Inspection on 20/09/06 for Clarendon Mews
Also see our care home review for Clarendon Mews for more information
This inspection was carried out on 20th September 2006.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.
The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.
Other inspections for this house
What follows are excerpts from this inspection report. For more information read the full report on the next tab.
What the care home does well
Assessments are carried out for people who wish to move into the home, to check what their needs will be and ensure that staff in the home can meet their needs. Staff have training in different aspects of care, such as dementia awareness, and moving and handling to enable them to give good support to residents. Care plans are in place for residents, which give information about their likes and dislikes and preferences for their daily living routine. Some aspects of risk relating to residents` needs were noted and assessed. Accident records are kept in the home.. Daily records and issues logs (where particular concerns are noted) are made. There is a keyworker system in the home, with carers responsible for making sure particular residents have the things they need, such as toiletries. Carers were able to describe needs of residents. Residents spoken with said that they mostly got good support from staff. There is some information in care planning and daily records about people`s preferences for leisure and activities. Residents` families are able to come into the home. The manager had arranged meetings with families to kept them involved in the running of the home. Residents are able to bring personal possessions into the home. Residents and relatives maintain overall responsibility for residents` finances. Small amounts of money are held in home on residents` behalf, to enable them to make small purchases, and have hairdressing and other services. Receipts and records are kept on behalf of residents. The provider undertakes audit checks to ensure that monies are safely kept. Most residents who commented said that they liked the meals in the home. Menus showed a balance and variety in food provided to residents. Residents` weight and well-being are monitored, and the GP notified about any concerns. There is a complaints procedure in the home, and residents who commented said that they knew how to make a complaint. The manager had appropriately referred one incident of concern to social services and the police, and a proper investigation was carried out. All parts of the premises, which were seen, were clean and tidy, and odourfree. Bathrooms and toilets were clean with equipment in place to aid bathing. Cleaners are employed in the home on a daily basis. Residents spoken with were happy with their bedrooms and the environment generally. Arrangements for washing and drying of laundry remain in place. Most required records about staff employed in the home are in place, including application forms, and evidence of Criminal Records Bureau checks Ongoing training is provided to staff. Four members of staff have started National Vocational Qualifications in care since the last inspection. Training has recently been given to staff in medication administration and first aid. One member of staff spoken with confirmed that she received ongoing training. Clarendon Mews DS0000031736.V311458.R01.S.doc Version 5.2 Page 7Staff meetings are held in the home, for members of staff to give their views about the home and get consistent information about ways of working. Residents are enabled to have input into the inspection process. Safety checks are carried out, and safe working practices are implemented. The cooks and cleaners are doing relevant National Vocational Qualification training.
What has improved since the last inspection?
There was some improvement noted since the last inspection in medication administration. The home has a new medication fridge. Medicines were properly stored. A new arrangement has been set up with a pharmacist, and staff have received training from the pharmacist about safe practices. A number of staff are currently studying a course in safe handling of medication. A medication policy is in place, and one member of staff described the proper procedures as outlined in the policy. Photographs of residents are kept in medical records to show identification. Internal audits are carried out.
What the care home could do better:
Since the last inspection, the Commission for Social Care Inspection granted registration for seven places in the home for people who are physically disabled (PD/E registration category). As part of the registration, the provider was asked to amend the Statement of Purpose to inform people who are looking to move to the home that the en suite facilities in the PD registered rooms are not accessible to wheelchairs, but that there are accessible shared bathroom facilities. This has not been done, and the provider must ensure that it is put into the Statement of Purpose. Care plans were noted to be inconsistent in some cases, in that they contained differing information about the needs of residents. It was also noted relating to residents whose care was tracked that not all issues of concern, which were noted in daily records/issues logs, were then transferred to care plans so ongoing attention to particular needs of residents had not been given. There were a number of gaps in assessment of risk relating to residents whose care was tracked. Accident records are kept in the home, but there is not evidence of follow up action where a number of falls have been noted. The issues logs have not been signed by staff, which could be problematic in ensuring issues are followed up. It would be good if all records made by staff were signed.There were some issues noted in case tracking medication administration, highlighting some inaccuracies and gaps in recording. During the inspection there was limited involvement of residents in activities and stimulation. In the afternoon, one carer was involved in a game with residents, but there were long periods of time in which a number of residents with dementia had little or no stimulation. One resident, whose care was tracked, said they were not so keen on the food. It might be good if the provider checks with all residents to find out if they like the food and whether any improvements could be made, to make sure everyone is satisfied. During case tracking of care of residents, a number of serious concerns were highlighted, in which there had been a lack of follow-up investigation and care, and a lack of required reporting to the Commission for Social Care Inspection and other agencies. This had potentially put a number of residents at continuing risk of harm. The provider must ensure that all serious incidents affecting the health or welfare of residents are reported to relevant agencies as required. Records of temperature testing of water at en-suite sinks is carried out although there was no evidence of action taken where temperature was noted to be higher than the recommended safe level. The provider should ensure that attention is paid to this. One resident said that sometimes he cannot always reach the buzzer - care plans and records indicated that this resident is at risk of falling (see Section 2). The provider should ensure that all residents have good and safe access to call systems. There was only one written reference in place for two members of staff in the home the provider was aware of this and said he was following it up. The provider should ensure that all relevant checks are carried out before someone is employed in the home. One gap in training, which needs to be looked at further, is how to manage behaviour which challenges, particularly in relation to people who have dementia, and further training in safeguarding adults again in relation to people who have dementia. The Inspector was informed during the visit to the home that the manager had resigned and left at short notice the week before. It was apparent during the inspection that the provider had not been aware of everything that had been happening in the running of the home over the past few months. The manager had not yet submitted a completed application for registration with the Commission for Social Care Inspection. It is crucial that the provider maintains an overview of how the home is running, particularly in the absence of aClarendon Mews DS0000031736.V311458.R01.S.doc Version 5.2 Page 9registered manager. The home has been without a registered manager since December 2005. The providers are expected to carry out a monthly visit to the home to check on standards, and to provide a report of their visit to the Commission for Social Care Inspection (Regulation 26, Care Homes Regulations 2001). The last received reports from the providers relating to this home were of visits carried out in February 2006 and May 2006. The lack of a registered manager and of input from the providers on a regular basis adds to the potential risks for residents. At the last inspection some concern was raised by staff about wearing protective gloves for safe working in infection control. A recommendation was made that staff have training about appropriate wearing of protective clothing in infection control but this has not taken place. From talking to staff, it was clear that there was still some confusion about