Inspection on 30/08/05 for Clere House

This inspection was carried out on 30th August 2005.

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

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

Other inspections for this house

Clere House 24/02/09

Clere House 20/10/06

Clere House 19/01/06

Clere House 01/03/05

Clere House 09/09/04

Clere House 02/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Clere House Pippin Close Ormesby St Margaret Great Yarmouth NR29 3RW Lead Inspector Linda Wells Announced 30 August 2005 at 09:30 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Clere House I55 s35320 Clere House v239717 AN 300805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Clere House Address Pippin Close, Ormesby St Margaret, Great Yarmouth, Norfolk. NR29 3RW. 01493 731291 01493 733180 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Norfolk County Council - Community Care Mrs Carole Patricia Nisbett Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Clere House I55 s35320 Clere House v239717 AN 300805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Old age, not falling within any other category (OP) 20 Old age, with dementia (DE) 02 (E) Date of last inspection 1st March 2005 Brief Description of the Service: Clere House is a single storey, residential care home providing care and accommodation to up to 22 older people and is owned and run by Norfolk County Council. All bedrooms are single rooms and contain a washbasin and there is communial use of an adapted, walk-in shower room, a bathroom, eight toilets, two lounges, a large lounge area that is divided into two areas and a dining room. There is a small, well kept garden with seating in a patio area to the front and the rear of the property and road side parking. The home is situated in a residential area, within the rural village of Ormesby St Margaret. Local amenities include shops, a medical centre, post office and pubs. There is a bus service to both Great Yarmouth and Norwich. Clere House I55 s35320 Clere House v239717 AN 300805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection undertaken on the 3Oth August 2005 over five hours and was carried out as part of a routine inspection plan. Gillian Warren, Regulation Manager, was present for part of the inspection undertaking an appraisal of the inspector. Prior to the inspection ten comment cards were received from relative/visitors and one from a visiting professional. Six of those who returned the comment cards said that the home was friendly, always clean, staff members were caring and residents were well cared for. Three people indicated that there was not always enough staff on duty and the remaining two indicated that they were satisfied with the overall care provided. On the day of inspection twenty residents were living at the home, one resident was staying for respite care and an additional four people were visiting the home for day care. Residents were seen to be having a meal, sitting in the lounges, their bedroom or the garden listening to the radio, reading or watching television and visiting the hairdresser who was working in the home. The inspection took the form of a tour of the premises, individual discussion with four residents, four staff members, the hairdresser and the manager, group discussion with four residents and two visitors, examination of care plans, records, certificates and compliance of requirements and recommendations from the last inspection. What the service does well: The home has a friendly, relaxed atmosphere and the residents spoken to said that they liked living at the home, they were well cared for, staff treated them with respect and assisted them with all necessary tasks in a kind and considerate manner. Two residents said that the home was “better than Buckingham Palace”, one said “I have nothing but utmost praise for the staff, who will do anything for you” and they all said that the routine of the home could be flexible and that the home was always clean and tidy. Residents and day care visitors said that they were happy living and visiting the home, felt included and safe and staff members said that the senior care team gave them support. Staff members were well trained, enthusiastic and said that they put the needs of residents first. This was demonstrated in the records held and the comments received from residents and visitors. The staff members spoken to said that Clere House I55 s35320 Clere House v239717 AN 300805 Stage 4.doc Version 1.40 Page 6 they liked working at the home and that they were encouraged to promote resident choice and independence. What has improved since the last inspection? What they could do better: The following eight requirements and four recommendations were made to further improve the experience of living and working at the home for residents and staff. • • • • • • • • • • • Adequate staffing levels must be in place to ensure that all residents are safe and receive the necessary care and attention when they need it. Under review. Repeated requirement. Adequate management hours must be provided at the home to ensure the manager can fulfil her duties. Under review. Repeated requirement. Residents must be assisted to complete comment cards and questionnaires to show that they are consulted and their views recorded. A lock must be put on the sluice door to protect residents. The sluice room must be kept clean from any spillages to ensure residents are protected and infection control measures are in place. An additional bathroom must be provided to ensure adequate bathing facilities in the home. It would be good practice for the funeral arrangements of each resident to be recorded in their plan of care to ensure that their wishes are known, at death. The home must produce and commence a program of redecoration giving priority to those areas where walls are cracked and chipped. The exposed pipes in bedrooms must be boxed in to ensure the safety of residents and to make the rooms more attractive. To ensure that residents are fully stimulated it is recommended that a review of the activities provided daily in the home is undertaken. It is recommended that a review of the menus be undertaken to ensure that residents are given choice, their preferences considered and the menus varied (menus are currently under review jointly with NCS and social services). It is recommended that any bedroom carpets in the home that are stained or have a slight odour are deep cleaned to make the areas more pleasant for residents, visitors and staff. • Clere House I55 s35320 Clere House v239717 AN 300805 Stage 4.doc Version 1.40 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. Clere House I55 s35320 Clere House v239717 AN 300805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Clere House I55 s35320 Clere House v239717 AN 300805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 4, 5, 6 The admission procedure and written information available is good and fully enables residents and staff to make a decision on whether the home will meet the needs of anyone wishing to live, stay or visit there. EVIDENCE: The homes Statement of Purpose, Service User Guide and Terms and Conditions contract were seen and found to contain relevant information. The manager said that prior to admission as much information as possible was collected from a prospective resident, their family and other professionals. She said residents, their family or friends sometimes visited the home, that she or one of the care co-ordinators often visited residents in their own home and that residents were admitted on a one-month trial basis. A resident visiting the home for the day said that he regularly stayed at the home for a short break and that he had stayed at many other homes for short term care over the years but that “this was the best because staff treat everyone so well, helped him to settle and kept him informed of any changes to his care or home situation”. Clere House I55 s35320 Clere House v239717 AN 300805 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 9, 11 The health, social and personal care needs of residents were met, they were well cared for but not all records were completed. EVIDENCE: Residents said they were well looked after and four individual plans of care were examined and found to contain relevant health, social and personal care information, photograph, data protection agreement, care needs, weight records, reviews, daily records, risk assessments, choices, past history, list of falls, visiting professionals and the signature of the resident. However, they did not contain the wishes of each resident upon death and a recommendation was made that the wishes of residents at death be recorded in their plan of care to demonstrate involvement, consultation and agreement of each resident on their funeral arrangements. Medication policies and procedures were seen, a member of staff was observed safely administering medication and the records held demonstrated that medication was administered, recorded and stored correctly. Clere House I55 s35320 Clere House v239717 AN 300805 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15 There are some social and creative activities and a choice of meals is available but they do not fully meet the interests and preferences of the residents. EVIDENCE: Residents said that they were not fully stimulated by the activities provided daily in the home. Records were seen to demonstrate that some activities were provided such as musical entertainment once a month, local groups visiting the home on special occasions and outings. The manager said the daily activities were regularly reviewed with residents, that if staff had to go to the local shop or chemist they always took a resident with them, that occasionally bingo was played and that a retired member of staff visited the home weekly to organise games or a quiz. Staff spoken to said that they very rarely had the time to sit and talk to residents or organise an activity due to the workload and the high dependency care needs of the more frail residents. This will be dealt with in detail in standard 27. A recommendation was made that an additional review of the daily activities provided is undertaken with residents to ensure residents are offered a program of activities that is varied and meets their interests. The main meal and menus were seen and were balanced and varied. Records showed that residents were given a choice and an alternative offered. The manager said that the menus are currently under review jointly with NCS and social services and that individual preferences are always considered and acted Clere House I55 s35320 Clere House v239717 AN 300805 Stage 4.doc Version 1.40 Page 12 upon. However, everyone spoken to said that the menus were limited and repetitive and a recommendation was made that a review of the meal option is carried out with the residents. Clere House I55 s35320 Clere House v239717 AN 300805 Stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 The home has an active procedure on the protection of vulnerable adults that protects residents and supports the investigation of any cause for concern. EVIDENCE: One complaint had been received by the home and records demonstrated that the complaint was investigated and the appropriate action taken. The residents spoken to all agreed that if they had reason to complain they would speak to staff or the manager and all felt confident that the problem would be resolved quickly and to the satisfaction of all involved. Residents are protected from abuse, neglect and self-harm by the objectives, policies and procedures of the home and records showed that staff have undertaken training in Adult Abuse to help them recognise, prevent and deal with any potential abuse. Clere House I55 s35320 Clere House v239717 AN 300805 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 22, 23, 24, 26 The standard of the environment within this home is mainly satisfactory but does not fully provide residents with an attractive, safe and homely place to live. EVIDENCE: A tour of the building revealed that residents live in a home that is decorated and furnished to a reasonable standard in most areas but is in need of redecoration in some areas where walls are cracked, chipped and the decoration worn and/or tired looking. In two bedrooms, exposed pipes were seen and required covering and there was a need for a lock to be fitted on the sluice door to protect residents. As a result three requirements were made. The home had recently had one bathroom refurbished and adapted into a walk-in shower with tracking hoist and whilst it meets the preferences and specialist needs of some residents and makes life easier for the hairdresser it was not in use at the time of the inspection, and it has resulted in the home having the use of only one bath. The Homecare service use the bath facility three days a week to bath those residents visiting the home for day care. Staff Clere House I55 s35320 Clere House v239717 AN 300805 Stage 4.doc Version 1.40 Page 15 spoken to said that residents mainly preferred to have a bath and that problems have arisen where residents have not been able to have a bath when they wish. A requirement has been made that an additional bathroom must be provided to ensure adequate bathing facilities in the home. Residents said that they benefited from a home that was comfortable, clean and tidy and this was found in most areas during the tour of the building. The carpets in two bedrooms were found to contain a slight odour and to be stained and a recommendation was made that they be cleaned. Residents were seen to have personalised their bedrooms and each wing of the home had adequate toilets that were adapted to suit the needs of the residents. Infection control measures were not fully in place and a requirement was made that the sluice room be kept clean from any spillages to prevent cross infection and to protect residents. The manager said that the spillage seen was porridge from an apron and agreed that it should not have been left. Clere House I55 s35320 Clere House v239717 AN 300805 Stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 The needs of residents are not fully met, staff members are competent and the procedure for the recruitment and training of staff provides safeguards to offer protection for the people living at and visiting the home. EVIDENCE: Residents said that they were well cared for but that staff members were very busy caring for frail residents and they had to sometimes wait longer than usual for assistance. Staff spoken to said that they were under pressure most of the time to complete all tasks and that nearly three quarters of the residents required two carers to assist them constantly which resulted in other residents not receiving as much attention as they would like to give. The manager said that a review of the current hours available to the home was taking place and a requirement was repeated and will be met once adequate staffing levels are in place to meet the needs of all residents. The four staff members spoken to said that they were supported by the senior care staff and the manager, handover, staff meetings and supervision and demonstrated that they were aware of their role and responsibilities. Records showed that residents were protected by the staff recruitment checks that had been carried out. CRB checks, references, personal details, proof of identity and a photograph of each staff member were seen to be held in the file of each staff member. Records demonstrated that staff members had a mix of experience and skills and those spoken to had all completed NVQ2 and one staff member was Clere House I55 s35320 Clere House v239717 AN 300805 Stage 4.doc Version 1.40 Page 17 waiting to commence NVQ3 training. Certificates showed that an induction, foundation and updated training programs were undertaken by all staff to enable them to gain the knowledge necessary for the range of needs of residents living at the home. Once the 50 target is reach this standard will be met. Clere House I55 s35320 Clere House v239717 AN 300805 Stage 4.doc Version 1.40 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 37, 38 The manager is supported by the senior staff in providing leadership, guidance and direction to staff to ensure that residents receive a good standard of care. EVIDENCE: The manager has been in post for five years, has twenty-two years experience of working in the care setting and has completed the NVQ4 Registered Managers award. As part of her duties she has to work three shifts a week as a care co-ordinator and undertake moving and handling training for the district. This has resulted in her sometimes struggling to complete all management tasks within her half post and although an administrator is in post for fifteen hours a week a repeated requirement is made that adequate management time be provided. The manager said that her management hours were under review. Prior to the inspection those connected with the home were given the opportunity, by CSCI, to comment on the home and care provided. Whilst Clere House I55 s35320 Clere House v239717 AN 300805 Stage 4.doc Version 1.40 Page 19 replies were received by relatives/visitors and a GP none were received from residents. The manager said that she had displayed service user comment cards on the notice board but residents said that they had not been asked if they wished to complete them by their key-worker or asked if they wished to comment. Therefore a requirement was made that residents must be offered the opportunity to complete comment cards and questionnaires to show that they are consulted and their views recorded. The inspector is of the view that the pressure of staff workload may have contributed to residents not being offered assistance if required. (See standard 27) The manager agreed to offer residents the chance to complete a comment card and to send any that are completed to CSCI. The commission is pleased to say that this requirement was immediately fulfilled. Residents said that the home was well run and records demonstrated that residents are protected by the management and administration procedures carried out in the home. Policies and procedures have been produced and were seen on all aspects of the home and service provided. The records held were found to promote and protect the rights and best interests of each service user. The handover, staff meeting minutes and supervision records demonstrated that staff members worked as a team and were supported and regularly supervised by the senior staff to ensure that their knowledge of the needs of each resident, their work practice, commitment and training needs were identified, clarified and reviewed. The records seen showed that incidents of poor practise were identified, discussed with the staff member and monitored to ensure that a good standard of care was provided to residents. The servicing and testing of all equipment had been carried out and relevant and timely certificates were held to ensure that the health and safety of residents is protected. Clere House I55 s35320 Clere House v239717 AN 300805 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 x 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 2 x 2 3 3 3 x 2 STAFFING Standard No Score 27 2 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 2 x 2 3 2 3 x x 3 3 Clere House I55 s35320 Clere House v239717 AN 300805 Stage 4.doc Version 1.40 Page 21 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. OP19 23.2 The registered person must ensure that a program of redecoration is provided and commenced. The registered person must ensure that all exposed pipes are boxed in. The registered person must ensure that a lock is fitted to the sluice door. The registered person must ensure that the home has adequate bathing facilities. The registered person must ensure that infection control measures are in place and carried out. The registered person must ensure that adequate staffing levels are provided in the home. REPEATED. The registered person must ensure that adequate management hours are provided in the home. REPEATED The registered person must ensure that service users are consulted and offered the opportunity to comment on the quality of care provided. 31st December 2005 30th November 2005 31st October 2005 31st December 2005 1st November 2005 and ongoing. 31st December 2005 and ongoing 31st December 2005 31st December 2005 Standard Regulation Requirement Timescale for action 3. 4. 5. 6. OP19 OP21 OP21 OP26 13.4 13.4 16.1 13.3 7. OP27 18.1.a 8. OP31 18.1.a 9. OP33 24.3 Clere House I55 s35320 Clere House v239717 AN 300805 Stage 4.doc Version 1.40 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP12 OP15 OP26 Good Practice Recommendations It is recommended that a review of the activities provided daily in the home is undertaken with service users to ensure that residents are fully stimulated. It is recommended that a review of the meal options is undertaken with the service users to ensure their preferences are considered and the menus varied. It is recommended that the bedroom carpets in the home that are stained or have a slight odour are deep cleaned to make the areas more pleasant for residents, visitors and staff. It is recommended that the wishes of service users at death is known and recorded. 4. OP11 Clere House I55 s35320 Clere House v239717 AN 300805 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 3rd Floor Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Clere House I55 s35320 Clere House v239717 AN 300805 Stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!