Inspection on 04/04/05 for Clarendon Nursing Home

This inspection was carried out on 4th April 2005.

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

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

Other inspections for this house

Clarendon Nursing Home 21/06/07

Clarendon Nursing Home 08/05/06

Clarendon Nursing Home 27/07/05

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 7A Zion Place Thornton Heath Croydon CR7 8RR Lead Inspector Margaret Lynes Announced 4th & 5th April 2005 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 Version 1.00 Page 3 SERVICE INFORMATION Name of service Clarendon Nursing Home Address 7A Zion Place, Thornton Heath, Croydon, Surrey CR7 8RR 0208 689 1004 0208 689 1019 manager@clarendon.co.uk Paul Ware/ Life Style Care plc 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) Mrs Faith Bossa Care Home 51 Category(ies) of Old Age not falling into any other category, with registration, with number nursing of places Conditions of registration Date of last inspection None 31/1/05 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 Version 1.00 Page 4 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and took place over two days. Residents and their relatives/friends had been made aware that the inspection was due, and a number made a point of meeting with me. They are all thanked for their time and assistance. Additionally more than half of the residents completed a questionnaire about their life in the home. Their efforts in doing so are greatly appreciated, and their mainly positive comments were welcomed by the manager. The duration of the inspection was spent examining records, talking to staff, touring the communal areas of the building, talking to, as mentioned above, residents their relatives and friends, and meeting with the home manager and the home’s regional manager. While this was the home’s first inspection in this current (inspection) year, it should be noted that additional visits, on top of the two statutory inspections, were made to the home during the last year, because of concerns about the quality of the care being provided. The home manager was asked to meet a number of requirements over the course of those visits, and of these two are still unmet. Comment will be made on these overleaf. What the service does well: What has improved since the last inspection? Since the last annual inspection there has been a reduction in the number of areas of the service that require attention. The manager and staff were much more approachable, and responded more positively to constructive criticism. This is in part due to the manager being better supported by the company owning the home, and receiving advice and guidance regarding good practice issues. The number of complaints being made about the home have reduced, and far fewer errors in records were noted. The care plans and daily notes about resident care had greatly improved. Clarendon Nursing Home Version 1.00 Page 5 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Clarendon Nursing Home Version 1.00 Page 6 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 Version 1.00 Page 7 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 (Standard 6 is not applicable in this home) Changes are needed to both the Service User Guide and the Statement of Purpose so that they accurately reflect the aims and objectives of the home, and provide full information about the services on offer. This will provide the correct information to enable people to make informed decision about the home on whether it will meet their needs. Not all service users had been fully assessed prior to admission. This means that neither they, nor the home, can be certain that individual needs can/will be met. EVIDENCE: Previous inspections have highlighted the need for both the Statement of Purpose and the Service User Guide to provide accurate information about the home, including the type of clients catered for, staff information and the facilities available. In spite of previous requirements, both documents remain in need of revision. Clarendon Nursing Home Version 1.00 Page 8 The files of five (relatively) new residents were examined. Three contained a pre-admission assessment, which had been carried out by a member of staff from Clarendon. These clearly showed that the individual needs of each resident had been identified, and the home was confident that it could meet those needs. One file contained only a hospital pre-discharge assessment. Nevertheless, this assessment was detailed and fully indicated the type of care that was needed. Unfortunately an almost blank assessment was found in one file. The lack of a needs assessment prior to the provision of care results in both residents and the provider not being aware whether the home has the capacity and resources to meet individual needs. Clarendon Nursing Home Version 1.00 Page 9 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 Not all resident plans contained reference to the client’s social care, thereby not providing staff with the information they need to meet residents needs. In most respects the resident’s health needs were being satisfactorily met. However, not all records of residents’ weight were accurate which could lead to delays in identifying a serious health concern. Despite staff have recently undergone training and having clear procedures to follow residents continue to put at risk by staff making errors in the recording of medication. Residents spoken with were happy that they were treated with respect and that their privacy was respected as much as was possible. EVIDENCE: Three quarters of the resident files inspected contained comprehensive documentation relating to the resident. This included well-written resident plans, with clearly identified needs and the action that needed to be taken in order to address those needs. There was clear evidence that the plans were being reviewed on a monthly basis. It was pleasing to note that the daily records of care directly related to the assessed needs identified in the resident plan. Both resident and relatives are invited to join in the care planning process, and are asked to sign the completed plan. Unfortunately, two of the Clarendon Nursing Home Version 1.00 Page 10 plans inspected made no reference to the client’s social needs. This is as important as documenting their health care needs, and was brought to the attention of the manager. To supplement the service user plan, staff had conducted a number of other assessments, so as to ensure that the health needs of the residents were being met. These included assessments of nutritional needs, pressure areas, moving and handling, continence, wound care and treatment [where applicable] and resident dependency levels. It was noted that the home has produced a specific form on which to record an overall assessment of each resident once they have been admitted. The form is well designed and could be very useful to staff, if it is consistently used. There were records to indicate that residents were being weighed on a monthly basis, however the manager was advised that she must ensure that the records were being accurately completed. The Commission has expressed previous concerns about the number of errors being made regarding the recording of medication administered to residents. Disappointingly, this visit highlighted that these errors were continuing. At least six charts had been incorrectly or not fully completed. In spite of steps being taken to reduce mistakes, including staff training, and closer liaison with the GP surgery and visiting health professionals, staff continue to fail to follow procedures. Residents who are capable of looking after their own medication are enabled to do so. A number of residents kindly gave their views regarding the way staff treated them. All felt that their privacy was being maintained as much as possible and that they were treated with respect. Observation of the staff team interacting with the residents also showed that the carers were mindful how they addressed residents, and they were seen to be polite and friendly. Clarendon Nursing Home Version 1.00 Page 11 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) 12, 13, 14 and 15 The general consensus from residents and their relatives/friends was that the service provided at Clarendon had of late begun to match more their expectations, recreational interests and social and cultural needs. Some concerns were raised about the residents and their families’ level of involvement in making decisions about issues in the home. If this is not tackled it could lead to a reduction in choice and control over their lives. Whilst the overall improvements had been noted these would not be consolidated unless issues about the availability of staff, communication, facilities and staff training were improved. EVIDENCE: All of the residents spoken with commented that Clarendon was not home, but was perhaps the next best thing to it, provided you were willing to accept that at times not everything would be to your liking. Residents and their relatives/friends are periodically invited to meetings where any concerns and ideas can be expressed. The manager was advised that if, at these meetings, specific issues were raised, then she should, once the issue has been dealt with, convey both the action she has taken, and the outcome, to the individuals who raised the issues. In this way they could feel that their input was valued and their concerns acknowledged and acted upon. Clarendon Nursing Home Version 1.00 Page 12 The home employs an activities co-ordinator who records both the activities that are provided and which residents participated. The majority of residents spoken with felt that the activities provided were both adequate and enjoyable, however several expressed a wish for an increase in the amount of physical activities available. This comment was passed on to the manager, as was a request for Sky television. It was very helpful that more than half of the residents and/or their relatives/friends had completed the Commission’s questionnaire. A number had been assisted to do this by a student on a placement at the home. The vast majority had commented positively. Where negative comments had been made, these almost all referred to a wish to be more involved in decision making within the home; and that residents did not always know whom to approach if they had a problem. These views were passed on to the manager. Staff determine residents specific likes and dislikes regarding activities and these should be recorded. Reference has been made in earlier comments about the need for staff to complete the resident assessment form. The home has also produced a form on which to record each residents ‘life history’, unfortunately these were not being completed with any consistency. The food provided was sampled and found to be tasty, well prepared, hot and plentiful. All of the residents spoken with commented favourably on the food. Halal food is provided for those who require it. Clarendon Nursing Home Version 1.00 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 and 18 Adequate procedures are in place for dealing with complaints. Since the last inspection (January 05) there has been one complaint made to the manager. This was satisfactorily dealt with. There are also adequate procedures in place regarding the protection of vulnerable adults. Provided that these are followed, residents and their families can be confident that staff will be vigilant and aware of the action they must take should they suspect anything untoward. EVIDENCE: The complaints record was inspected and one new complaint, since the January inspection visit, was noted. This had been dealt with in a satisfactory manner by the manager, and her investigation and outcome had been recorded. Residents and their relatives/friends are made aware of the complaints procedure within the Service User Guide and the Statement of Purpose. Several relatives commented that in recent times they had found the staff team, including the manager, to be much more approachable, and willing to listen to their concerns. This is an improvement and such positive comments are to be welcomed. Over the course of the past year, since the last annual inspection, there have been several strategy meetings held under the auspices of Adult Protection. While there was no evidence of abuse, some aspects of the investigations were substantiated, which resulted in a number of requirements being made by the Commission, and additional visits being made to the home. Although not as promptly as requested, these requirements have now been met. On this visit the manager was advised that should a complaint even remotely link to Clarendon Nursing Home Version 1.00 Page 14 potential abuse, then guidance must be sought from the Local Authority and the Commission. Clarendon Nursing Home Version 1.00 Page 15 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) 19 and 26 Clarendon is a purpose built nursing home, opened in 1998. The facility is, therefore, only 7 years old and remains in good repair throughout. Several relatives commented on the helpfulness of the home’s maintenance personnel, and his willingness to take immediate action to resolve issues. A walk around the home showed it to be clean, pleasant and hygienic. EVIDENCE: On this occasion, the communal areas were inspected but not the bedrooms as they were visited within the past year and found to be in a good state of repair throughout. With the exception of one trailing electrical lead in a corridor, and concerns regarding the temperature of the hot water in the showers (see Standard 38), there were no health and safety issues identified. There are ample communal areas, including a quiet room and a smoking lounge. All areas were found to be clean and odour free. Clarendon Nursing Home Version 1.00 Page 16 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, 29 and 30 Resident’s needs were not being met in a timely manner as a result of the low numbers of staff on duty which could lead to their safety and care needs being compromised. Recruitment policies have not been consistently followed resulting in residents receiving care from staff members who have not been properly vetted. This potentially leaves people who use the service at risk. All new staff are trained to do their jobs and receive further training to maintain their competences. EVIDENCE: From observation and from comments made by residents and their relatives it was evident that staffing levels need to be increased. Some residents are having to wait until almost lunchtime before being assisted to get out of bed, washed and dressed, while others are put to bed in the early evening, sometimes before supper (although they were given their meal in bed) so as to ensure all residents were in bed before the night shift commenced. Additionally, residents were seen to have to wait some 20-30 minutes for assistance to the lavatory. This does not mean to say that the current staff team are lacking in their care, but simply that they are too finely stretched, and cannot carry out all of their care tasks in a timely fashion. While the staff team were seen to work vigilantly, it was evident that there were simply not enough of them to ensure that all residents were provided Clarendon Nursing Home Version 1.00 Page 17 with good quality care. There is an urgent need, therefore, for additional care staff on each shift, plus an additional qualified member of staff on the afternoon/evening shift so as to ensure that there is one qualified nurse for each of the three floors. All new staff who commence work in the home must undergo a thorough vetting procedure. This should include a police check and a check against the Protection of Vulnerable Adults register. In three cases, it was found that staff had commenced work without the home waiting for these latter checks to have been carried out. This potentially puts residents are risk. Immediate reassurances were sought from the Company that the staff in question would not work unsupervised until their checks came through. This assurance was given in writing before the end of the inspection. Information supplied prior to the inspection indicated that staff had been able to access a number of training courses during the past year, including fire safety, food hygiene, first aid, infection control, moving and handling, nutrition, wound management, care planning and elder abuse. Staff confirmed that they had access to training and were enabled to enrol on NVQ courses. Over 60 of the care staff have achieved an NVQ level II or III award. This is commendable. Clarendon Nursing Home Version 1.00 Page 18 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) 33, 35, 36 and 38 Overall improvements have been made in the way the home monitors the quality of the service it provides so that it can more quickly recognise where standards have/are falling and can take action to remedy this. This includes periodically seeking the views of residents so that the home serves their best interests. While further improvements can be made these may not maintained if staffing levels are not reviewed. The resident’s finances are safeguarded by the way that the home’s administrator keeps accurate and up to date records of residents’ monies. Care staff were receiving supervision every two months which contributes to the standards of care to the residents being maintained. Generally the health, safety and welfare of the residents and staff were being promoted and protected. Clarendon Nursing Home Version 1.00 Page 19 EVIDENCE: Concerns had been previously expressed regarding the lack of in-house audits, which meant that the manager was unable to assess the quality of the service being provided. On this visit it was evident that matters have improved. A number of audits of various aspects of the service are now carried out routinely, and reports made. Of equal importance, records are now also being kept of any remedial action that is needed, and what action is ultimately taken to resolve these issues. Further work is needed however, as the audits had not picked up the recent medication errors, or noted that some resident’s plans did not include social care needs or, indeed, noted that one resident had apparently been admitted without a full assessment. Many of the residents have pocket money and this is administered for them by a designated member of the staff. This administrator was able to show how she kept the records, including evidencing receipts for monies spent on the residents behalf. These records were being satisfactorily maintained. Previous inspections had indicated that staff communication was not as good as it could be – this included communication between senior management and junior staff; between the staff themselves, and between staff and residents and their families. It was felt that this was an issue that needed to be addressed, and one way to do this was to ensure that staff received regular supervision and were kept up to date with developments in the home. Staff meetings were also important, as they were being held infrequently. Improvements have been made in these areas – supervision is now being held on a two-monthly basis, and two staff meetings have been held so far this year. In a similar way to feeding back to residents and relatives who raise issues at meetings it is recommended that the manager ensure that where staff raise issues in their meetings these are addressed and they are informed as how they have been addressed. The home was found to be well maintained and, generally, to promote a safe environment. Risk assessments for residents were being carried out and recorded. Maintenance issues are attended to promptly, and maintenance records were up to date. Staff receive training in health and safety matters, including fire and first aid. Two areas of concern were noted. The first related to a trailing electrical power lead – this was ‘made safe’ immediately. The second issue concerned the temperature of the shower hot water. This was measured and found to be in excess of the maximum recommended temperature (43C). Staff recordings of the temperature, conversely, showed that they were showering residents in water as cool as 30C. Both extremes are unacceptable, and a requirement has been made to resolve this issue. Clarendon Nursing Home Version 1.00 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 1 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 3 x 2 Clarendon Nursing Home Version 1.00 Page 21 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 the Service User Guide must contain all of the information listed in the Regulations. Previous timescale of 30/6/04 not met. The manager must ensure that all service users are assessed prior to admission. The manager must ensure that the service user plans include reference as to how social care needs will be met. The manager must ensure that records relating to service users weight are accurate at all times. The manager must ensure that medication administration records are accurately completed at all times. Previous timescale of 30/04/04 not met. The Registered Proprietor must ensure that there are adequate numbers of staff on duty at all times. The manager must ensure that all new staff supply the documentation listed in the Regulations before commencing work at the home. Version 1.00 Timescale for action 30/5/05 2. 3. 3 7 14 15 2/4/05 2/4/05 4. 8 12 2/4/05 5. 9 13 2/4/05 6. 27 18 2/4/05 7. 29 19 2/4/05 Clarendon Nursing Home Page 22 8. 38 13 The manager must ensure that the temperature of the shower hot water supply is neither too low or to high. She must also ensure that care staff are able to correctly read and record the temperature shown on the thermometer. 2/4/05 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. 3. Refer to Standard 7 12 13 Good Practice Recommendations It would be good practice for staff to consistently use their own in-house resident assessment form. It would be good practice if the staff completed the inhouse ‘life history forms for the service users. It would be good practice if the manager formally fed back to service users, relatives/friends the action taken following residents meetings – specifically where issues have been raised by any of the aforementioned. Should a complaint even remotely link to potential abuse, then guidance must be sought from the Local Authority and the Commission. It would be good practice to ensure that when staff raise issues in team meetings there is a formal method whereby they receive feedback. 4. 5. 18 36 Clarendon Nursing Home Version 1.00 Page 23 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 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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