Inspection on 21/06/07 for Clarendon Nursing Home

This inspection was carried out on 21st June 2007.

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

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

Other inspections for this house

Clarendon Nursing Home 08/05/06

Clarendon Nursing Home 27/07/05

Clarendon Nursing Home 04/04/05

Clarendon Nursing Home 08/10/04

Clarendon Nursing Home 29/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Clarendon Nursing Home Clarendon Nursing Home 7a Zion Place Thornton Heath Surrey CR7 8RR Lead Inspector Michael Williams Key Unannounced Inspection 9:30am 21st June 2007 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 Nursing Home DS0000019024.V343071.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 Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clarendon Nursing Home Address Clarendon Nursing Home 7a Zion Place Thornton Heath Surrey CR7 8RR 020 8689 1004 020 8689 1019 manager.clarendon@lifestylecare.co.uk www.schaelthcare.co.uk Southern Cross (LSC) Ltd 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) Post Vacant Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51) of places Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th December 2006 Brief Description of the Service: Clarendon nursing home is registered to provide a service to 51 older people. The house itself is purpose-built and located in the centre of Thornton Heath. It is therefore well placed for access to public transport, community based services and shopping facilities. However, the site is extremely compact, it has no garden, just a very small, enclosed courtyard for service users. There is little on-site parking and there are parking bays in the local streets. Within the building there is ample communal areas, several lounges and dining rooms, but it is all located on the ground floor so there are no visitors’ rooms or communal lounges on the first and second floors. All bedrooms are 12 square metres which is adequate for wheelchair users and each bedroom has ensuite facilities. Clarendon has the usual facilities associated with a nursing home, including offices and nurse stations, kitchen, laundry, staff training room and staff changing rooms and so forth. The home provides information about its services in a Service User Guide, which is made available to current and potential Service Users. Additional information can be found in the home’s Statement of Purpose. The current weekly fees, at the time of writing this report, vary between approximately £560 and £650. Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. To monitor all aspects of care we ‘tracked’ the care provided to a sample number of residents and cross checked the information by examining the documentation supporting care, observing the meals provided, and by checking the arrangements for medication, handling money. We also crosschecked information by examining records of food, fire safety, complaints and accidents and so forth. Staff providing care were interviewed, we also met with several relatives as well as interviewing or observing the residents themselves. Questionnaires were distributed and feedback noted. All care homes are expected to respect the diversity of the residents and in Clarendon they do this by assessing the residents’ individual needs; by speaking to their relatives to ascertain specific needs and preferences; by providing service for those with diverse needs including sensory impairments and by employing staff from a range of backgrounds – and rather unusually the mix of staff does reflect the racial and cultural backgrounds of many residents in so far as there are a large proportion of African and Caribbean residents living in the home and this is matched by the staff team. The home also employs a large proportion of male staff which again reflects the gender mix of residents. What the service does well: What has improved since the last inspection? What they could do better: Whilst it was commendable to see that a written note is kept in the care plans about any ‘living wills’ that residents may have drafted their location was not clear to staff nor were key elements translated into care planning where this might be appropriate. Minor damage was noted throughout the building, such Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 Page 6 as damaged walls and torn wall-paper; we also note that some equipment is not working so we make a requirement to ensure all equipment is maintained in working order but we are advised that new equipment is on order and the home is to be refurbished by the new owners. The home must update its fire risk assessment in accordance with the new regulations (Reform Order) of 2005 and note any exits that have a key including the patio gate. We also advise that the kitchen staff are informed about the new food safety regulations of 2005 in particular the ‘safer food better business’ guidance. 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. The summary of this inspection report can be made available in other formats on request. Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1 and 3: Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. New service users are being admitted only on the basis of a full assessment undertaken by people trained to do so and this involves the resident or, in some cases, their representative so residents know that they will be provided with sufficient information and that their needs have been fully assessed and can be met in this home. EVIDENCE: The owners of Clarendon Nursing Home, Southern Cross, understand the importance of having sufficient information when choosing a Care Home. It has developed clear information to help them understand what specialist services the home can provide, this includes an information pack that includes a detailed resident guide but this does not yet include any observations by existing residents but the guide is being updated and should include their observations in future. The home provides a Statement of Purpose that is specific to Clarendon and the resident group they care for. It clearly sets out the objectives and philosophy of the service supported by the resident Guide. These documents detail what the prospective individual can expect and gives a clear account of the specialist services provided – in particular that the home is physically well Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 Page 9 adapted for older people with physical disabilities – it also outlines the type of accommodation, qualifications and experience of staff, how to make a complaint, recent Commission inspection findings. All residents are given a copy of the Guide. When requested the service could also provide a copy of the Statement of Purpose and guide in a format which will meet the capacity of the resident. Both documents are being updated by the new owners. Admissions are not made to the home until a full needs assessment has been undertaken. We are advised that the home makes sure it receives a copy of the care manager’ or hospital assessment before deciding upon admission. But for people whom are self funding and without a Care Management Assessment the assessment is always undertaken by a skilled and experienced member of Clarendon’s staff team. The assessment is conducted professionally and sensitively and involves the individual, and their family or representative, where appropriate. Where the assessment has been undertaken through care management arrangements the service insists on receiving a summary of the assessment and a copy of the care plan. Admissions to the home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. This point was discussed at some length during the inspection because the Commission is revising all registration certificates and ids asking care home to update their statement of purpose to make clearer the criteria for admission. In Clarendon this will mean their statement of purpose will emphasise its strengths, particularly their ability to provide for the needs of older people with physical disabilities and who use a wheelchair. Prospective residents are given the opportunity to spend time in the home. An individual member of staff, referred to as a ‘key worker’, is allocated to give them information and to help them understand how the home is organised and run and the facilities and services available. The allocated staff member will give them special attention, help them to feel comfortable in their surroundings, and enable them to ask any questions about life in the home. So residents know who this person is their details are added to a notice on each bedroom door. New residents are provided with a Statement of Terms and Conditions or Contract; this sets out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the individual. This is clear, jargon free, easy to understand and gives a very clear understanding of what residents can expect. Areas of strength include the very detailed statement of purpose and guide and although no requirements are made we recommended revision of the statement of purpose and guide to make clearer the criteria for admission and to add some feedback from existing residents. This section, about choice of home, is assessed as good. Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7 to 11: Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. The arrangements for care planning, the provision of health care and the procedures for dealing with medication, and with the care of the dying, are all satisfactory so as to ensure the social, and health care of residents can be met. EVIDENCE: Clarendon is one a number of homes in the Croydon area operated by Southern Cross and the company uses a very detailed care plan format with multiple assessment and care plan forms. This means that personal healthcare needs including specialist health, nursing and dietary requirements are all clearly recorded in each resident’s plan and gives a comprehensive overview of their health, social and spiritual needs and provides an indicator of change in requirements. This information is initially taken from the assessment provided by care manager at the time of admission. The statement of purpose details the specialist treatments the home can deliver with a commitment to person centred planning, and it refers to the skills and ability of the staff group. As this is a nursing home the statement makes clear what nursing staff area available in the home. To evaluate the care provided in Clarendon a sample of residents’ case files were read and other records were checked; residents and relatives were Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 Page 11 interviewed; staff and visiting professionals were also sent questionnaires. The manager and her deputy explained how they aim to met the social and health care needs of all residents. The administration in this home is very good and the case files were in good order despite the home being in transition from old to new formats these vital documents need to be well managed and they are. Personal support is responsive to the varied and individual needs and preferences of the residents. The delivery of personal care is individual and is flexible, consistent, reliable, and person centred. Staff respect privacy and dignity and are sensitive to changing needs. The service listens and responds to individuals’ choices and decisions about who delivers their personal care. Residents are supported and helped to be independent and can take responsibility for their personal care needs in so far as that is possible given that many residents are quite dependent because of the frailty and mobility problems. Staff appeared to be listening to residents and taking account of what is important to them and this was observed during the meal time when staff asked about choice and preferences. The care plans also provide evidence that staff consult residents about their individual needs including we noted any ‘Living Wills’ residents might have drafted. Here we noted when this part of the form indicated that Will had been drafted but staff were not at all clear where it was and what the resident’s wishes were. With the forthcoming introduction of the Mental Capacity Act in October (2007) this information will need to be much clearer. In the example we saw staff agreed to check the details directly with the resident concerned. The home may also note that the London Ambulance Service have devised a form to assist all parties if an emergency arises. Residents have access to healthcare and remedial services and staff make sure that those residents who are fit and well enough are encouraged to be independent, have regular appointments and visit local health care services. However, as most residents are too frail to attend appointments the home arranges visits from local health care services including General Practitioners, Specialist nurses such as Palliative Care Nurses, Opticians, Dentists and so forth. Residents have the aids and equipment they need and these are well maintained to support both residents and staff in daily living. We observed maintenance staff replacing or adjusting raisable beds to ensure they are suitable for particular residents. We also note that a range of pressure relieving mattresses are available for preventing pressure sores. This care home was purpose built and whilst its location is very problematic, sited as it is between terraced house and lacking adequate parking and garden space it is otherwise well suited to older people with mobility problems. It has wide corridors and door openings, large bedrooms that are ensuite, adapted baths, handrails and other adaptations. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. We checked to confirm that medication records are fully completed, that they contain the required entries, and are signed by appropriate staff. Regular management checks are recorded to monitor compliance using their various and numerous audit Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 Page 12 systems. Residents are given the support they need to manage their medication. If individuals prefer or where they lack capacity, care staff can manage medication and this is usually the case in Clarendon. The home has a good record of compliance with the receipt, administration, safekeeping, and disposal of Controlled Drugs. Nurses administer medication and they confirm that they have completed and passed an appropriate medication course. They advised us that they have also undertaken other specialist training courses for example, phlebotomy (blood-taking). Staff have access to training in health care matters and are encouraged and given time to attend seminars on specialist areas of work – for example staff advised us the they are being supported in using the ‘Liverpool pathway’ which is a programme of care to support the dying in a caring and sensitive manner taking account of known wishes and cultural beliefs. This is in line with Clarendon’s aims and objectives to reinforce the importance of treating individuals with respect and dignity. During the dying process there are arrangements in place, which enable family and friends to stay and help with the care with the agreement of the resident. Staff support both the family and the homes’ other residents during the bereavement process. The home seeks out guidance and support of care for individuals who are dying and learns from best practice in this case a local Hospice provides the support and advice. In summary, we are satisfied that staff work to clear and robust practices when caring for individuals who have degenerative conditions and terminal illnesses. Areas of strength are the comprehensive care planning documentation that is being introduced and the specialist care for older people with mobility problems and the use of the Liverpool Pathway to support the terminally ill. No requirements are made but a recommendation is made to make clearer the location of and the details noted in residents’ Living Wills’. This section, about health care, is assessed as good. Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12 to 15; Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. The daily routines in this home are reasonably flexible, within the constraints of a large service. Residents are being supported and encouraged to maintain links with family, friends and to exercise choice and control over their lives in so far as they wish and are able to do so. Residents are receiving a wholesome, appealing and well balanced diet in a congenial setting in accordance with their recorded requirements and preferences. EVIDENCE: As most residents are older people and already quite dependent when they arrive few have any ambition to learn new skills for independent living, they have been independent are now retired and often quite frail. But, whenever possible staff encourage residents to maintain such independence as they can manage and this usually means in areas such as personal hygiene and selfcare; use of self-propelled wheelchairs; maintaining contact with friends and family independently and so forth. The practice of staff promotes individual rights and choice, but also considers protection of individuals, supporting people to make informed choices so the home will take account of close personal relationships whilst being mindful of the need to protect vulnerable adults from abusive relationships. Help with communication skills is given by the staff team, both within the service and when accessing the community to enable residents to fully Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 Page 14 participate in daily living activities. In practice this means use of aids such as hearing aids when residents have sensory impairment or support in language translation when English is their second language as it is in several cases at Clarendon. This home is a little unusual in that it is providing care for a larger than average proportion residents from a wide range of backgrounds, African, Caribbean, Asian and so forth, there are also a large proportion of male residents in this home compared to similar nursing homes. The staff team reflects a similarly wide range of backgrounds and is therefore well equipped to meet the needs of residents not just from the local English community but those from minority ethnic groups. The home tries to ensure that residents are involved in meaningful daytime activities of their own choice and according to their individual interests and capability but in the feedback we received the residents are looking for more meaningful way to past the time. One described the activities (in April 2007) as “very pointless”. We note that an interim activity coordinator has been allotted pending the appointment of dedicated activities leader. This person will need to ensure each resident is consulted and an acceptable programme of engagement is developed. We were also told that staff tend to provide very good basic care but little beyond that – so again we recommend that all staff are reminded that meeting nursing and personal care needs is only the beginning of daily life, thereafter a social life can be expected. This service is committed to the principles of inclusion and promotes, and fosters good relationships with neighbours and other members of the community and to this end the new managers intends to make use it encourages visitors and community representatives such church leaders. The menu is varied with a number of choices including a healthy option. It includes a variety of dishes that encourage individuals to try new and sometimes unfamiliar food. The meals are balanced and nutritional and cater for the varying cultural and dietary needs of the individuals using the service. For example Caribbean residents advised us that as they are routinely offered meals familiar to them and their own culture. On the day of inspection, Roast Chicken or Macaroni and Cheese were the main choices and both were popular with residents. We observed the midday meal being served and saw that care staff are sensitive to the needs of those residents who find it difficult to eat and give assistance with feeding in thoughtful and kindly manner. They are aware of the importance of feeding at the pace of the resident, making them feel comfortable and unhurried. Areas of strength include the care planning which identifies individual needs, wishes and preferences and the support that is provided by a large and well managed staff team however we do advise that the activity programme is developed both for large group events and for individual residents - who may want something more demanding than Bingo. Overall we assess this section, about daily living, good. Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16 and 18: Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. The home has a clear and simple procedure for dealing with complaints so residents’ are confident their concerns will be dealt with promptly and effectively. To ensure vulnerable residents are safeguarded from abuse the home has written policies and procedures about the protection of residents and their property; this includes procedures for passing on concerns to the relevant authorities. EVIDENCE: The home now appears to be developing an open culture that allows staff and residents to express their views, and concerns in a safe and understanding environment. Residents and others involved with the service say that they are happy with the service provision, feel safe and well supported by an organisation that has their protection and safety as a priority We interviewed staff, residents a number of visitors as well as noting written feedback to confirm this is the case. The manager whom we also interviewed said Clarendon has a complaints procedure that is clearly written and easy to understand and could be made available on request in a number of formats including other languages and large print to help anyone living at, or involved with, the service to complain or make suggestions for improvement. The record of complaints held by the home indicates the procedure is working and that concerns are being dealt with in a timely manner. The complaints procedure is supplied to everyone living at the home and is displayed in a number of areas within the service. Most residents and others involved with the home understand how to make a complaint and are clear about what will Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 Page 16 happen if a complaint is made but we did receive some feedback to suggest the information is not made widely enough known and that sometimes the manner in which has been handled has not sensitive enough nor followed through as might be expected according to the feedback we received. The policies and procedures for Safeguarding Adults are available and give clear specific guidance to those using them. We interviewed staff to confirm that they know when incidents need external input from local care managers and who to refer the incidents to, which includes the Commission. The home understands the local authority’s procedures for Safeguarding Adults and has been attending strategy meetings when requested. There are a low number of referrals made as a result of lack of incidents, rather than a lack of understanding about when incidents should be reported. Training of staff in the area of protection is regularly arranged by the Home. Other training around dealing with physical and verbal aggression and restraint is also made available to staff as needed. Areas of strength include the new manager’s positive approach to resolving complaints and concerns in an effective and thoughtful manner and the staff’s awareness of safeguarding adults procedures. We make a recommendation that the complaints procedures, should be widely available and should include details about how to contact care managers as well as providing information about the Commission who the handling of such information. This section, about complaints and protection is assessed as good. It is also recommended that residents and visitors are periodically consulted as part of a quality auditing process and the outcome of such consultation summarised in the residents’ guide as indicated in Standard 1. Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19, 22 and 26: Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. Premises: The layout of the home and the manner in which it is being maintained means that this is a safe, comfortable and suitable environment for the residents. There were a number of matters requiring attention and they are outlined below. The home is adapted to meet the needs of older people who need a variety of aids and adaptations. The premises are being kept clean, hygienic and free from offensive odours and systems are in place to control the spread of infection. EVIDENCE: The home provides a physical environment that is appropriate to the specific needs of the people who live there, that is, older people with nursing needs and who may have substantial mobility problems. To meet those needs the home has a variety of specialist aids and equipment. Internally the home is a very pleasant, safe place to live in, the bedrooms and communal rooms meet the modern standards and bedrooms have en-suite facilities. The lay out and design of the home does not allow allows for small clusters of people to live Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 Page 18 together in a non-institutional environment, and regrettably there aren’t even any lounges on the first and second floor. This means everyone stays in their own room or descends to the ground floor to join the larger groups – not the best layout. There are several lounge and dining areas including conservatory that is designated for smokers (and which does not contain any equipment or activity that would compel not smokers to use the room, this is in compliance with the new non-smoking laws coming into force July 2007). This problem of ‘communal space’ inside is compounded by a lack of garden space outside the premises as intended by standard 20.3 and regulation 23(2)o but there is little realistic opportunity for providing suitable grounds now the home is up and running – it therefore remains an unresolvable shortcoming in the service. Residents are encouraged to personalise their bedrooms. All the homes fixtures and fittings meet the needs of the individuals and can be changed if their needs change a point we noted when visiting as beds were being modified to meet the specific needs of several residents. The shared areas (lounges for example) provide a choice of communal areas but there is little opportunity for residents to meet relatives and friends in private away from their bedroom – privacy can be provided for meetings but a private visitors’ room is not readily available. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of the residents, and are in sufficient numbers and of good quality and well maintained. Residents say that there is plenty of hot water and the temperature in the home generally or in individual rooms can be changed, on request. We conformed that water supplies are checked to ensure they are maintained at safe temperature for cold storage and hot water supply is at a safe level at hot taps, that is, 43oC. The home is well lit, clean and tidy and smells fresh. The management has a good infection control policy; they seek advice from external specialists, e.g. infection control, and encourage their own staff to work to the homes’ policy to reduce the risk of infection. Staff confirmed that they have been on training courses about infection control. Areas of strength are the general layout of the building and its adaptation for wheelchair users and matters requiring improvement are limited to only minor damage was noted in various locations, often the corners of walls damaged perhaps by wheelchairs. Some areas of carpets looked a little dirty, at least in appearance. Some walls are in need of repair, particularly were wallpaper has been removed and plastered over leaving an unsightly patch. We are advised that the whole home is due to be refurbished. We did notice a substantial crack through one bathroom wall –fault that may need to be checked by the company’s surveyors. Overall this section, about the environment, is assessed as good. Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27 to 30: Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. The number of staff employed and their skill mix are appropriate to the assessed needs of the current residents in this home – so this will ensure that their needs are being met. The required procedures are in place to ensure recruitment of staff protects residents. The home has a staff induction, training, support and supervision regime in place so residents can be assured that staff are competent in their jobs. The recruitment, training and support of staff will ensure residents are ‘safe in their hands’. EVIDENCE: Residents of Clarendon can have confidence in the new manager and the staff team she is building to take care of them. Rotas show well organised with particular attention given to busy times of the day and changing needs of the residents. This includes varying the number of nurses and social care staff available on each floor as residents’ dependency levels changes. When we visited there were 3 nurses, one for each floor and 12 care staff plus the manager, who is herself a qualified nurse, and later in the day she was joined by the deputy who is also a nurse. In addition there were catering, laundry and housekeeping and maintenance staff. There is little need for a gardener in this home. We are advised that the laundress today was agency staff. Staff members undertake external qualifications beyond the basic requirements and certificates are in place to confirm this. Managers encourage and enable this training and development and recognise the benefits of a skilled, trained workforce. Job descriptions and specifications clearly define the roles and responsibilities of staff and again staff we interviewed confirmed this Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 Page 20 to be the case. Residents report that staff working with them are very skilled in their role, and are consistently able to meet their needs. Although we did receive comments about good nursing and health care but little beyond that – that is, a lack of stimulating activity during the day. We note that care plans do include a mental health and social assessments but given the comments about a lack of meaningful activity in Clarendon this seems to be an area for development. The manager advises us that there are consistently enough staff available to meet the health care needs of the residents, with more staff being available at peak times of activity if required. The home uses detailed assessment and dependency charts to gauge quite accurately the overall dependency levels of residents and so the staffing structure can be based around delivering outcomes for the residents, and not be led by staff requirements. The service now has a satisfactory recruitment procedure that clearly defines the process to be followed as demonstrated in the detailed index to each staff file, this allows the managers to monitor all stages of recruitment. Staff recruited confirm that the service was clear about what was involved at all stages and was robust in the following of its procedure and that these the correct procedures had been followed in their case, for example police checks, references, work history, work permits and so forth. Staff meetings take place regularly and supervision sessions are now set up to held with each member of staff six times each year. Notes are taken of meetings and sessions and were available for inspection. Areas of strength include the recruitment processes, the induction, training and support systems and the professional attitude of staff shown during our inspection visit. We recommend that in addition to the activity coordinator, who will lead activity programmes, all staff are given guidance in supporting residents’ social aspirations by reviewing their social assessments and following up their ideas in order to address residents’ observations that health care is good but social life weak. This section, about staffing, is assessed as good. Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31, 33, 35, 37, 38: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is applying to register registered with the CSCI as a person competent to run this home in accordance with its stated aims and objectives and so in the best interests of the residents. The home is well managed, including finances, and is safe for residents. EVIDENCE: The Manager appears, from the evidence deduced during the inspection, to be someone with the required qualifications, experience skills to run Clarendon. This will assessed more formally during the processing of her registration. In the case of a corporate provider, which is the case in this home as it is owned by Southern Cross, the manager will need to demonstrate that she has knowledge of the organisation’s strategic and financial planning systems and the operational or business plan for the home. Supported by these systems the manager is competent in delivering effective financial planning and Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 Page 22 budgetary control within the budgets that she will be responsible for and she appears to have every confidence this is the case. The acting manager advises us that she will work assiduously towards continuously improve services to improve quality of life for residents with a strong focus on equality and diversity issues as demonstrated by a diverse resident group and an equally diverse staff team. There already appears to be a strong ethos of being open and transparent in all areas of running of the home. The acting manager is aware that strong clear and dynamic leadership is needed if this home is attain the high standards she is aiming for in Clarendon. The service has sound policies and procedures, which the manager with the support of the owners effectively reviews and updates, in line with current practice and changes in law. The manager ensures staff follow the policies and procedures of the home, and in the case of the corporate provider, Southern Cross, those of the parent organisation. The staff team are positive in their approach to translate policy into practice. Efficient systems are in place to monitor staff adherence to policies and procedures during their practice. Management processes ensure that staff receive feedback on their work. This is achieved by multiplicity of internal auditing and cross-checking methodologies, not least of which are the monthly visits by senior managers of the organisation. These visits are also used to supervise and support the (acting) manager of the home appropriately in the running of the service. The home has access to professional business and financial advice and has all the necessary insurance cover in place to enable it to fulfil any loss or legal liabilities. We checked a wide range of written records including staff files, residents’ case files, food records, catering records, fire, complaint and accident records and the visitors book. Records are of a good standard and are routinely completed. Residents are aware of safety arrangements and have confidence in the safe working practices of staff. The manager ensures risk assessments are completed and taken into account in planning the care and routines of the home and this includes both local risk associated with individual residents and risks of a wider nature affecting the whole home such as infection control and fire safety. Only one health and safety matter was identified during the course of the inspection and that was equipment, including pictures and wheelchairs, stored in stairs which are intend to act as unobstructed fire exits. The manager agreed to remove these items during the course of the inspection and it is noted that they did not pose an immediate hazard to residents. Areas of strength include the development of a robust management team intending to lead by example and improve the quality of care for all residents. And as no matters requiring improvement arise, other than the prompt application to register the manager, this section, about management and administration, is assessed as good. Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 3 3 Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations Statement of purpose: we recommend that the statement of purpose be reviewed to take account of proposed changes to the registration certificate so as to make clearer the criteria for admission to this home; this will ensure that prospective residents know that their needs can be met. Care Plans: If care plans indicate that residents have drafted a ‘Living Will’ then it is recommended that its location is also noted and any key elements relevant to care provided in the home, or to any hospital the resident may be sent, is noted on file, possibly in care plans. This will help ensure resident’s known wishes are acted upon. Social Activity: We endorse residents’ request to increase the range of activities and to offer more meaningful recreational and social activities. We recommend that residents be consulted in this matter so as to improve the quality of their daily life in the home. DS0000019024.V343071.R01.S.doc Version 5.2 Page 25 2 OP7 3 OP12 Clarendon Nursing Home 4 OP15 5 OP19 6 OP30 7 OP31 8 OP33 OP1 9 OP38 Kitchen: It is recommended that the home review its kitchen risk assessments to ensure they meet the revised food regulations and comply with the Food Standard Agency guidance, ‘safer food, better business’. Premises: It is recommended that areas of damage are made good including damage to wallpaper and paintwork and the old and worn carpets replaced without undue delay. Staff training: it is recommended that staff receive further training in respect of the social and recreational lives residents aspire to so as to meet their expectations in respect of their daily lives, in particular social rather than health related care. Registration of manager: It is recommended that the acting manager submit an application for registration with the Commission without delay so that residents can be assured the home is being managed by a qualified and competent person. Quality assurance: It is recommended that residents be consulted about life in Clarendon and a summary of their observations be included in the resident guide; this consultation to include enquiries about their aspirations for meaningful social and recreational activity. Fire risk assessment: It is recommended that the home review its fire safety risk assessment to take account of such matters as storage space in stair wells and keys in final exits. Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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. Extracts may not be used or reproduced without the express permission of CSCI Clarendon Nursing Home DS0000019024.V343071.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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