Inspection on 04/07/07 for Clarondene Residential Care Home

This inspection was carried out on 4th July 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 14/02/07

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 John Hurley Key Unannounced Inspection 4th July 2007 10:00 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.V343498.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Clarondene Residential Care Home DS0000065695.V343498.R01.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.V343498.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th February 2007 Brief Description of the Service: Clarondene residential care home is registered to provide care and accommodation for a maximum of 12 residents. At the time of the inspection there were only seven individuals in residence. The home has been registered to Ms Alison Curtis, the proprietor, 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 the proprietor said that improvements are planned for the near future. The proprietor’s private accommodation is located on the first floor close to private rooms used by their elderly mother. Neither the Proprietor nor their mother have a kitchen and so they share the home’s registered kitchen and basically eat what the people who use the service eat. The home has an assisted bathroom and a separate assisted shower room, which has recently been upgraded to a high standard. There is a small, enclosed and levelled front garden with flower borders 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 range from £350 to £450 per week. Additional charges include hairdressing, chiropody and newspapers. Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 5 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.V343498.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced key inspection of Clarondene care home for the inspection year 2007/8. The inspection process followed the Commission for Social Care Inspection Inspecting for Better Lives methodology. The views of the people who use the service and people important to them were also sought; where appropriate their comments are included in this report. The inspector toured the building, spoke with the management and staff on duty and spoke privately with people who use the service on both an individual and group basis. They inspected a sample of the documentation relating to the individuals who reside at the home along with records relating to staff and other documents required by regulation. What the service does well: What has improved since the last inspection? The proprietor has met a number of the requirements made at the last inspection but not all. The proprietor has began to address the shortfalls in the care planning process used within the home. Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 7 The proprietor has enrolled on a NVQ level four course in relation to care home management. The floor covering in the bathroom has been replaced. Some environmental risks have been reassessed but not all identified through the inspection process. What they could do better: The responsible individual (proprietor) must ensure that; • all manual handling assessments are reviewed and any action that is required to ensure the safety of the people who use the service and staff are recorded and acted upon. all pressure ulcer risk management is recorded and where the assessment establishes a high risk it must demonstrate the action that will or has been taken to minimize the identified risk in order to protect the people who use the service. there is a recorded rationale and practice guidelines for the administration of medication via the per required needs route. they can evidence that all staff that administer medication have been adequately trained. all people who use the service have a detailed care plan which is reviewed on a monthly basis. approaches in dealing with challenging behavior are age appropriate and recognize the depth and scope of the reasons for the behavior, setting out a clear and consistent approach to this issue. activities are based on individuals needs and aspirations. all environmental risks are assessed and the identified action to minimize the risk is recorded and acted upon to minimize the risk of harm to people who use the service and staff. all new staff receive the statutory training. robust employment practices must be established in order to protect the people who use the service. • • • • • • • • • Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 8 • all guests of the proprietor who stay overnight or longer are suitably vetted to establish their fitness to be in contact with vulnerable people. the service’s vulnerable adults policy is updated to reflect the local authorities policies. all staff must receive formal supervision on a regular basis. they establish and maintain a COSHH register and ensure that all substances hazardous to health are appropriately stored. they must establish good practice in relation to the use of the kitchen by staff in relation to food hygiene practices. they must ensure that the office is kept in such a way that is does not undermine any fire risk assessments. statutory requests for information in relation to carrying out the business of the commission are attended to in a timely fashion • • • • • • The responsible individual / proprietor will be asked to submit an action plan detailing how they will address these issues and meet the requirements set as a result of this report. The action plan will be closely monitored to ensure compliance with requirements set. Any further non-compliance may result in enforcement action. 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.V343498.R01.S.doc Version 5.2 Page 9 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.V343498.R01.S.doc Version 5.2 Page 10 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): 2,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service gives sufficient information with regards to what it can offer to prospective residents enabling them to make an informed choice. Intermediate care is not offered at Clarondene. EVIDENCE: The statement of purpose has been updated to reflect the current managerial arrangements at the home. The people who use the service confirmed that they had been involved with the pre assessment process. A visiting relative further confirmed that they had been given lots of useful information with regards to the service on offer. Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 11 The individuals documentation that was sampled contained an assessment that had been undertaken before the home confirmed by letter that they were able to meet the individual needs. This assessment included the individual’s personal details and information relating to their care needs. A basic contract was also seen. Copies of these details were seen on the individual’s documentation. Through discussion with the designated home’s manager and staff the inspector established that intermediate care is not a feature of this service. Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 12 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): 7,8,9,10 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 inspector observed staff being kind and caring towards people who use the service. Staff spoken with demonstrated a good awareness of how to meet individuals needs. Their comments included ‘staff couldn’t be kinder or more friendly’ and ‘the staff are very good’. The feedback from people important to the service users further confirmed these observations. Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 13 The inspector sampled the individuals documentation and found that care plans are not maintained for people who use the service. There was little detail with regards to individuals’ needs, daily routines, preferences and health care needs. Only one care plan was available for inspection that could be seen as an operational tool but this had a number of areas that required improvement. For example although there was a falls risk assessment there was no detailed directions to staff of the level and type of assistance to be provided to each person in order to minimise the risk of falls, the manual handling assessment related to objects rather than living persons. One section of the plan addressed challenging behaviour. The instructions to staff were to ignore challenging behaviour and reward positive behaviour. This approach appears to be child centred and does not recognise the very complex issues that the individual is presenting. Through sampling the people who use the services documentation they could find no formally recorded review of the persons’ needs. Through discussion with staff and management it was reasonably clear that one individual’s needs had altered following a recent discharge form hospital. Although all staff spoken too told the inspector of the change in their individual needs no review had been undertaken. The hand over sheets used by staff evidenced that doctors, district nurses and other health care professionals visit the home to address any health care needs. Pressure-relieving equipment was seen to be available for one individual but the reasons why were not apparent in their documentation. Tissue viability assessments had been carried out but not all care plans had been regularly reviewed and updated as required. In order to have a robust approach to pressure sore management it would be helpful if all people who use the service have an assessment relating to tissue viability which was regularly reviewed and influenced their plan of care. Similarly it would be helpful if the home could evidence that all people who use the service had a nutritional assessment and their weight monitored on a regular basis in line with the good practice. One person 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. Medication is supplied by a local pharmacy and dispensed using a NOMAD system. A list of staff who administer medication is available and a sample of their signatures was seen at the beginning of the medication recording sheets. All medications are stored securely. The inspector viewed the medication administration recording sheets and noted a number of issues that needed to be addressed. Some directions required Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 14 medication on a Per Required Needs (PRN) basis but the rationale for administration on this basis was not available (either on the medication sheets or service users file).The inspector noted that the medication recording sheets are routinely filled in to state that the person did not require any PRN medication on a daily basis. It is recommended that the sheets are only completed when medication is administered with regards to PRN administration as it makes it easier to establish patterns of usage with only a administration signature. It was also noted that a individual had recently went to hospital their medication being handed over to the paramedics. The medication recording sheets had not been completed to state the amounts that had been handed over thus not providing a robust audit trial. People who use the service confirmed that they are able to meet privately with visitors in their bedroom. Interaction between staff and people who use the service was friendly and respectful. Through discussion with the service user the inspector established that the care staff respected their privacy and dignity and that they were not made to do anything they did not wish to, such as attending activities or having meals in the dining room. They further confirmed that all personal care was provided in the privacy of their bedrooms or bathrooms. It would be helpful if all care plans and associated documents supported these representations. Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 15 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): 12,13,14,15, 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 peoples social care preferences to ensure that they are satisfying their social and recreational interests and needs. The flexibility of the home enables people to maintain contact with their family and friends. It would be helpful if people who use the service are made aware of what is planned for meals in advance. EVIDENCE: People who use the service 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 they were always made welcome by the staff. One individual was looking forward to their relative visiting and others talked about their family and friends who visit. Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 16 They confirmed that they could spend their time as they want to and that they are given choices. The inspector toured the building and noted that many of the service users rooms were personalised with their own possessions. There are planned activities, which provide some stimulation to the resident group. These range from singing and bingo, gentle exercise, ball type games and outings. Several people told the inspector that they knew what activities were taking place, some they liked others they did not. The pre inspection questionnaires further supported their representations. There was little recorded evidence to demonstrate that the activities are based on the persons past or emerging interests or social needs. Those people who require support during meal times were assisted in a dignified manner. Through discussion with the people who use the service it was further established that the food is good, home cooked and plentiful. The dining room table was laid with a tablecloth. No menu is displayed, food being cooked fresh each day. Although there is a record of what people have had for their lunch in the kitchen diary, people who use the service were not aware of what it would be in advance. The inspector discussed with the proprietor the issue of menus. As this is a small service, catering at the time of the inspection for seven, a monthly planned menu may undermine the domestic ambience of the home. However it would be helpful if the people who use the service knew on the day what was for lunch so they could comment on if they wanted the meal or seek an alternative. The inspector observed staff asking people who use the service what they wanted for pudding at dinner time and what they wanted for tea thus offering a degree of choice. Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure that is available to residents and staff. People who use the service are confident that their complaints will be taken seriously and acted upon. The Vulnerable adults procedure requires to be updated in order to protect the people who use the service. 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. People who use the service who were spoken with agreed that although they haven’t had to make a complaint they were sure that the proprietor would listen and do all they could to sort it out and put things right. The home has a policy and procedure concerning the protection of vulnerable adults. This states that the manager of the home will carry out an investigation into any allegations of abuse, this is at odds with the local authorities policies and procedures which have a statutory responsibility to lead vulnerable adult protection issues along with the police. This policy therefore requires updating. Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 18 A copy of the Dorset multi agency guidance ‘No Secrets’ has been obtained and is kept with the homes procedure. Staff training records do fully indicate that all staff have been provided with training relating to the protection of vulnerable adults and abuse. Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 19 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): 19,21,22,23,24,25,26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home has been decorated and furnished to a good standard. There are sufficient communal areas and bathroom facilities to meet service users needs. Service users rooms are personalised to reflect their individual tastes. There are areas within the home where the safety of residents cannot be assured and require robust risk assessments. EVIDENCE: The inspector toured the premises accompanied by the designated homes manager shortly after entering the premises. They found that the home was generally clean in all areas observed. It was noted that all toilet and bathrooms were found to be clean and hygienic, although it was noted that a number of cleaning products were in the communal bathrooms in unlocked cupboards. Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 20 The home now provides liquid soap and paper towels in line with good practice guidance relating to infection control policies. The inspector noted that the bathrooms had a “swing bin” for rubbish. In order to strengthen the home’s infection control policies it would be helpful if pedal bins were introduce into these areas. The floor covering in one bathroom that was seen to be problematic at the last inspection has now been replaced. The home is adequately decorated and furnished to provide a homely, comfortable environment. People 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. 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 inspector noted that in the hot water is regulated by the means of individual thermostatic regulators. The designated manager informed the inspector that all hot water outlets are covered in this way. The inspector noted that the hot water temperatures are regularly monitored in the communal bathrooms. The ground floor dining room/ lounge is accessed from the bedrooms by negotiating two steps. Staff were observed moving residents in wheelchairs without footplates. The staff struggled to negotiate the steps safely. A individual who has 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. Despite staff having had manual handling training they were seen to be putting themselves and the people who use the service 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 proprietor was required to have risk assessed this issue but this had yet to be carried out. Through discussion with the proprietor it was established that they had consulted builders and architects to find a resolution to this issue but had yet to act on the advice gained through these consultations. 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 office was poorly organised. The amount of paper and documents over one of the desk and overflowing rubbish bin undermined the homes fire risk assessment. A housekeeper is employed to undertake basic cleaning and the laundry. Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 21 One individual confirmed that the ‘laundry is very good with clothes always returned’. The inspector noted that the staff continually entered the kitchen without the use of aprons. The staff did not appear to be following any good food hygiene procedures. Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 22 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): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 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 means that people who use the service cannot be assured that they are in safe hands at all times. EVIDENCE: Discussion with the proprietor, designated manager, staff and residents demonstrated that there are sufficient staff on duty to meet the needs and dependency levels of the seven people who reside at the home. During the night time period there is one wakeful and one sleeping member of staff on duty. This will need to be reviewed if the dependency levels change. A housekeeper has been employed to undertake the laundry, general cleaning and the provision of the morning coffee/tea. The home has obtained the Skills for Care Induction programme but structured induction training was not evidenced at the inspection. Therefore the requirement to “ensure that the persons working at the home receive training appropriate to the work they are to perform including structured induction Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 23 training and the specialist needs of the residents” remains in place and will be further evaluated at the next inspection. Training is provided to staff using a distance-learning programme. The 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 the statutory training expected such training in health and safety, infection control and adult protection. The designated home manager informed the inspector that adult protection training was due to be given via a interactive IT package. Staff have not received training to meet the specialist needs of their residents for example diabetes and epilepsy, managing challenging behaviour or training in relation to the psychiatry of old age. An independent training provider had supplied the training and certification in relation to manual handling. Through discussion with the proprietor the inspector was not able to establish if an accredited trainer had delivered this training at the time of the visit, the proprietor agreed to seek further confirmation relating to the trainer’s accreditation following the inspection. New staff confirmed that they have undergone a thorough recruitment and selection process by way of a formal interview and statutory checks to establish their suitability to work in the home. The inspector sampled some of the staff recruitment files and found that in line with good practice prospective staff had been interviewed by two people and interview notes taken. It is therefore unfortunate that in many cases not all the references had been taken up thus undermining the aforementioned good practice. Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 24 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): 31,33,36,37,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The practices at the home do not consistently promote and protect the safety and welfare of the residents. The proprietor failed to respond to requests for information about the home as required by statute. The lack of a registered manager has impacted on the progress that is required to ensure the National Minimum Standards are established and maintained. Not all of the previous requirements have been met within the time scales agreed thus putting service users at risk of harm. Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 25 The continued lack of formal staff supervision fails to ensure that the home’s training programme and policies and procedures are implemented to order to protect the people who use the service. EVIDENCE: The proprietor purchased Clarondene 18 months ago. At the time they had no previous experience of working in a residential care setting and employed a designated person to manage the home on their behalf. Since the last inspection the proprietor has registered and commenced an NVQ level 4 in management and care, their intention is to take on the role of registered manager when they are suitably qualified and experienced. A requirement was set at the February 07 inspection requiring the proprietor to 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 by the 30/06/07. This was not achieved and further dialogue will take place to seek a resolution to this matter by way of an action plan which sets out when this requirement will be fulfilled. Problems identified between the proprietor and care staff team at the last inspection were not apparent at this one. The people who use the service informed the inspector that they considered the proprietor to be approachable and fair. A visiting relative further confirmed these representations. The staff who were spoken to also described the proprietor as consistent in their approach to them and the people who use the service. Through discussions with the proprietor it was established that no formal staff supervision has taken place. Records relating to staff have now been put into a lockable filling cabinet. The office is situated on the first floor and is also used for staff that occasionally provides ‘sleep in’ cover. The office was poorly organised with large amounts of documents one of the desks the waste bin was overflowing. This undermines the fire risk assessment that had recently been carried out. It was found that not all people who use the service have a recent photograph on file, it would be helpful if they did. 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, for example fire safety equipment had been checked on the 22/01/06 gas and electrical hard wiring certificates were also found to be valid. Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 26 A programme of staff training and fire drills was sampled which appeared to evidence that staff had received in house training in relation to fire safety. In both of the communal bathrooms the inspector observed cleaning materials in unlocked cupboards, these could pose a risk to the health of the people who use the service. Through discussion with the designated manager the inspector established that no staff member had re-established the COSHH (Control of substances hazardous to health) register since the previous owner left. During the inspection a number of residents were observed requiring assistance with their mobility but the home does not undertake any useful manual handling assessments. One assessment that was seen related to the risk of moving an object and not a person. 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. Following the inspection in February 2007 an action plan was sent to the regulator stating when and the requirements set at that inspection would be attended too. At this inspection it was found that insufficient progress had been made in a number of significant areas such as care planning, medication administration, risk assessment, staff training and staff supervision. At the time of the inspection the proprietor had a guest staying in one of the registered rooms on the ground floor. This individual was not vetted in line with statutory requirements of people staying or working in a registered care home. The proprietor acknowledged the inspector’s concerns with regards to this issue. Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 27 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 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x 2 2 3 3 2 3 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x x 1 1 1 Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 28 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 (2) Requirement The Registered Person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in the care home including: 1. must ensure that staff that administers medication have been suitable trained and hold the appropriate certificates relating to there competence Previous timescale of 30/06/07 not met. 2. Recording the rationale for administering Per required needs’ administration of medication. Previous timescale of 30/6/06 and 30/06/07 not met. 3. To ensure that all returned, disposed of or medication given to others such as paramedics is robustly accounted for. Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 29 Timescale for action 10/08/07 1. OP7 15(1)(2) 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 and sign the plan to evidence they agree with actions taken on their behalf. Previous timescale of 30/06/07 has not been met. 10/08/07 2. OP8 14(1)(a) 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. Previous timescale of 30/06/07 has not been met. 10/08/07 3. OP9 13 (2) The Registered Person shall 10/08/07 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in the care home including: -must ensure that staff that administers medication have been suitable trained and hold the appropriate certificates relating to there competence Previous timescale of 30/06/07 not met. Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 30 4. OP12 16(n) -Recording the rationale for administering Per required needs’ administration of medication. Previous timescale of 30/6/06 and 30/06/07 not met. -To ensure that all returned, disposed of or medication given to others such as paramedics is robustly accounted for. After consultation with residents the registered person must provide social activities to meet their individual needs. Previous timescale of 30/06/07 has not been met. 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 and 30/06/07 has not been met 01/09/07 5. OP18 13(6) 10/08/07 6. OP19 13(4)(a) (b)(c) 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 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. Previous timescale of 30/06/07 has not been met 10/08/07 7 OP29 19 schedule The home must be able to demonstrate that a thorough DS0000065695.V343498.R01.S.doc 01/08/07 Clarondene Residential Care Home Version 5.2 Page 31 2 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 and the 30/06/07 has not been met 8 OP30 18(c)(1) 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. Previous timescale of 30/06/07 has not been met An action plan must be submitted that illustrates when the registered provider will submit an application to CSCI for the registration of a manager who has the qualifications, skills and experience necessary for managing the care home. Previous timescale of 30/06/07 has not been met (revised wording of requirement) The registered person must establish and maintain a system for evaluating the quality of the services provided at the care home. Previous timescale of 30/06/07 has not been met The registered person must ensure that staff receive regular formal supervision. Previous timescale of 30/06/07 has not been met DS0000065695.V343498.R01.S.doc 31/08/07 9 OP31 8(a)9(2)( b)(i) 01/08/07 10 OP33 24 30/09/07 11. OP36 18(2) 21/07/07 Clarondene Residential Care Home Version 5.2 Page 32 12. OP38 13(4)(5) 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 that is certified by an assessor who themselves are certified to carryout the training Previous timescale of 30/06/07 has not been met The registered person must ensure that a photograph of each resident is kept in the home. Previous timescale of 30/06/07 has not been met The registered person must ensure that the office is maintained in such a way as to not cause a potential fire risk. 01/09/07 13. OP38 17(1)(a) schedule 3 01/08/07 14. OP38 23(4A) 20/07/07 15 OP18 13(6) 16 OP31 Not specified 17 OP38 13(4)(C) The responsible individual must 01/08/07 ensure that all people staying as guests of the proprietor and having unsupervised access to the registered care home are suitable vetted as fit to be in the close proximity as vulnerable adults. The responsible individual must 21/07/07 ensure that all statutory requests for information are complied with in a timely fashion. This is in relation to requests to have a completed AQAA returned. The responsible individual must 01/08/07 establish and maintain a COSHH register and ensure that all DS0000065695.V343498.R01.S.doc Version 5.2 Page 33 Clarondene Residential Care Home 18 OP38 16(J) substances identified on the register are kept in line with the COSHH legislation. The responsible individual must ensure that all staff comply with health and safety legislation with regards to the kitchen area in order to protect the people who use the service from infection and possible contamination of foodstuffs. 21/07/07 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. The registered person must be able to evidence the training that has been supplied to staff. The registered person must be able to evidence that the homes policy with regards to vulnerable adults reflects the local authorities protocols and practice. 2. OP19 3. OP30 4 OP18 Clarondene Residential Care Home DS0000065695.V343498.R01.S.doc Version 5.2 Page 34 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.V343498.R01.S.doc Version 5.2 Page 35 - 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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