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Inspection on 08/05/06 for Clarendon Nursing Home

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

This inspection was carried out on 8th May 2006.

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

The inspector 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

It was pleasing to hear from a number of service users that they felt that the staff team were helpful, kind and attentive, that the premises were clean and that the food was always very good. These sort of positive comments are indicative that the home continues to improve, and that these improvements are noted and welcomed by the service users.

What has improved since the last inspection?

The additional visit in November 2005 was made to determine if the requirements that had remained outstanding from earlier visits had been actioned. Of the five that were outstanding four have now been met. In addition the overall atmosphere in the home had noticeably improved. Both staff and service users were interacting in a far more relaxed and open manner, which made the house feel welcoming and more homely.

What the care home could do better:

There is still room for improvement, as the requirements that have been made show. Of most concern was that two members of staff had been recruited before even a POVA first had been obtained for them. This is a clear breach of Regulations and places the service users at unnecessary risk. The other requirements relate to service user plans, and the need for them to include reference to social care needs; the importance of staff ensuring that they are both familiar with the health needs of each service user, and accurately record the health care given (including medication); some minor repairs to light switches and the need to treat all service users with respect and consideration at all times.

CARE HOMES FOR OLDER PEOPLE Clarendon Nursing Home Clarendon Nursing Home 7a Zion Place Thornton Heath Surrey CR7 8RR Lead Inspector Margaret Lynes Key Unannounced Inspection 8th May 2006 09:30 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.V289676.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Clarendon Nursing Home DS0000019024.V289676.R01.S.doc Version 5.1 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.co.uk 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) Lifestyle Care PLC Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51) of places Clarendon Nursing Home DS0000019024.V289676.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th November 2005 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. 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 £524.59 and £630. Clarendon Nursing Home DS0000019024.V289676.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over the course of a day and consisted of inspecting records, talking to service users and staff and touring the premises. The last inspection visit, conducted in November 2005, was an additional visit due to ongoing concerns regarding the overall quality of the service being provided at Clarendon. That visit indicated that matters were improving, and this visit indicated that improvements had continued to be made. This inspection has resulted in five new requirements and four good practice recommendations. Additionally there was one requirement that had been previously made and had again not been met. This low number of requirements is indicative that the quality of the service in this home has improved, and hopefully it will continue to improve in the months ahead. Evidence to support the comments below was gathered from a range of sources – the service users themselves, relatives, members of staff and inspection records. What the service does well: What has improved since the last inspection? The additional visit in November 2005 was made to determine if the requirements that had remained outstanding from earlier visits had been actioned. Of the five that were outstanding four have now been met. In addition the overall atmosphere in the home had noticeably improved. Both staff and service users were interacting in a far more relaxed and open manner, which made the house feel welcoming and more homely. Clarendon Nursing Home DS0000019024.V289676.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Clarendon Nursing Home DS0000019024.V289676.R01.S.doc Version 5.1 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.V289676.R01.S.doc Version 5.1 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 the following standard(s): 3 (6 is not applicable) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. It was felt that service users were being appropriately assessed before moving into the home. This means that they should be assured that their needs can be met, and the staff team can gain an understanding of each client prior to their arrival, which should enhance the service that they provide. EVIDENCE: The files of five newly placed service users were examined. All but one contained a well written in-house pre-admission assessment. The file that did not contain one did, however, contain a detailed placing Authority referral and assessment. Clarendon Nursing Home DS0000019024.V289676.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the plans of care continue to improve, omissions in them, errors in the medication administration records and discrepancies in the health care records means that there is still room for improvement. Lack of attention to detail in these areas means that it is feasible that the care provided is not as thorough as it could and should be. EVIDENCE: The service user plans of five residents were inspected. While all contained a service user plan, and with one exception were being reviewed on a monthly basis, the plans themselves were not complete. Only one contained any reference to social care needs. The home had in place a more than satisfactory proforma on which staff could specifically record a social needs assessment. Only two of these were found to have been completed, and even then, the information had not been transferred into the care plan. Clarendon Nursing Home DS0000019024.V289676.R01.S.doc Version 5.1 Page 10 The wound care records were much improved, however the Inspector was a little concerned that parts of some service user plans in relation to diabetic clients were not being adhered to. Specifically this related to the frequency of some blood sugar tests – the records did not indicate that these were being done at the frequency stated in the care plans. The medication records were also much improved, with just two gaps in the recording found. There were also discrepancies found in the in-house audits, which need to be investigated. While all of the service users who were kind enough to give up their time to talk with the Inspector said that they felt that they were treated with respect, and their right to privacy and choice was respected, it was unsatisfactory to overhear one member of staff refer to a service user in a non-complimentary manner, and to observe another being less than positive in her response to a service user. These matters were brought to the attention of the manager. On a more commendable note, however, it should also be said that without exception, the remainder of the staff team were seen to interact very well with the service users, which the service users clearly appreciated. Clarendon Nursing Home DS0000019024.V289676.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users were generally of the opinion that the home was able to satisfy their social, cultural, religious and recreational interests and needs. EVIDENCE: While the Inspector felt that the amount of stimulation for service users was limited, and the records did not indicate that there were many activities on offer, this did not quite tally with the views of most of the service users (who commented on daily life in the home). While a few felt that the activities were limited, and sometimes just consisted of the TV blaring out, most were of the view that if they wanted to join in an activity there would be sufficient to choose from. This was discussed with the manager who was of the view that while the amount of activities had been increased, there was always room to do more. Visitors to the home are welcomed and the manager has started to hold periodical relatives meetings. Although not particularly well attended, the effort made to facilitate them is commendable. The Inspector was only able to talk with one relative, and that very briefly. They were unhappy as they felt that Clarendon Nursing Home DS0000019024.V289676.R01.S.doc Version 5.1 Page 12 staff had not communicated information to them. This concern appeared to be quickly resolved however. A number of service users were asked if they felt that the staff were attentive to their needs, and encouraged them to exercise choice and control over their lives. They all responded positively, and felt that they were treated with respect and their right to choice and privacy promoted. Clarendon Nursing Home DS0000019024.V289676.R01.S.doc Version 5.1 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 the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Both the complaints and adult protection procedures were adequate so as to provide both a means of addressing concerns and sufficient protection to service users. EVIDENCE: The complaints log was examined – there had been just three complaints since the November Inspection visit and all had been resolved through dialogue between the manager and complainants. Staff are able to access adult protection training, and there are no current adult protection issues concerning this home. Clarendon Nursing Home DS0000019024.V289676.R01.S.doc Version 5.1 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 the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While the home is now looking a little ‘tired’, it still provides a safe and adequately maintained environment for service users. It was found to be clean and pleasant throughout. EVIDENCE: A tour was made of the communal areas and some of the bedrooms. While the home remains functional it is starting to look jaded and would benefit from redecoration/refurbishment. A number of the main light switches in the bedrooms were missing the dimmer knob, making it very difficult to turn the lights on/off. It was noted that one of the communal areas was not in use, and while there is ample other space for service users, this particular room is very pleasant and should be made available as soon as possible. Clarendon Nursing Home DS0000019024.V289676.R01.S.doc Version 5.1 Page 15 With the exception of one toilet (brought to the attention of the manager) the home was found to be clean and odour free. Clarendon Nursing Home DS0000019024.V289676.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. While the number of staff on duty meant that service users’ needs could be met, and staff were able to access plenty of training, some poor recruitment practice means that it was not felt that service users were fully protected in this area. EVIDENCE: The files of eight staff were inspected and a number of omissions were found. This largely related to the lack of a photograph, some gaps in employment histories, and some unexplained departures from previous work with vulnerable people. Of most concern, however, was the fact that two staff had been employed before the home had received a POVA first. This is contrary to the Regulations and may result in further action by the Commission. After some considerable time, the home finally has its full staff compliment. This means that there are usually 3 trained staff and 8-9 carers on duty during the day, with 2 trained staff and 3 carers overnight. These are ably assisted by administrative, domestic and catering staff. The home has recently employed its own training co-ordinator, which is proving beneficial. Staff are able to access a variety of training, including fire safety, manual handling, infection control, health and safety, adult protection Clarendon Nursing Home DS0000019024.V289676.R01.S.doc Version 5.1 Page 17 and wound care. The appointment of a tissue viability nurse for the Company as a whole is proving a worthwhile investment. The home is to be commended for having the vast majority of the carers trained to NVQ level II and in some cases level III. Clarendon Nursing Home DS0000019024.V289676.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered manager has now been in post for 10 months, and both staff and service users benefit from her leadership and management. The home has in place a number of quality assurance systems, which enables the management to identify any areas where the service is sub-standard and then take action to improve it. This means that the home is run in the best interests of the service users. From discussion with service users, the Inspector judged that their well-being, and that of the staff, was being promoted. Clarendon Nursing Home DS0000019024.V289676.R01.S.doc Version 5.1 Page 19 EVIDENCE: The benefit to the home of having consistent management is starting to show. There was a much-improved atmosphere in the home, with the staff team welcoming and the service users stating that they were well cared for and content. The manager is keen to continue her improvement agenda, and bring this home up to the highest standard that she can. This enthusiasm is commendable. There are a number of quality assurance systems in place, including a weekly floor audit (which covers areas such as medication, room cleanliness and health care records), a care plan audit carried out by the home’s Regional Manager during her monthly visits and periodical checks on the quality of the food by the manager (these checks should be recorded). The Company also carries out an annual audit. Recent surveys sent out to service users and relatives indicated that their satisfaction with the home had increased. The Commission has had previous concerns regarding this home’s tendency to seek hospital admission for residents who are in the last stages of their lives, rather than allow them to remain in the home, in familiar surroundings with people they know. While the percentage of service users remaining in the home compared to those sent to hospital has slightly increased, this is still an area that needs further analysis, so as to ensure that service users wishes in the event of their serious illness/death are both ascertained and then acted upon. Unfortunately it was not possible on this visit to include examination of service users financial records. This will be done on the next inspection visit. Risk assessments for service users were seen in the files examined. A walk around the home did not reveal any health and safety issues. Clarendon Nursing Home DS0000019024.V289676.R01.S.doc Version 5.1 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. 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Clarendon Nursing Home DS0000019024.V289676.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 Requirement The manager must ensure that medication administration records are accurately completed at all times. The previously set timescale for this requirement has again not been met. The service user plans must cover all needs, including those relating to social care. Staff must ensure that health care records are accurately maintained at all times. Staff must ensure that service users are treated with respect at all times. Replacement light switches are needed in several of the service users’ bedrooms. Staff cannot commence work in the home until they have at least a POVA first check (alongside all other necessary recruitment documentation) in place. Timescale for action 08/05/06 2. 3. 4. 5. 6. OP7 OP8 OP10 OP19 OP29 15 13 12 23 19 08/06/06 08/05/06 08/05/06 08/06/06 08/05/06 Clarendon Nursing Home DS0000019024.V289676.R01.S.doc Version 5.1 Page 22 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. 4. Refer to Standard OP7 OP12 OP19 OP12 Good Practice Recommendations It would be good practice to ensure that all care plans are reviewed monthly. It is recommended that staff continue to increase the amount of activities available, and to ensure that they record all the work that they currently do in this respect. It is strongly recommended that the home be redecorated and refurbished. It would be beneficial to both service users and staff if cordless telephones were available. Clarendon Nursing Home DS0000019024.V289676.R01.S.doc Version 5.1 Page 23 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. Extracts may not be used or reproduced without the express permission of CSCI Clarendon Nursing Home DS0000019024.V289676.R01.S.doc Version 5.1 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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