Inspection on 14/02/07 for Clarondene Residential Care Home

This inspection was carried out on 14th February 2007.

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.

Other inspections for this house

Clarondene Residential Care Home 18/06/09

Clarondene Residential Care Home 17/04/09

Clarondene Residential Care Home 21/04/08

Clarondene Residential Care Home 17/12/07

Clarondene Residential Care Home 04/07/07

Clarondene Residential Care Home 04/07/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Clarondene Residential Care Home View Road Lyme Regis Dorset DT7 3AA Lead Inspector Chris Gould Unannounced Inspection 14th February 2007 10:05 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 Clarondene Residential Care Home DS0000065695.V329659.R02.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. Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clarondene Residential Care Home Address View Road Lyme Regis Dorset DT7 3AA 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) 01297 442876 01297 442025 alia@alcurtis.fsnet.co.uk Ms Mary Alison Curtis Care Home 12 Category(ies) of Old age, not falling within any other category registration, with number (12) of places Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th July 2006 Brief Description of the Service: Clarondene residential care home is registered to provide care and accommodation for a maximum of 12 residents. At the current time there are 11 residents living in the home including one married couple. The home has been registered to Ms Alison Curtis since January 2006 and she takes an active role in the management of the home. The home has not had a registered manager since April 2006. The home is situated in a quiet residential area of Lyme Regis. There is a steep walk to the town centre, which offers all the amenities of a small historic coastal town. A small parking area is available at the front of the home and a large town car park is situated nearby. The front door to the home is located at the side of the house and is accessed by a steep flight of steps. There is also a raised driveway to the home’s back entrance/kitchen door, which has an uneven surface but Ms Curtis said that improvements are planned for the near future. Ms Curtis’s private accommodation is located on the first floor close to private rooms used by her elderly mother. The home has an assisted bathroom and a separate assisted shower room, which has recently been upgraded to a high standard. There is small, enclosed and levelled front garden with flower boarders and lawn at the side of the home near to the front entrance: this is easily accessed through patio doors from the lounge area. Garden furniture is available outside for residents to sit, relax and enjoy the warmer weather and potted plants provide an attractive display. Additionally, there is a back garden but residents rarely use this as it can only be accessed by a series of steep steps. The fees for the home as provided to CSCI at the time of inspection range from £350 to £450. Additional charges include hairdressing, chiropody and newspapers. See the following website for further guidance on fees and contracts. http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_c hoos.aspx Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection by two inspectors took place over eight hours on one day in February 2007. This was the second key inspection to be undertaken this year. A tour of the premises took place and staff files, two residents care records and relevant documentation and policies and procedures relating to the running of the home were inspected. Seven residents, a visitor to the home and the staff on duty including the acting manager were spoken with. Ms Alison Curtis the proprietor was available throughout the inspection. Following the inspection the home has submitted a plan detailing the improvements they are putting in place to meet the requirements and comply with the Care Homes National Minimum Standards and Regulations. Compliance will be monitored by CSCI during future inspections. What the service does well: An assessment is undertaken before the home agrees that they are able to meet the prospective residents needs. This is confirmed by letter. The home is adequately decorated and furnished to provide a homely, comfortable environment. Residents spoken with agreed that it was a very homely, friendly place to live where the staff are cheerful, very helpful and polite. The flexibility of the home enables residents to retain control over their lives as much as possible and to maintain contact with their family and friends. All residents spoken with were very positive about the quality of the meals provided commenting ‘food good and plentiful’ and ‘I really look forward to mealtimes’. Residents spoken with agreed that although they haven’t had to make a complaint they were sure that Alison (Ms Curtis) would listen and do all she could to sort it out and put things right. The home is staffed each day by adequate numbers of management, care and domestic workers to meet the needs of the residents at Clarondene. Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Sixteen requirements and four recommendations have been made following this inspection a number have been repeated from the previous inspection. Residents care records must provide sufficient detail to ensure that the resident’s health and personal needs are being fully and safely met. The home has systems in place for managing residents’ medicines but some aspects must be improved including staff training to protect residents. The home would benefit from identifying residents social care preferences to ensure that they are satisfying their social and recreational interests and needs. Training for all staff in the identification and prevention of abuse will ensure that residents are protected from abuse. The recruitment and employment practices within the home do not consistently protect the residents from the risk of unsuitable staff being employed. Short falls in staff training including induction may result in some care staff not being adequately trained to undertake all care tasks competently and therefore residents can not be assured that they are in safe hands at all times. The management of Clarondene does not ensure that the residents and staff live and work in a home that is run effectively, efficiently and safely. The lack of a fully implemented formal quality assurance system limits the extent to which the home is able to demonstrate that it meets the expectations of residents. The introduction of regular staff supervision will ensure that the homes training programme and policies and procedures are implemented to protect the residents. The practices at the home do not consistently promote and protect the safety and welfare of the residents. Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 7 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. Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 8 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 Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 9 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): 1, 2, 3 and 4 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents have the information they require to decide if the home is able to meet their needs and is the right place for them to live. EVIDENCE: Following the last inspection the home compiled a statement of purpose and service user guide that was submitted to CSCI. Following feedback from the inspector further changes were made and the service user guide and a new terms of residency was provided for all residents. The residents spoken with during the inspection confirmed this and a copy of the letter that accompanied the documents was seen on two residents files. Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 10 The two residents files viewed contained an assessment that had been undertaken before the home confirmed by letter that they were able to meet the individual needs. The assessment included the resident’s personal details and information relating to their care needs. Copies of the letter were seen on the residents’ files. Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 11 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): 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. Care records do not provide sufficient detail to ensure that the resident’s health and personal needs are being fully and safely met. The home has systems in place for managing residents’ medicines but some aspects need improving to protect residents. Staff treat residents with respect and dignity, promoting residents’ feelings of worth as valued members of the household. EVIDENCE: The two residents files viewed included care plans using a new format that has recently been introduced by the home. Staff spoken with commented that although care plans contained a lot of information they were not always easy to read and could be improved by providing the detail in statement form rather Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 12 than long sentences. The information provided was variable. One contained a very full and descriptive care plan for personal care whilst the other file did not. Both residents had personal care needs. Accident records and a falls risk assessment in the file of one resident identified them as having a high risk of falls but there was no clear action plan detailing how this risk is to be managed. One resident has diabetes but their care records do not include a care plan detailing the care required to assist the resident to manage their diabetes including the actions needed to prevent complications. Space is provided at the end of the care plans for the resident or their representative to sign but in the two files viewed this had not been completed. Risk assessments for nutrition and the potential for the development of pressure ulcers are undertaken by the home but when a risk is identified there is no care plan to inform how the risk is to be managed. If the home identifies that the resident is at risk a more in depth assessment undertaken by an appropriately trained person should take place. Discussion with residents and viewing two files confirmed that the residents have access to health professionals including the doctor and district nurse when needed. The system for medication was reviewed. Most medicines are appropriately stored and kept locked away. Some tablets come to the home in monitored dosage packaging; others are in boxes and bottles. Any residents’ allergies are noted on the Medication Administration Records (MAR). Insulin and eye drops that need to be stored in the refrigerator are kept in the door of the domestic refrigerator in a metal box. A non-corrosive box should be used and stored in the body of the fridge, not the door as the temperature will be less varied. The home is storing insulin and other medicines that regularly need refrigerating and need to be kept below a certain temperature but the temperature range of the fridge is not being monitored. The home does not have a record of the signatures of the carers who are involved in the administration of medication to residents. Not all care workers that who regularly administer medication have received training. One commented that they did not feel that the content of the training they had received was adequate to cope with the complexity of the task. A pot labelled ‘spoilt tablets’ contained a large number of different tablets. There was no indication in the records to demonstrate whose tablets they were or how or when they were ‘spoilt’. The MAR chart for one resident had a line through two boxes where a medicine should have been administered but there was no record of why it had been omitted. When changes are made to the MAR charts two signatures are required, this was not evidenced when looking at the charts. Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 13 Staff were seen knocking on doors and waiting for an answer before entering residents’ rooms. Residents spoken with said that they were always addressed in the way they had requested and the staff are very polite. Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 14 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): 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 home would benefit from identifying residents social care preferences to ensure that they are satisfying their social and recreational interests and needs. The flexibility of the home enables residents to retain control over their lives, where feasible, and to maintain contact with their family and friends. Meals are nutritious, include alternatives and offer a healthy varied diet for residents. EVIDENCE: The two care records viewed did not include a social assessment to provide a full picture of the person’s past family, work and social history that would assist with planning for their future care. Staff commented that they enjoy talking with and playing board games with the residents. These activities when they take place are not recorded. Outings are arranged but mainly during the warmer months. One resident spoken with had enjoyed going out Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 15 to lunch with their family on the previous day. One resident spoken with commented ‘it would be nice to have a bit more to do. It can get boring’. Service users receive visitors whenever they wish. A record is maintained of all visitors to the home. The home encourages friends and relatives to keep in contact. Visitors spoken with confirmed that visitors were always made welcome by the staff. One resident was looking forward to their relative visiting and others talked about their family and friends who visit. Residents spoken with confirmed that they were able to make choices about such matters as what they ate and when they got up in the mornings and went to bed at night. Residents are able to “personalise” their bedroom with additional items of their choice. This was confirmed when visiting residents’ bedrooms. All residents spoken with were very positive about the quality of the meals provided. Lunch was observed as a leisurely social occasion with staff providing help when needed. Meals are eaten sat at a table placed at one end of the communal room or in the resident’s own room if this is their choice. The Environmental Health Officer visited the home shortly after the change of ownership requirements made have been addressed. Residents commented ‘food good and plentiful’ and ‘I really look forward to mealtimes’. The menus provided a varied and well balanced diet with choice based on the residents’ likes and dislikes. One resident commented ‘If I don’t like the meal then there is always something else’. The cook maintains a record of all the meals supplied. Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 16 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): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are confident that their complaints will be taken seriously and acted upon. The home has a procedure available on the identification and prevention of abuse; training for all staff in this subject will go towards ensuring that residents are protected from abuse. EVIDENCE: The home has a complaints procedure that has now been provided to all residents with the service user guide. No complaints have been received by the home or the Commission for Social Care Inspection since the last inspection. Residents spoken with agreed that although they haven’t had to make a complaint they were sure that Alison (Ms Curtis) would listen and do all she could to sort it out and put things right. The home has a policy and procedure concerning the protection of vulnerable adults and the identification and prevention of abuse. A copy of the Dorset multi agency guidance ‘No Secrets’ has been obtained and is kept with the procedure. Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 17 Staff training records indicated that some but not all staff have been provided with training relating to the protection of vulnerable adults and abuse. Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 18 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): 19 and 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home is a homely comfortable, clean and pleasant place to live although there are areas where the safety of residents cannot be assured. Practices within the home do not consistently ensure that the residents are protected from the spread of infection. EVIDENCE: The home is adequately decorated and furnished to provide a homely, comfortable environment. Residents spoken with agreed that it was a very homely, friendly place to live where the staff are cheerful and very helpful. The home has nine single bedrooms and one double bedroom situated on the ground floor. The ground floor dining room/ lounge is accessed from the Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 19 bedrooms by negotiating two steps. Staff were observed moving residents in wheelchairs and were seen to have difficulty negotiating the steps safely. Despite staff having had manual handling training they were seen to be putting themselves and the residents at risk of harm by pushing residents in wheelchairs up and down this step. A portable ramp was available to assist with this task but staff said that they did not use it as the ramp itself was very heavy and cumbersome to use. The managers did not insist upon its use. A resident who haws been identified as being at risk from falling and who uses a walking aid was also observed to have difficulty maintaining their balance when negotiating the step leading to the communal area. A single bedroom available on the first floor is currently being used as the home’s office and for staff who provide sleep in cover. The way in which the lounge/dining area is arranged at the present time does not provide sufficient seating if all the residents in the home needed to use the space at the same time. Ms Curtis said that there are residents who prefer to stay in their own room and this was confirmed when talking with one resident. It was evident that residents are encouraged to personalise their rooms with items of furniture and pictures and possessions from their former homes. Two bedrooms have en-suite WC’s and the remaining rooms are fitted with vanity units and washbasins. The Fire Safety Officer has not been informed about the changes made to the ground floor shower room and so has not confirmed that he is satisfied with the completed works. Call bells are fitted in all residents’ bedrooms but are not always accessible when the resident is sat in a chair away from the bed. The call bell in the dining area was not working. This, along with a number of other maintenance tasks, had been identified but not remedied. The staff commented that they experience difficulty when helping residents to use the assisted bath, as they have to ‘twist themselves’. The bath and the bathing procedure needs risk assessing and any actions identified as a result of this assessment must be implemented and staff trained appropriately. The area of floor around the toilet in the bathroom needs replacing as it has been covered with tiles that do not provide a smooth well covered surface. The resulting numerous gaps do not look attractive and have the capacity to spread infection. It was observed that towelling hand towels were being used in the bathroom and laundry. Ms Curtis said that she was aware that paper disposable towels should be used to help prevent the spread of infection and would ensure that they are provided. Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 20 A housekeeper is employed to undertake basic cleaning and the laundry. One resident commented ‘laundry very good. Clothes always returned’. All areas that were seen during the tour of the home were in a clean condition and free from unpleasant odours, residents and visitors confirmed that this is always the case. Residents confirmed that their bedrooms were regularly cleaned. Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 21 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): 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. The home is staffed each day by management, care and domestic workers to ensure that residents’ collective needs are met. The recruitment and employment practices within the home do not consistently protect the residents from the risk of unsuitable staff being employed. Short falls in staff training including induction may result in some care staff not being adequately trained to undertake all care tasks competently and therefore residents can not be assured that they are in safe hands at all times. EVIDENCE: A copy of the staff rota was seen. Only the first names of the staff were used and they were listed in alphabetical order. The rota should include the full names of staff members and identify the role they undertake in the home e.g. care worker, cook or housekeeper. Discussion with Ms Curtis, staff and residents demonstrated that there are sufficient staff on duty to meet the needs and dependency levels of the eleven residents at the home. During the night time period there is one wakeful and Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 22 one sleeping member of staff on duty. This will need to be reviewed if the dependency levels change. Since the last inspection a housekeeper has been employed to undertake the laundry, general cleaning and the provision of the morning coffee/tea. One resident commented that they didn’t need help often but when they did there was always someone available. Five of the ten care staff employed at the home have achieved at least an NVQ level 2 in care. This meets the Department of Health target. There are no staff currently undertaking NVQ training. The staff recruitment procedure has improved since the last inspection. POVA First and CRB checks had been applied for and received prior to employment but staff records do not consistently contain proof of identity, two written references and evidence to demonstrate the staff members right to work in this country or at the home. Neither staff contracts of employment or job descriptions were seen on files. The home has obtained the Skills for Care Induction programme but structured induction training is yet to be implemented. Training is provided to staff using a distance learning programme. Staff work through the learning material, complete a questionnaire and then send the papers away to be marked. The records available and discussion with staff did not evidence that they had all received training in health and safety, first aid, manual handling, infection control and adult protection. Staff have not received training to meet the specialist needs of their residents e.g. diabetes and epilepsy. Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 23 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): 31, 33, 35, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of Clarondene does not ensure that the residents and staff live and work in a home that is run effectively, efficiently and safely. The lack of a fully implemented formal quality assurance system limits the extent to which the home is able to demonstrate that it meets the expectations of residents. Resident’s financial interests are safeguarded. The introduction of regular staff supervision will ensure that the homes training programme and policies and procedures are implemented to protect the residents. Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 24 The practices at the home do not consistently promote and protect the safety and welfare of the residents. EVIDENCE: Ms Curtis purchased Clarondene a year ago. At the time of purchase a registered manager was in post but since her departure Ms Curtis has been undertaking the management role. She has no previous experience of working in a residential care setting and although she has registered to undertake NVQ level 4 management & care training Ms Curtis is yet to commence the course. Six months ago Ms Curtis employed an acting manager to work alongside her for twelve months to enable her to gain experience in home management. The acting manager has an appropriate management and care qualification and previously managed another care home in the area. Observation during the inspection and discussion with Ms Curtis and the acting manager identified that there is confusion as to who is managing the home on a day to day basis and their individual responsibilities. Ms Curtis has a very good rapport with the residents whose comments included ‘Alison is very approachable’ and ‘will always listen to me’. She said that talking to the residents was the part of the work she really enjoyed. Talking with staff it was clear that their working relationship with Ms Curtis is not always satisfactory. Working at building an improved relationship between Ms Curtis and the staff would benefit all who work and live at the home. Ms Curtis often works as part of the care team but cannot evidence that she has received the appropriate training to undertake this role. A quality assurance system has still to be fully implemented. A residents survey was provided in August 2006 and three completed replies were received. The home has still to develop a system for continuous selfmonitoring, including an internal audit, that will provide the information needed to produce an annual development plan. Residents’ personal allowances are managed by the home and individual records are kept. Ms Curtis pays expenses for other items; she then sends an invoice requesting payment from either the resident or their representative. A format for recording staff supervision has been obtained but a programme for providing staff with regular supervision is yet to be implemented. Staff confirmed this. The office is situated on the first floor and is also used for staff that occasionally provides ‘sleep in’ cover. Records, including staff recruitment Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 25 records and information relating to the running of the home, are stored in this area but not securely. Regulation 37 notifications have been received by the Commission for Social Care Inspection as appropriate since the last inspection. The records of one resident did not contain a photograph as required by legislation. The missing persons procedure does not include the importance of having photographs of residents. Photographs are also important when new staff are employed or if the home uses agency staff to assist with identification. Records were available to demonstrate that equipment used in the home had been serviced: electrical items had been PAT tested on 30/6/06 and a clinical waste contract was set up with the council on 29/6/06. Ms Curtis confirmed that a person with a relevant and up to date certificate in first aid is not available in the home at all times. The home has obtained a format but has still to produce a fire risk assessment for Clarondene. When this has been completed an action plan needs to be drawn up and implemented to meet any shortfalls identified. A programme of staff training and fire drills will need to be undertaken at the intervals and frequency identified as appropriate by the fire risk assessment. Discussions with staff and records evidenced that not all staff had had fire training in the last six months. Training had been provided for new and agency staff. It is recommended that staff sign to say that they have received the training. Fire fighting equipment tests are undertaken but identified problems are not consistently rectified. A heavy fire extinguisher situated near the entrance to the communal area has not been fitted to the wall and could cause harm if it fell onto a resident, member of staff or visitor to the home. An unlocked cupboard door in the bathroom contains an uncovered hot water tank that requires risk assessing and where appropriate action taken to minimise any risks identified. Following a recent electrical power cut Ms Curtis has identified the need to undertake an assessment of the utilities provided to the home and the actions that would be taken should they be stopped for any reason. During the inspection a number of residents were observed requiring assistance with their mobility but the home does not undertake manual handling assessments. The training provided for the staff on manual handling is by distance learning with no practical experience or the input from a manual handling trainer. The need to provide the appropriate manual handling training was discussed with the proprietor. One incidence of a resident being transferred using a wheelchair inappropriately was observed. Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 26 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 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 X 1 Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 27 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 OP7 Regulation 15(1)(2) Requirement The registered person must ensure that the residents care records include an action plan with sufficient detail to provide clear guidance to staff on the actions to be taken to meet all their identified needs. The resident or their representative must be consulted when preparing the care plan. The registered person must ensure that when the home identifies health related risks including nutrition and the potential for the development of pressure ulcers assessments are undertaken by a suitably qualified or suitably trained person. The residents care plan must record how the identified risk is to be managed. Timescale for action 30/06/07 2. OP8 14(1)(a) 30/06/07 3. OP9 13 (2) The Registered Person shall 30/06/07 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in the care home including: DS0000065695.V329659.R02.S.doc Version 5.2 Page 28 Clarondene Residential Care Home a) All staff that give medication must be trained and assessed as competent to do this. b) Having a system to ensure that medication is given and recorded correctly, including the dose given when a choice is prescribed, e.g. monitoring records and the audit trail. c) Having a system for ensuring that where there is a discrepancy between the dose on the medicine label and that on the MAR chart, or as directed instructions or when the GP is asked to update the prescription. d) Recording the reason for when required medicines. Previous timescale of 30/6/06 To ensure that medicines are stored at the correct temperature the maximum and minimum temperatures of the medicines fridge must be monitored and recorded daily and corrective action taken if they are outside the recommended range (2-8°C). 4. OP12 16(n) After consultation with residents the registered person must provide social activities to meet their individual needs. The registered person must be able to evidence that all staff are trained in the Protection of Vulnerable Adults. Previous timescale of 1/7/06 The registered person must ensure that: a) the steps that need to be negotiated to access the communal areas from the bedrooms are risk assessed and DS0000065695.V329659.R02.S.doc 30/06/07 5. OP18 13(6) 30/06/07 6. OP19 13(4)(a) (b)(c) 30/06/07 Clarondene Residential Care Home Version 5.2 Page 29 action taken to address any issues identified. b) the assisted bath and the bathing procedure is risk assessed and any action identified as a result implemented. c)The uncovered hot water tank in the cupboard situated in the bathroom must be assessed and appropriate action taken. 7. OP26 13(3) The registered person shall make 30/06/07 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. a) Disposable paper towels must be available and easily accessible for drying hands when using a wash hand basin. b) The flooring in the bathroom must be replaced. The home must be able to demonstrate that a thorough recruitment and employment procedure is followed to ensure that residents are in safe hands at all times: associated paperwork and records must be individually organised and properly kept. Previous timescale of 1/5/06 The registered person must ensure that the persons working at the home receive training appropriate to the work they are to perform including structured induction training and the specialist needs of the residents. The Registered Person and manager must have clear roles of accountability: with appropriate job descriptions documented. DS0000065695.V329659.R02.S.doc 8. OP29 19 schedule 2 30/06/07 9. OP30 18(c)(1) 30/06/07 10. OP31 12(1)(a)( 5)(a) 30/06/07 Clarondene Residential Care Home Version 5.2 Page 30 Previous timescale of 1/7/06 The registered person must improve and maintain good personal and professional relationships with persons working at Clarondene Care Home. 11. OP31 8(a) 9(2)(b)(i) The registered provider must ensure that an application is submitted to CSCI for the registration of a manager who has the qualifications, skills and experience necessary for managing the care home. The registered person must establish and maintain a system for evaluating the quality of the services provided at the care home. The registered person must ensure that staff receive regular formal supervision. The registered person must: • make suitable arrangements for the training of staff in first aid; • ensure a person trained in first aid is working in the home at all times. • make suitable arrangements to provide a safe system for moving and handling residents including assessment, the development of an action plan and staff training. The registered person must ensure that a photograph of each resident is kept in the home. The registered person must undertake a fire risk assessment DS0000065695.V329659.R02.S.doc 30/06/07 12. OP33 24 30/09/07 13. OP36 18(2) 30/06/07 14. OP38 13(4)(5) 30/06/07 15. OP38 17(1)(a) schedule 3 23(4A) 30/06/07 16. OP38 30/06/07 Page 31 Clarondene Residential Care Home Version 5.2 for the care home and as a result develop and implement an action plan. A programme of staff training and fire drills will need to be undertaken at the intervals and frequency identified as appropriate by the fire risk assessment 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 OP9 Good Practice Recommendations The home should follow guidance from the Royal Pharmaceutical Society including: a) When medicines are handwritten on the MAR chart a second competent person should check the details are accurate and countersign. The Fire Safety Officer should be informed about the changes made to the ground floor shower room to ensure he is satisfied with the completed works. Each member of staff should be supplied with a contract of employment and job description. The registered person must be able to evidence the training that has been supplied to staff. 2. OP19 3. 4. OP29 OP30 Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Clarondene Residential Care Home DS0000065695.V329659.R02.S.doc Version 5.2 Page 33 - 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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