Inspection on 08/11/05 for Clumber Court Care Centre (Care Home)

This inspection was carried out on 8th November 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

Clumber Court Care Centre (Care... 24/05/07

Clumber Court Care Centre (Care... 11/05/06

Clumber Court Care Centre (Care... 16/03/05

Clumber Court Care Centre (Care... 28/07/04

Clumber Court Care Centre (Care... 11/03/04

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

CARE HOMES FOR OLDER PEOPLE Clumber Court Care Centre (Care Home) Bolham Lane Retford Nottinghamshire DN22 6SU Lead Inspector Karmon Hawley Unannounced Inspection 8th November 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Clumber Court Care Centre (Care Home) DS0000024636.V262011.R01.S.doc Version 5.0 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. Clumber Court Care Centre (Care Home) DS0000024636.V262011.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Clumber Court Care Centre (Care Home) Address Bolham Lane Retford Nottinghamshire DN22 6SU 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) 01777 700823 01777 705143 clumber.court@ashbourne-homes.co.uk Ashbourne Homes Limited Gerard Anthony Stanley Care Home 64 Category(ies) of Dementia (8), Dementia - over 65 years of age registration, with number (64), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (64) Clumber Court Care Centre (Care Home) DS0000024636.V262011.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 34 of the beds for people in the category DE(E) must be reserved for people who do not require Nursing Care. 06/09/05 Date of last inspection Brief Description of the Service: Clumber Court Care Home was established in 1993 and is owned by Ashbourne Health Care. Clumber Court is situated around a mile from the lively market town of Retford and enjoys a pleasant, picturesque and quiet location alongside the river Idle. Due to limited transport links the home has access to a car and accommodates relatives who may have difficulty with transport. Clumber Court is built on two levels and caters for the care of older people and offers specialist residential and nursing care for up to 64 older people with dementia type illness. There are sufficient seating areas throughout the building and a pleasant secure garden for service users to enjoy. Accommodation is provided in single rooms and service users are enabled to bring in personal possessions in order to personalise them. Clumber Court Care Centre (Care Home) DS0000024636.V262011.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place in one day and was performed by one inspector. The main method of inspection was case tracking, this is a method of sampling the records of six randomly selected service users to ascertain if the needs of service users are appropriately assessed and identified needs are being catered for by the home to maintain optimum health and wellbeing of the service user. Due to the complex needs of service users within the home, four service users were spoken with and staff were observed interacting and caring for service users so as to give the inspector an insight into the conditions and standards within the home. Those service users spoken with were satisfied with the care received and the standards within the home, staff were observed to care for service users and interact with them at a good standard. Due to the general manager being off sick the senior support nurse assisted in the inspection process and four members of staff were spoken with. Staff were able to discuss core values and principles of care and their job role in meeting service users needs. Staff morale was noted to be reduced at present due to staff sickness issues, however senior management was aware of this and working towards a solution. It was stated there had been communication difficulties within the staff team, however this has now been addressed and senior staff are in the process of working with the management team with regards to this. What the service does well: What has improved since the last inspection? Clumber Court Care Centre (Care Home) DS0000024636.V262011.R01.S.doc Version 5.0 Page 6 Care plans have been improved and complex needs identified are now included in service users individual plans. What they could do better: 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. Clumber Court Care Centre (Care Home) DS0000024636.V262011.R01.S.doc Version 5.0 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 Clumber Court Care Centre (Care Home) DS0000024636.V262011.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Not assessed during this inspection. Clumber Court Care Centre (Care Home) DS0000024636.V262011.R01.S.doc Version 5.0 Page 9 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 the following standard(s): 7,8,9 Individual plans of care are in place however service users needs may not be fully met, as reviews are not service users focussed. Service users may also be placed at a degree of risk due to limited information and risk management available. Service users health care needs are fully met. Service users may be placed at a degree of risk due to practices employed in dealing with medicines. EVIDENCE: Service users undergo various assessments with regards to nutrition, pressure area care, manual handling, mental health and the daily activities of living; these form the basis of the plan of care. Care plans examined were personalised and reflected individual needs and preferences. There was evidence that changes are recorded, however reviews that take place were not service user focussed and did not fully reflect care and condition of the individual. Risk assessments were place in all but one file examined despite an identified risk. Also in place were photocopied risk assessments taken from the central file with regards to choking and strangulation, these were not personalised and did not reflect management of the risk. Within two risk Clumber Court Care Centre (Care Home) DS0000024636.V262011.R01.S.doc Version 5.0 Page 10 assessments information was brief and again did not fully action how the risk would be reduced. There was evidence that the multidisciplinary team are liaised with and appropriate equipment and aids are available, however one staff member spoken with did express there were difficulties in pad supplies, the senior support nurse was aware of this and was currently working towards resolving this issue. Daily progress notes were maintained and documented significant events. There was evidence to demonstrate that specialist services such as the optician, and chiropodist are accessed and liaised with as required and service users have access to national health entitlements. Relevant policies with regards to medicines are in place, however the senior support nurse stated that the home is awaiting clear guidance with regards to the new legislation of disposal of medicines prior to completing this change so as not to compromise staff. Medicines were checked against the prescription sheet, one sheet demonstrated that medicines had not been booked in to the home and the written entry did not match the prescription, also there were no written instructions on a prescription of warfarin, the staff member stated this had been written in the care plan but not on the chart. These issues were dealt with on the day of inspection in order to protect service users. One service user was noted to have been out of stock of one medicine for ten days. There was evidence of two staff members signing hand written entries. Fridge and room temperatures are recorded, however these demonstrate that on many occasions the room temperature exceeds 25oC. Clumber Court Care Centre (Care Home) DS0000024636.V262011.R01.S.doc Version 5.0 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 the following standard(s): 15 Service users receive a wholesome appealing and balance diet in pleasing surroundings. Despite the kitchen looking clean and tidy hygiene standards may be compromised due to the lack of documentary evidence available to substantiate that appropriate cleaning has taken place. EVIDENCE: Service users undergo a nutritional assessment and specialist needs are catered for if required, there was evidence to demonstrate that the dietician is liaised with when necessary. Staff were able to discuss supplements and how these are administrated to service users. A four weekly menu is followed, which demonstrates that a wholesome and appealing diet is offered. There was also evidence that choice is given at each mealtime and one service user was able to substantiate this and stated that food is of a good standard. The kitchen was clean and tidy and records examined were satisfactory with the exception of the cleaning rota, which demonstrated gaps in this taking place. Clumber Court Care Centre (Care Home) DS0000024636.V262011.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 18 Service users are protected from abuse. EVIDENCE: Relevant policies and procedures are in place with regards to the protection of vulnerable adults. Seventy four percent of staff have undertaken the resident welfare course and were able to discuss these policies and the procedures they would follow. Some staff have undertaken training with regards to dementia care. All staff employed have undergone satisfactory criminal records bureau checks. Service users personal allowances are kept in the homes safe should they wish to use this service. Clumber Court Care Centre (Care Home) DS0000024636.V262011.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 26 The home is clean, pleasant and hygienic. EVIDENCE: There are ample domestic staff employed to maintain the cleanliness of the home. During the tour of the home all areas were clean and tidy. The laundry room is situated on the upper floor and was well maintained, had all required equipment and complied with requirements. Staff are currently undertaking a distance learning course in infection control. Clumber Court Care Centre (Care Home) DS0000024636.V262011.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28,30 Staff are continuing to develop to ensure service users are in safe hands and they are trained and competent to do their jobs, however this may be compromised due to the lack of first aid training. EVIDENCE: Two staff have attained the National Vocational Qualification level two in care and twelve are registered and working towards the qualification, this amounts to thirty six percent of care staff. Each member of staff have an individual training plan and there was evidence to demonstrate that training is at a good standard, however staff do not undertake training in basic first aid. Staff are paid for all training courses attended. Staff spoken with stated that they felt supported in their training and substantiated that it was at a good standard. New staff members undertake an induction at a recognised level, which is over the course of thirteen weeks, followed by a review to ensure competency. One new staff member was spoken with and it was stated that her induction had been disjointed due to staff sickness, this was discussed with the senior support nurse and plans have been put into place to further support this staff member. Staff spoken with were able to discuss the core values and principles and the whole person needs of service users. One service user spoken with stated that she was well looked after and staff were very nice. Clumber Court Care Centre (Care Home) DS0000024636.V262011.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,35,38 The home is run and managed by a person who is fit to be in charge and who is of good character. Service users financial interest may be compromised due to the current system in place with regards to personal allowances. The health safety and welfare of service users and staff is promoted, however may be compromised due to the improvements required in individual risk assessments, first aid training and medicine practices. EVIDENCE: The manager has been in post for 3 years and prior to this also worked at the home. He is currently working toward the National Vocational Qualification level four managers award and has undertaken various training courses to remain up to date with his practices. Staff when spoken with spoke highly of the management team and stated that he was approachable and understanding of needs. Clumber Court Care Centre (Care Home) DS0000024636.V262011.R01.S.doc Version 5.0 Page 16 Service users personal allowances are currently kept in a locked box in the safe. Each has individual accounting sheets, however these did not differentiate between the amount that is kept in the home and in the bank. A central bank account is in use due to the difficultly in opening individual accounts. Monies are reconciliated on a weekly basis to ensure safety, however at other times this information would be time consuming to be made available. Receipts were kept for transactions and two signatures were obtained. Staff were unaware that money could be obtained from an emergency fund should it be required in the absence of the administrator. Relevant servicing, maintenance checks and contacts were observed to be in place, however an omission was noted in the testing of the emergency lighting tests. Accident logs were monitored and statistics sent to head office on a monthly basis. All staff employed have a criminal records bureau disclosure check in place, all registered nurses identification numbers were observed to be checked on a monthly basis. Staff training is at a good standard, however staff are not trained in basic first aid. Risk assessments were in place, however in several case file examined information was brief and did not reflect appropriate management and one file an appropriates risk assessment was not in place despite a risk being highlighted. There were also noted concerns with regards to medicine procedures. Clumber Court Care Centre (Care Home) DS0000024636.V262011.R01.S.doc Version 5.0 Page 17 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X 3 STAFFING Standard No Score 27 X 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 2 X X 2 Clumber Court Care Centre (Care Home) DS0000024636.V262011.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13(4,c) Requirement To fully protect service users it is required that appropriate individual risk assessments and management plans are in place. This is an outstanding requirement and must be addressed to avoid enforcement action. Service users reviews are required to be service user focussed to reflect care and condition. The registered person shall make necessary arrangements for the recording, handling, safe administration and disposal of medicines received in to the care home. Appropriate records with regards to the cleaning that takes place within the kitchen is required to demonstrate proper provision is made for service users health and welfare. The responsible person shall make suitable arrangements for the training of staff in first aid. The responsible person shall ensure service users finances are DS0000024636.V262011.R01.S.doc Timescale for action 30/11/05 2 OP7 15 10/12/05 3 OP9 13(2) 10/12/05 4 OP15 12(1) 10/12/05 5 6 OP30 OP35 13(4,c) 20(1) 10/02/06 10/12/05 Clumber Court Care Centre (Care Home) Version 5.0 Page 19 7 OP38 23(4,c) fully protected, not pooled into a central banking system and accounts differentiate between money held within the home and the bank. The registered person shall after consultation with the fire authority review the testing of emergency lighting to fully protect service users. 10/12/05 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 OP28 Good Practice Recommendations That staff continue to work towards the completion of the National Vocational Qualification in care so as comply with this standard. Clumber Court Care Centre (Care Home) DS0000024636.V262011.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Clumber Court Care Centre (Care Home) DS0000024636.V262011.R01.S.doc Version 5.0 Page 21 - 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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