Inspection on 15/02/07 for Claxton House

This inspection was carried out on 15th February 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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

CARE HOME ADULTS 18-65 Claxton House Church Lane Claxton Norwich Norfolk NR14 7HY Lead Inspector Linda Wells Unannounced Inspection 15th February 2007 14:30p Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 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 Claxton House DS0000067451.V330888.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 Adults 18-65. 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. Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Claxton House Address Church Lane Claxton Norwich Norfolk NR14 7HY 01508 480312 01508 480312 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) Atlanta Healthcare Ltd Mrs Robina Clarke Care Home 15 Category(ies) of Learning disability (9), Learning disability over registration, with number 65 years of age (6) of places Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: A maximum of fifteen (15) service users, of either sex, who have learning difficulties, may be accommodated. Of these fifteen (15) persons, six (6) may be over 65 years. The maximum number not to exceed 15. Date of last inspection 22/11/2005 Brief Description of the Service: Claxton House is a three storey Victorian house that has been modernised and still retains many of its original features. There is no assisted passage to any of the floors and the home provides accommodation and care for up to fifteen people with a learning disability. The accommodation is provided over the three floors in the form of one shared bedroom with washbasin and thirteen single bedrooms, eleven of which contain a washbasin and two have access to their own bathroom. Residents have communal use of five toilets, four bathrooms and three shower facilities, two lounges, one on the first floor and one on the ground floor, a conservatory and a dining room. Two of the single bedrooms are contained in a flat located on the third floor and are designed to enable two people to live a more independent life style. The house stands in extensive grounds and has a static, mobile classroom to the rear of the property that is used as a Day care/Activity centre for those living at the home. The grounds provide ample space for residents to walk in and there is a patio area with seating, tables, chairs and recreational equipment to the rear of the home. The home has a large, friendly dog and two cats and there is parking space available to the front and side of the main building. The home is located in the small village of Claxton, which is approximately six miles east of Norwich in a rural setting. The current fees for living at the home are from £388 - £708.93 per week. There is an additional fee for personal items such as toiletries, hairdresser, chiropodist, newspapers, dentist and outings. Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out, by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgments for each outcome group. Since the last key inspection the ownership and management of the home has changed. The new owner/manager has owned and run the home for the last six months and all of the requirements made at the last key inspection were complied with, prior to the sale of the home. What the service does well: What has improved since the last inspection? What they could do better: Residents said that they are satisfied with the care they receive and liked living at the home. All of the requirements from the last inspection have been Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 6 complied with, however, four requirements were made to further improve the experience of living and working at the home for residents and staff. • • • • All money received for residents and held at the home must be paid into their own bank account to ensure they benefit from any interest accrued. The receipt and administration of controlled drugs must be recorded in an official controlled drugs book to ensure a clear audit trail of the drugs given and remaining in stock. A record of the complaints received, the action taken and the outcome must be maintained to assist in the monitoring of complaints and issues of concern. All staff must hold current food hygiene certificates to ensure the health and safety of residents when they prepare, cook and serve the meals. 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. Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,3.4.5, (6 N/A) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The written information and admission procedure is good so that residents know that their needs can be met and are informed of and agree to the terms and conditions of living at the home. EVIDENCE: The assessed needs of residents were recorded in their plan of care prior to admission to the home and showed that the health, personal and social care needs of residents could be met. A revised service user guide and statement of purpose had been produced that contained the aims and objectives of the home, details of the new owner/manager, staffing structure and training, routine of the home, facilities and complaints procedure. A copy was available for residents in their bedrooms. Residents had signed a new, terms and conditions contract that contained relevant information on the new owner/manager and details of the services provided, accommodation, facilities, the fees and the complaints procedure. Residents could not remember the content of the contract but said that the manager and their key worker had discussed it with them to ensure they understood it and were happy to sign it. Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 9 No new residents had been admitted to the home and staff gave good examples of how they ensured that the needs of residents were met and showed that they knew how to involve family members and assist a resident to settle at the home. Records were held to support this. Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are consulted and the information held in the individual plans of care ensures that their personal and health care needs are identified and met. EVIDENCE: Case tracking confirmed that improvements had been made to the plans of care and that they were good, contained health and social care information and assessments and were complete and up to date. Risk assessments had been carried out on service users, daily records were now stored correctly and all residents had a family member or an advocate to represent and/or support them. Key workers were assigned to each resident, who carried out monthly reviews and recorded the views of residents on their plan of care and level of satisfaction on the care and support they received. Staff members showed Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 11 that they were knowledgeable on the care needs and preferences of each resident and this was recorded in the records held. Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities and meals are both well planned, creative and provide daily variation and interest for the people living in the home. EVIDENCE: Case tracking confirmed good practice. Residents take part in educational and leisure activities appropriate to their individual needs and interests. They attend local training centres, work placements and day care at the home during the week and a community club on a Wednesday evening. Residents said that they liked to go out at the weekend to the shops or beach and they were looking forward to going on holiday with staff in the summer. Staff spoken to gave examples of taking residents shopping, for a walk and to local community attractions and of residents doing activities in the home such Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 13 as art and craft, cooking and being in the garden. They said that residents were encouraged to live a full and varied life that included their interests, goals, choice and promotion of their life skills. This was seen recorded in the records held. Throughout the visit residents were occupying themselves by walking around the home, watching television in the lounge or listening to music in their bedroom. Residents said that they could do as they liked during the evening and at weekends and that the routine of the home was flexible. Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Personal support is given to residents in the way they prefer, their needs are met, they are consulted, however, medication records for a controlled drug were not recorded in the correct place. EVIDENCE: Residents were offered personal, physical and emotional support in the manner they preferred. Records were complete and up to date and showed that advice and guidance was taken from other professionals such as dietician, GP and LD Nurse to ensure the needs of service users are met. Residents said that staff treated them well, kindly and with patience. Observation of staff assisting other residents confirmed this approach and showed that staff worked at the pace of each person and used a friendly and calm manner. Many of the residents were suffering from the effects of a flu virus/chest infection and staff and the manager were observed to give care, attention and reassurance to residents and to make sure that they were warm enough and had drinks, tissues and a waste bin within their reach in an Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 15 appropriate manner that promoted choice and dignity. Records confirmed that the GP had visited residents, their plan of care had changed to suit their health needs and their, well-being, was monitored. Resulting in residents being well care for and their needs met. Medication was stored individually and appropriately in a locked cupboard in the office and the monitored dosage system used was supplied by the local pharmacy. Records showed that all medication had been checked, recorded and returned correctly and that the administration records were accurate and complete. However, one resident was prescribed a controlled drug and the record of the initial amount of the drug received, date, dosage and administration records were recorded on the MAR sheet of the resident and not in a controlled drugs book. Two staff members had signed the MAR sheet to verify that the drug had been administered but there was no record of the exact tablets remaining in stock. An audit check confirmed that all tablets were accounted for and the correct number stored but resulted in incomplete medication records. A requirement was made. Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have their rights promoted and are protected by the care practice, policies and procedures carried out by staff members. However, a record of all complaints received and resolved had not been produced and not all money held for all residents is stored correctly. EVIDENCE: Case tracking confirmed that no complaints had been received since the last inspection and since the new owner/manager took over the home. Records and monthly reviews showed that staff and key workers dealt with concerns and problems as they occurred and that residents were listened to and treated with respect. Residents said that the staff and the manager constantly checked with them that everything was ok and took action to resolve things when a problem arose. No one was able to give an example of anything they had complained about and all said that they trusted the staff with their confidential information. This means that residents are protected. Staff members had completed training in protecting vulnerable adults from abuse and demonstrated that they understood the process of protecting residents and reporting any incidents of potential or actual abuse. However, a Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 17 list of complaints, the details and how they were resolved had not been produced to enable the monitoring of the complaints received. A requirement was made. Residents were supported to manage their money with help from their family, advocate or the home. Staff members regularly took residents to their own bank or post office to withdraw their own money and up to date, complete, accurate and individual records were seen that recorded all debits, credits and money held for safekeeping. Four residents had Social Services as their advocate who paid their personal allowance money to the home. This money was stored together in one account under the business name of the home and although records were held that identified how much money each resident had and spent they did not have their own individual account. Resulting in the residents not benefiting from any possible interest on the money held for them. The manager said that she would change the arrangement to individual accounts. A further requirement was made. Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home is mainly good and provides residents with a comfortable and safe place to live. EVIDENCE: Residents, benefit from a home that is clean, tidy and odour free and decorated and furnished to a reasonable standard. Improvements had been made to the home and all radiators were guarded and the exposed pipes covered. Residents have the use of generous communal space and were seen to have personalised their bedrooms to reflect their personal choice and style. Two residents share a self-contained flat in the home and are able to live semiindependent lives. They had benefited from the re-grouting of the tiles in the shower room of the flat and were able to cook their own meals. There are adequate toilets, showers and bathing facilities in the home that are adapted, meet the needs of residents and offer privacy. Specialist equipment Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 19 had been provided in the form of a hoist and bath and toilet seats to ensure the needs of residents, is met. Residents said that the home was comfortable and that they were encouraged and assisted by staff to clean their own bedrooms and do their own laundry. The laundry room contained a service washing machine and tumble dryer, adequate protective clothing was provided around the home and infection control measures were in place, resulting in the health and safety of residents being protected. Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The needs of residents are met, recruitment procedures are robust and staff training good, however not all staff had a food hygiene certificate. EVIDENCE: Case tracking confirmed good practice and that an adequate number of staff are on duty to care for the numbers of residents living at the home. Some staff changes have occurred and the manager said that she had recruited two new members of staff. Complete and thorough recruitment checks had been completed on the staff members employed, current CRB checks were held for all except one new member of staff for which a POVA first check was held and the CRB applied for and it’s return awaited. This means that residents are protected, as far as possible, from unsuitable staff being employed. All staff had completed an induction and basic training and six staff had completed and four are currently doing NVQ2. Resulting in 50 of staff Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 21 trained to NVQ2 level. A list of the training each staff member had completed was now held in their individual file and showed that all staff had updated basic training and completed training in moving and handling, protection of vulnerable adults from abuse, challenging behaviour and administration of medication but not all staff held a current food hygiene certificate and food preparation was part of their duties, resulting in staff members being competent but not fully trained to meet the needs of residents. A requirement was made. Residents said that staff were friendly, assisted them with making appointments at the doctors and that they liked their key worker. Staff members and the owner/manager were observed talking, joking and interacting with residents in a friendly and helpful way that included all residents. Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42,43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of residents and their rights are safeguarded by the policies and procedures and record keeping held. EVIDENCE: Case tracking confirmed good practice and that the home is owned, managed and run by an experienced manager who has extensive past experience of owning and running residential care homes. She is a trained nurse with qualifications in management systems and in the six months that she has owned and managed the home she has demonstrated that she has the skills to provide an effective and open style of management. She has adapted the policies and procedures from the previous owner to suit her aims and Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 23 objectives and has produced her own terms and conditions contracts, statement of purpose and service user guide. Residents said that staff members and the new owner/manager were well organised, supportive and approachable and that the deputy manager supported the manager in providing leadership to staff and a good service that met their needs. They gave examples of the manager talking to them about changes in the home that affected them and said they felt included in decisionmaking. Staff members said that they had settled quickly into working with the new owner/manager and that although some staff changes had occurred the staff team worked well together and that they were guided and supported to provide a good standard care through discussions and instructions at handover, supervision and appraisal. They said that the manager was clear on her instructions, dealt with problems as they occurred and encouraged them to have the best interest of the residents at heart. This was seen in the records held. Servicing records held were complete and up to date and protected the health and safety of residents and staff. Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 3 3 3 3 3 3 Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 25 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 17(3) Requirement The registered person must ensure that a controlled drugs book is used and complete records held. The registered person must ensure that a record is maintained of all the complaints received by the home. The registered person must ensure that all service users have their money paid into their own bank account. The registered person must ensure that all staff members hold current food hygiene certificates. Timescale for action 30/06/07 2. YA22 22(8) 31/07/07 3. YA23 17(2) 31/07/07 4. YA32 18(1) 01/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Claxton House DS0000067451.V330888.R01.S.doc Version 5.2 Page 27 - 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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