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Inspection on 27/07/05 for Clarendon Nursing Home

Also see our care home review for Clarendon Nursing Home for more information

This inspection was carried out on 27th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

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

A number of service users and several relatives kindly took the trouble to speak with the Inspector. Generally, they commented that the care being provided was of a good standard, and that while in recent times the quality had appeared to drop, things had recently improved.

What has improved since the last inspection?

Of the eight requirements that were made after the last annual inspection, the home has now met four of them. Of particular relevance has been the increase in staffing numbers. This means that service users should face fewer delays in being attended to, and be provided with better quality care.

What the care home could do better:

There remain four outstanding requirements, and the most significant of these is the ongoing failure of some staff to ensure that they correctly complete the medication administration records. Another concern, also previously raised, is the failure to provide/record sufficient fluids and fluid intake. Clearly this is unacceptable, as any mistakes made in giving out medication, and a lack of fluids, can have serious consequences for the service users.

CARE HOMES FOR OLDER PEOPLE Clarendon Nursing Home Clarendon Nursing Home 7a Zion Place Thornton Heath, Surrey CR7 8RR Lead Inspector Margaret Lynes Unannounced 27 July 2005 11:30 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 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 G53-G53 S19024 Clarendonnh V241915 270705 Stage 4.doc Version 1.40 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 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Lifestyle Care PLC Mrs Faith Bossa Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51) of places Clarendon Nursing Home G53-G53 S19024 Clarendonnh V241915 270705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4/4/05 Brief Description of the Service: Clarendon nursing home is registered to provide a service to 51 elderly clients. The house itself is purpose-built and located in the centre of Thornton Heath. It is therefore well placed for access to public transport links, community based services and shopping facilities.The site is compact, with a small patio garden for service user enjoyment. Ample communal areas are provided. The housekeeping facilities, laundry and kitchen are generally well appointed and well maintained by their respective staff teams. Clarendon Nursing Home G53-G53 S19024 Clarendonnh V241915 270705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit was carried out almost 4 months after the annual inspection. In the intervening period, two additional visits have been made to the home to investigate complaints and to look at a specific care issue. The home has had a turbulent few months, having had to cope with the sudden departure of the Registered Manager, and the recent arrival of a new manager. This report contains four new requirements and two recommendations. Additionally, four requirements have been repeated from earlier inspection visits. The report of the announced visit last April indicated that improvements were being made in the home – this after several visits which had resulted in a notable number of requirements being made. Unfortunately, in the few months between April and now, standards have again started to fall. This led to 4 complaints being made directly to the Commission, and additional complaints being made to the home itself. It is to be hoped that now there is a new manager in post, the home will start to raise its standards. What the service does well: What has improved since the last inspection? What they could do better: There remain four outstanding requirements, and the most significant of these is the ongoing failure of some staff to ensure that they correctly complete the medication administration records. Another concern, also previously raised, is the failure to provide/record sufficient fluids and fluid intake. Clearly this is unacceptable, as any mistakes made in giving out medication, and a lack of fluids, can have serious consequences for the service users. Clarendon Nursing Home G53-G53 S19024 Clarendonnh V241915 270705 Stage 4.doc Version 1.40 Page 6 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 Nursing Home G53-G53 S19024 Clarendonnh V241915 270705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Clarendon Nursing Home G53-G53 S19024 Clarendonnh V241915 270705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 3 The previously required changes to the Statement of Purpose and the Service User Guide have not been finalised yet, which still means that service users are not provided with full information about the services on offer. Paperwork relating to four new service users included a pre-admission assessment. This means that the service user and their relatives can be reassured that the home has taken into account their individual needs, and feels that it can meet them; and the staff in the home can be as familiar as possible with new service users, and have an understanding of what specific service they will need to provide. EVIDENCE: Changes to the Statement of Purpose and the Service User Guide were requested following the last annual inspection, as neither document contained all of the information listed in the Regulations. The manager explained that this work was still being undertaken. Again, following the last inspection, the manager was required to ensure that all new service users were fully assessed prior to admission. On this visit the Clarendon Nursing Home G53-G53 S19024 Clarendonnh V241915 270705 Stage 4.doc Version 1.40 Page 9 files of four new admissions were examined. It was pleasing to note that each one contained the aforementioned assessment. Clarendon Nursing Home G53-G53 S19024 Clarendonnh V241915 270705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 The service user plans seen adequately covered the health, personal and social care needs of the service users. This means that the staff team are aware of the differing needs of their residents, and know what specific care should be given. The Inspector was not satisfied that the health needs of the service users were being fully met, as there was still poor recording with regard to fluid intake for some residents, while none of the communal areas were provided with jugs of water/glasses. The medication administration records were examined. Unfortunately a number of errors were noted. Clearly this is unacceptable, as any mistakes made in giving out medication can have serious consequences for the service users. From observation and discussion, service users were treated with respect, and their right to privacy was upheld. Clarendon Nursing Home G53-G53 S19024 Clarendonnh V241915 270705 Stage 4.doc Version 1.40 Page 11 EVIDENCE: There was good documentation in each of the service user files inspected. Supplementing the care plans were a number of assessments, including those for nutrition, pressure areas, moving and handling and continence. The home has some good in-house forms for staff to complete to enable them to gain a full, accurate and ongoing overview of each service user. Unfortunately, the quality of the recording on these documents was erratic. The manager was advised that it would be good practice to ensure consistent recording. Concerns have been expressed recently, and indeed a complaint made, with regard to the provision of fluids for service users, and the recording of the amount of fluids provided. On this visit it was again disappointing to see that there were no water jugs/glasses in the communal areas. Additionally, the keeping of fluid charts was once more noted to be poor. Of further concern was the lack of fluid provision in the evening/during the night. In a number of instances it appeared that residents went without fluids for 15 hours (and in one case for 18 hours). This is unacceptable. The mediation administration records were inspected and a number of errors were found – staff had failed in some instances to sign the charts, while blood glucose levels had not been recorded (in the appropriate place) for one resident. From observing the interaction between the staff and the service users, and having also talked to a number of service users and their relatives, it was evident that they felt that they were being treated with respect and that their privacy was upheld as much as was possible. Clarendon Nursing Home G53-G53 S19024 Clarendonnh V241915 270705 Stage 4.doc Version 1.40 Page 12 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 standard(s) na Not assessed on this visit. EVIDENCE: Clarendon Nursing Home G53-G53 S19024 Clarendonnh V241915 270705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 16 The Inspector was not satisfied that service users and their relatives had confidence in the home’s complaints procedure as two individuals who had raised their concerns with the home initially, then raised them with the Commission. This is of concern, as often relatives will act as advocates for service users who are unable to express themselves in this regard. EVIDENCE: Of the 4 complaints made directly to the Commission since the last inspection two were from individuals who had not felt that the issues that they raised had been satisfactorily dealt with by the home. Some work needs to be done therefore, to reassure both service users, their relatives and friends that concerns raised at the home will be taken seriously and action will be taken. Clarendon Nursing Home G53-G53 S19024 Clarendonnh V241915 270705 Stage 4.doc Version 1.40 Page 14 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 standard(s) 26 While a tour of the premises was not undertaken on this visit, one WC was found to be quite dirty. This means that the home is not as pleasant and hygienic as it could be. EVIDENCE: One of the WC’s on the second floor was found to have a noticeably dirty toilet seat. This is unpleasant for residents, relatives, friends and staff. This was brought to the attention of the manager. Clarendon Nursing Home G53-G53 S19024 Clarendonnh V241915 270705 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 On this visit, the rotas indicated that there was a sufficient number of qualified and unqualified staff on duty. This means that the service users needs should be attended to promptly. EVIDENCE: Following the previous visit it was required that the home increase the number of care staff on each day shift by one, and to also increase by one the number of qualified staff on duty in the afternoon/evening. It was pleasing to note that this has been done. Conversely, however, some relatives and residents commented on the length of time they had to wait in the mornings to be assisted out of bed, washed and dressed. It is recommended, therefore, that the manager review how the workload is managed, so as to avoid unnecessary delays for the service users. It was also required that staff recruitment be improved, so as to ensure that new staff supplied all of the required documentation before starting work. As no new staff had commenced work at the home since the last inspection it was not possible, on this visit, to determine if the Standard had now been met. Clarendon Nursing Home G53-G53 S19024 Clarendonnh V241915 270705 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The Inspector was not satisfied that the health, safety and welfare of the service users and staff was being promoted as well as it could be. EVIDENCE: It was previously required that staff accurately record the temperature of the shower hot water, and ensure that it is appropriate for service users. On this visit there were a number of recordings that indicated that the service users were being showered in water as tepid at 28°C. This was brought to the attention of the manager. It was noted that two of the four service user files examined did not contain a risk assessment. This is unacceptable as it is imperative that all residents are thus assessed so that staff have an understanding of the areas in which they are likely to be in danger. Clarendon Nursing Home G53-G53 S19024 Clarendonnh V241915 270705 Stage 4.doc Version 1.40 Page 17 Several of the bedroom doors were found to be wedged open. This practice is contrary to fire safety advice, and must be stopped. Alternative, acceptable means of holding doors open must be adopted. It should be noted that a new manager commenced work in the home almost a month ago. Once she has had time to settle in, an assessment can be made of her leadership and management approach. Clarendon Nursing Home G53-G53 S19024 Clarendonnh V241915 270705 Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION x x x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x x x x x x x 1 Clarendon Nursing Home G53-G53 S19024 Clarendonnh V241915 270705 Stage 4.doc Version 1.40 Page 19 yes Are there any outstanding requirements from the last inspection? 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 1 Regulation 4 Requirement The Statement of Purpose and Service User Guide must contain all of the information listed in the Regulations. The previously set timescale for this requirement has not been met. Staff must ensure that they accurately maintain fluid charts. The previously set timescale for this requirement has not been met. Staff must ensure that all service users have constant access to drinks. The manager must ensure that medication administration records are accurately completed at all times. The previously set timescale for this requirement has not been met. Steps must be taken to ensure that service users and relatives/friends consider that their complaints will be acknowledged and apporpriately dealt with. Risk assessments must be carried out for all service users. They must be recorded and regularly updated. The manager must ensure that Timescale for action 30/9/05 2. 8 13, 16 27/7/05 3. 4. 8 9 13, 16 13 27/7/05 27/7/05 5. 16 22 27/7/05 6. 38 13 30/9/05 7. 38 13 27/7/05 Page 20 Clarendon Nursing Home G53-G53 S19024 Clarendonnh V241915 270705 Stage 4.doc Version 1.40 8. 38 13 the temperature of the shower hot water supply is not too low. Bedroom doors must not be wedged open. Alternative, appropriate door closure devices must be fitted. 30/9/05 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 7 27 Good Practice Recommendations It would be good practice to ensure that the in-house forms re social history and resident assessment are fully completed. It would be good practice to review the workload management in the home so as to ensure that staff are deployed in the most effective way. Clarendon Nursing Home G53-G53 S19024 Clarendonnh V241915 270705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor, Grosvenor House 125 High Street, Croydon CR0 9XP 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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