and it was anticipated that work on the lift would take place in the next ten days. Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 24 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 OP7 Regulation 15 Requirement Timescale for action 09/08/06 2. OP7 13 3. OP9 13(2) 17(1)(a) 4. OP18 13(6) The registered providers must ensure that care plans illustrate how the service users needs in health and welfare are met. (Timescale of 24/01/05 not met) The registered providers must 09/08/06 develop risk assessment held in respect of service users, to include actions and measures taken to minimise the risk. (Timescale of 19/08/05 not met) The registered person must 09/05/06 ensure that on occasions where a variable dose of medication is prescribed, for example, one or two tablets to be taken, an accurate record is made of the actual dosage of each medication administered. (Timescale of 01/12/05 not met) The registered person must 09/09/06 make arrangements for all staff to attend training in Adult Protection. (Timescale of 24/11/05 not met) Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 25 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. 5. Standard OP33 Regulation 24 Requirement The registered person must supply to the commission a report in respect of quality monitoring conducted by the home and make a copy of the report available to service users. The registered manager must ensure that persons working at the care home receive formal supervision at least six times a year. Timescale for action 09/10/06 6. OP36 18 09/08/06 Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 26 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 OP22 OP1 Good Practice Recommendations The registered person should consider providing grab rail to assist service users when mobilising in the basement area of the home. The registered providers should review information detailed in the Statement of Purpose in respect of an activities co-ordinator being in post at the home and clarify the position. The registered providers should ensure that the registered manager periodically reviews care plans, daily records, risk assessments and medication administration records held in respect of service users. The registered person should ensure that an accurate dated record is maintained of all medication received or disposed of by the home. The registered person should ensure that stocks of medication are rotated regularly. The registered person should ensure that medication storage areas are used solely for the storage of medication. The registered person should ensure that the competency of carers with responsibility for medication administration is assessed regularly on a formal basis. The registered person should take into account service users choice and capacity to make choices when making decisions about service users monies. 3. OP7 4. 5. 6. 7. 8. OP9 OP9 OP9 OP9 OP35 Clarendon House DS0000008548.V290505.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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