Inspection on 04/06/07 for Clore Manor

This inspection was carried out on 4th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Clore Manor 24/07/06

Clore Manor 24/01/06

Clore Manor 14/04/05

Clore Manor 12/10/04

Clore Manor 18/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Clore Manor 160-162 Great North Way Hendon London NW4 1EH Lead Inspector Mr David Hastings Unannounced Key Inspection 10:30 4 and 5th June 2007 th 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 Clore Manor DS0000010423.V333446.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. Clore Manor DS0000010423.V333446.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clore Manor Address 160-162 Great North Way Hendon London NW4 1EH 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) 020 8203 1511 020 8202 6426 Jewish Care ** Post Vacant *** Care Home 72 Category(ies) of Dementia - over 65 years of age (72), Old age, registration, with number not falling within any other category (72) of places Clore Manor DS0000010423.V333446.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th July 2006 Brief Description of the Service: Clore Manor is registered to provide care for seventy-two elderly people some of whom have problems associated with dementia. The home is operated by Jewish Care and therefore observes a lifestyle promoting Jewish beliefs and culture. The home is located off the busy Great North Way in Hendon, on the edge of a residential area. It is a short drive to local shops and businesses and Brent Cross shopping centre. The stated purpose of care practice is to provide a homely, relaxed and safe environment for the residents, with an emphasis on individual differences. The aim is to treat residents with dignity and respect, where they can live as individuals leading as full and active lives as their physical and emotional condition will allow. The main building is on three floors. The two extensions that have been added over the years are on two levels at each end of the original building. The home has been effectively divided into three units. One of these, accommodating fourteen service users is designated as a dementia care unit. All service users bedrooms have en suite facilities, with a toilet and bath or shower. Each of the three units has communal sitting and dining space. There is a lift to assist people with mobility problems to gain access to the upper floors. The current scale of charges range from £678 to £725 per week. A copy of this report is available on the CSCI website or/and from the home. Clore Manor DS0000010423.V333446.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on 4th and the 5th June 2007 and lasted nine and a half hours in total. The manager of the home has recently resigned and I was assisted throughout the inspection by the two deputy managers who were extremely open and helpful. I spoke with seven staff and thirteen residents of the home. I inspected the building and examined various care records as well as a number of policies and procedures. The residents I spoke with said they were very happy with the care and support they received. One resident told me, “I think the staff are wonderful, they have patience with the people they look after”. What the service does well: What has improved since the last inspection? What they could do better: Five requirements and two recommendations have been issued as a result of this inspection. People with dementia should have their medication reviewed to Clore Manor DS0000010423.V333446.R01.S.doc Version 5.2 Page 6 see if it is having an impact on them sleeping during the day. Residents’ recreational and occupational interests must be recorded on their care plan so that staff know how to keep people suitably engaged. The receipt of medication received by the home must be accurately recorded. The dependency levels of residents at the home must be reviewed and staffing levels adjusted so that the staff can meet the needs of everyone at the home. The dependency levels of potential residents to the home should also be monitored so that staff can be sure they can meet their needs. All staff must attend adult protection training to ensure the safety of vulnerable residents at the home. A new manager must be recruited who has the capabilities and leadership qualities needed to run this busy home. 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. Clore Manor DS0000010423.V333446.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Clore Manor DS0000010423.V333446.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (6 not applicable) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All prospective residents have a full assessment of their needs carried out before they move into the home. EVIDENCE: I examined three assessments for people who had recently moved in to the home. Two assessments were from Jewish Care social workers and one was from a local authority social worker. All these assessments were satisfactory and clearly identified the needs of the individual. The manager of the home had also assessed the potential residents and had identified whether the home would be able to meet the person’s needs. These assessments carried out by the manager were in the form of a dependency assessment. The home is registered for 72 residents who may have dementia. The home is very popular and the number of residents being admitted with more advanced dementia is increasing. A number of residents I spoke with were concerned that this was putting pressure on the staff team. The deputy manager explained that “guest Clore Manor DS0000010423.V333446.R01.S.doc Version 5.2 Page 9 days” were vital to ensure that the home did not admit people whose needs they would not be able to meet due to their advanced dementia and possible related challenging behaviour. It is very important that the home strikes a balance between the levels of dependency of residents to ensure that people who use the service continue to receive a good standard of care. A recommendation has been issued in relation to this matter. Clore Manor DS0000010423.V333446.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans clearly set out residents’ health and personal care needs so that staff know how best to support everyone at the home. Some care plans need to have more detail in relation to people’s social and occupational needs. Residents have good access to health care professionals and they are treated with respect. Residents get the medication they require, at the right times and by appropriately trained staff. EVIDENCE: Seven care plans were examined from all three units in the home. These plans clearly set out the health and personal needs of the individual. Care plans were being reviewed on a regular basis. Some plans detailed the social and occupational needs of residents and how staff are to meet these needs. However not all plans identified these needs and a requirement has been issued relating to this matter. It is very important that residents, particularly those with dementia are able to remain occupied and engaged. I saw a large Clore Manor DS0000010423.V333446.R01.S.doc Version 5.2 Page 11 number of people in the dementia unit asleep during my visit. Information regarding people’s interests and recreational needs must be recorded so staff have a plan in place to meet these needs. There was evidence from care plans that residents have good access to doctors and other health care professionals. The doctor visits the home every week. Residents confirmed that they had good access to chiropodists, opticians and dentists. Care plans clearly detailed doctors’ visits and the outcomes of these visits. Care plans contained risk assessments covering risks associated with dementia such as walking out of the home and how these risks were to be minimised. A recommendation was issued at the last inspection that an over view of residents needs produced so that staff have a summary of how the resident would like their care to be delivered and highlight the important issues for each person. The deputy manager told me that this was being addressed and I saw a number of examples of these summaries. Records were examined in relation to the receipt, administration and disposal of medication at the home. In some cases medication was not always being signed for when it was received. A requirement has been issued that all medication coming into the home must be signed for in order that a clear audit trail can be maintained and staff are aware when medication is running out. Other records seen in relation to medication were satisfactory. As a number of residents were asleep in the dementia unit a recommendation has been issued that their medication is reviewed in order to assess whether this is having an impact on residents sleeping too much during the day. A recommendation was made at the last inspection that possible indicators of pain are recorded on individual’s files or within medication records. I saw a number of these pain indicators on the medication charts. This is very good practice and should help staff to know when to administer PRN pain control for people with cognitive impairment. Records seen indicated that staff have attended the required medication training. Throughout the inspection I saw examples of staff treating people with respect and upholding residents’ privacy. For example staff were seen to be knocking on people’s doors before going in. People I spoke with confirmed that they were treated with dignity and staff upheld their need for privacy. Staff I interviewed were able to give practice examples of when they have upheld peoples’ privacy. Clore Manor DS0000010423.V333446.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a very good range of activities arranged for the home. Visitors are encouraged and made welcome by staff and residents are able to exercise choice and control over their lives at the home. Residents receive a wholesome, appealing and balanced diet. Mealtimes are sociable and stimulating. EVIDENCE: The activities programme for the week was posted at the entrance to the unit as well as in all people’ rooms, and included varied activities that would appeal to a wide range of interests. Activities available during the week included sessions on arts and crafts, Jewish culture, aromatherapy, bingo, discussion groups, visits from PAT dog owners, manicures, card games and tea parties. Residents were very positive about the activities available to them and during the day of the inspection there was a quiz and bingo session. As previously mentioned more information in terms of occupation and engagement of people with dementia is needed so that everyone at the home is suitably occupied. I was pleased that the deputy managers understood the importance of staff Clore Manor DS0000010423.V333446.R01.S.doc Version 5.2 Page 13 sitting and chatting with residents. This ensures that relationships between staff and residents are allowed to develop. The visitors’ book indicated that residents were able to have visitors at any reasonable time. Residents I spoke with confirmed that visitors to the home were encouraged and I saw a number of visitors during the days of the inspection. People I spoke with confirmed that they were able to exercise choice and control over their lives as far as possible. Staff were able to describe how they enabled residents to exercise choice and residents told me they had regular residents’ meetings were they could talk about menus, care provision and other issues. Staff were observed sitting with residents during lunch and offering discreet assistance when needed. Lunch was relaxed, sociable and unhurried. All residents that I spoke with said the food at the home was very good. One resident commented that the chef was, “A charming man, he really puts himself out to please you”. The chef was aware of people’s likes and dislikes as well as any special diets that residents needed. I saw the chef coming around after lunch asking residents how they enjoyed their meals. Clore Manor DS0000010423.V333446.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their relatives and friends are able to make complaints and these complaints are taken seriously and dealt with in an open and nondefensive manner by the home. Residents are protected from abuse by clear policies and procedures however all staff must receive training in adult protection so they are able to recognise the many forms that abuse can take in a residential home. EVIDENCE: All residents spoken to said they had no complaints but knew how to complain if they needed to. The records of complaints were examined. Evidence from letters to complainants indicated that the home has dealt with these complaints in a timely and open manner and according to policies and procedures. The home has a satisfactory policy and procedure in relation to adult protection. Most of the staff I spoke to were able to describe to me how vulnerable people could be at risk of abuse in a residential care setting. All staff were clear of their responsibility to report any suspicions of abuse to the appropriate authorities. Records seen indicated that not all staff have attended training in adult protection. It is important that all staff are aware of the many forms adult abuse can present in a residential setting and a requirement has been issued that all staff must attend adult protection training. Residents that I spoke with said they felt safe at the home. Clore Manor DS0000010423.V333446.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Despite its size, Clore Manor has a homely atmosphere and is clean, safe, wellmaintained and generally decorated to a high standard. EVIDENCE: A tour of the premises indicated that the building is in a satisfactory state of repair and door alarms indicate when confused residents may walk out of the building. This is particularly relevant as the home is situated next to a very busy main road. The deputy manager told me that money is available in this years’ budget to improve the décor of the dementia unit and some of the rooms. The ground floor of the home has been refurbished and is decorated to a high standard. The garden areas are well maintained and I saw a number of residents enjoying the outside spaces. Clore Manor DS0000010423.V333446.R01.S.doc Version 5.2 Page 16 Residents told me that the standard of cleanliness at the home was excellent. Continence management systems are in place and the home was free from offensive odours. The home has policies on infection control and latex gloves and protective aprons were seen to be available. Laundry and clinical waste were kept separate from the kitchen and food storage areas. The laundry is adequately equipped and staff interviewed were aware of infection control procedures. Clore Manor DS0000010423.V333446.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All the staff at the home work very hard to meet the needs of residents and are provided with good training opportunities to further enhance their knowledge and skills. Recruitment practices are sufficiently detailed in order to fully protect residents at the home. EVIDENCE: Staff were observed interacting and supporting residents in a friendly and professional manner. All the residents I spoke to during the inspection were very positive regarding the management and staff at the home. One person commented that she was very happy at the home and that staff were very good. She added that the night staff were also very helpful. On the day of the unannounced inspection staffing levels matched those recorded on the staffing rota. As previously mentioned a number of residents were concerned that staff were very busy at the home due to the increased dependency of some residents. It is very important that staff have enough time to meet the needs of every one at the home. A requirement has been issued that the dependency levels of all residents are reviewed and staffing levels adjusted accordingly. This should ensure that staff are not overstretched and have enough time for all the residents. Clore Manor DS0000010423.V333446.R01.S.doc Version 5.2 Page 18 A number of files for newly appointed staff were examined. These contained the required documentation including two references, proof of identity and a CRB discloser (or POVA first). Staffing files indicated that staff had completed most of the required mandatory training with the exception of adult protection. Staff interviewed were positive about the training opportunities provided by Jewish Care. One staff member said the recent dementia training had been “very helpful” and she was able to describe to me how this training has improved her understanding and care provision to people with dementia. The training plan developed by the manager gives a clear overview of staff training needs. NVQ level 2 training is ongoing and I saw a NVQ training session with staff during the inspection. Clore Manor DS0000010423.V333446.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A permanent, full time manager is needed to run the home. Residents and their representatives have a say in how the home is run. Residents’ financial interests are safeguarded by clear policies and procedures. The home has good policies and procedures to monitor health and safety compliance. EVIDENCE: The current manager of the home has recently resigned. The deputy director of Jewish Care met with me during the inspection and assured me that the recruitment of a new manager was a top priority. Clore Manor has had a number of managers over the past few years and it is vital that a person is recruited who has the capabilities and leadership qualities needed to run this Clore Manor DS0000010423.V333446.R01.S.doc Version 5.2 Page 20 busy home. A requirement relating to the appointment of a suitably qualified manager has been issued in the relevant section of this report. The home has a number of quality monitoring systems including regular staff, residents and relatives meetings and monthly visits to the home by the provider. The organisation also operates a quality assurance system and produces an annual report which is available to people who use the service and their relatives. I asked a resident if they had recently received a quality questionnaire and I was pleased that she replied, “Yes, they are always asking us how we are”. I saw the minutes of residents’ meetings, which covered a number of topics including food, laundry and care provision. The home holds small amounts of money on behalf of residents for minor purchases. A random selection of these accounts were examined and were accurate. Clear audit trails were seen which included numbered receipts. Satisfactory documentation was available in connection with gas safety, electrical installation and PAT testing, Legionella checks and fire systems. The fire evacuation plan has been reviewed by Jewish Care’s fire training officer and a copy sent to the local fire brigade. Records seen indicated that fire drills were taking place on a regular basis. A recommendation was issued at the last inspection that an audit of falls at the home be undertaken to identify any possible patterns for individual residents. The deputy manager told me that this has taken place and a number of patterns were identified and action taken to reduce these risks. Clore Manor DS0000010423.V333446.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Clore Manor DS0000010423.V333446.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 16(2) m n The registered person must ensure that residents’ individual recreational and occupational interests are recorded on their plan of care so that staff know how to keep people suitably engaged. This is of particular relevance to those people with dementia. 2. OP9 13(2) The registered person must 01/07/07 ensure that the receipt of all medication received by the home is accurately recorded. The registered provider must ensure that all staff undertake adult protection training so they are aware of the many forms adult abuse can present in a residential setting. The registered provider must ensure that the dependency levels of all residents are assessed and staffing levels adjusted accordingly. 01/09/07 Requirement Timescale for action 01/08/07 3. OP18 13(6) 4. OP27 18(1) a 01/09/07 Clore Manor DS0000010423.V333446.R01.S.doc Version 5.2 Page 23 5. OP31 9(2) The registered person must ensure that a manager is recruited who has the capabilities and leadership qualities needed to run this busy home. 01/10/07 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 OP7 Good Practice Recommendations The registered provider should develop a summary of care needs on each, individual care plan. This will enable staff to have an overview of how the service user would like their care to be delivered and highlight the important issues for each service user. 2. OP3 The registered person should ensure that the dependency levels of prospective residents to the home are monitored to ensure that any additional challenges faced by staff do not impact on the needs of existing residents at the home. 3. OP9 The registered person should ensure that medication is reviewed for all those people with dementia in order to assess whether this is having an impact on them sleeping too much during the day. Clore Manor DS0000010423.V333446.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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. 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