Inspection on 08/11/05 for St Claires 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

St Claires Care Home 05/06/07

St Claires Care Home 22/06/06

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE St Claires Care Home 18-24 Claremont Road Folkestone Kent CT20 1DQ Lead Inspector Mrs Penny McMullan Announced Inspection 09.30 8 and 9 November th 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 St Claires Care Home DS0000064519.V254492.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. St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Claires Care Home Address 18-24 Claremont Road Folkestone Kent CT20 1DQ 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) Rosemere Care Home Ltd Mrs Margery Ann Martin Care Home 39 Category(ies) of Dementia - over 65 years of age (39) registration, with number of places St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23 May 2005 Brief Description of the Service: St Claire’s provides residential care to up to 39 older people with dementia. The Home is a detached premises and is situated in a residential area near to the town centre of Folkestone, within easy walking distance of facilities such as shops, health centres, railway and bus stations and churches. There are three floors incorporating four day rooms and 37 single bedrooms, 6 of which have en suite facilities and one double bedroom. Service users and visitors have access to all parts of home via two shaft lifts. The home has established a small garden at the front of the premises, which is accessible to all service users. St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place on Tuesday 8th and Thursday 10th November 2005. Mrs Marjery Martin, Registered Manager and Mrs Mary Coyne, Deputy Manager were in attendance. Mr & Mrs Permall purchased the home on 16 June 2005. Mr Permall holds the following qualifications M.SC (nursing) PCGE.E.A. RGN, BSC (nursing) RMN ENB 249 and Mrs Premall holds the Dip Care Home Management RMN and is also a qualified Registered Manager Rosemere Care Home. They both have over 20 years experience in caring for residents with health and mental problems. They are also own another care home in Folkestone. Mrs Permall also visited the home during the inspection. The home is currently experiencing problems in the retention of staff and Mr & Mrs Permall are currently working as part of the staff rota providing direct care to the residents. An anonymous complaint with regard to staff ratios, particularly at night was received direct to the Commission on the weekend of 9th and 10th October 2005. It was found that the ratios of care staff were adequate but the home is currently using agency staff to cover night and day care vacancies in the home. The home is actively recruiting staff including overseas staff. Interviews have been held and three other staff are in the process of being appointed once the relevant documentation is in place. Further information with regard to this complaint is included in this report. Due to the dependency needs of the service users feedback is minimal, however service users spoken to seemed to have enjoyed their meal and were content sitting in the lounge. The home was calm and the atmosphere was relaxed. A relatives meeting was held on Tuesday 8th November and eight relatives attended. The Registered Manager chaired the meeting and the Deputy Manager and Inspector also attended. Feedback from this meeting is included in this report. The Inspector spent time with the Registered Manager and Deputy Manager checking records, discussing resident’s care plans, speaking to residents and staff and observed the interaction of the staff with the residents. What the service does well: St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 Page 6 Overall relatives spoken to say that they are happy with the care being provided. Staff say the residents are looked after well and personal care is provided to a good standard. Staff interact with service users in a positive and respectful manner. One relative said that her mother was always clean, tidy and well looked after. What has improved since the last inspection? 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 St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 Page 7 contacting your local CSCI office. St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 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 the following standard(s): 1,6 The home’s Statement of Purpose and Service User Guide are in place to provide service users/relatives/representatives with the information they need to make a decision about moving into the home. EVIDENCE: The Statement of Purpose and Service User Guide have been amended to reflect the new ownership of the home. Standard 6 is not applicable to this home. St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9 Care plans do not contain sufficient detail to provide staff with the information they need to meet the service users needs. Moving and Handling risk assessments require a safe practice of work to minimise the risk to residents and staff. The lack of monitoring of health care needs with regard to accidents/incidents will result in the healthcare needs of people using the services not being met. The lack of checking written information on medicine administration sheets needs to be addressed to minimise the risk of recording errors in medication. EVIDENCE: The home has worked very hard to introduce a new format for service user plans. These contain considerable information however further detail is required to ensure that service users needs are met. Moving and handling risk assessments require further development to provide a safe practice of work. A requirement has been made in this report. Relatives confirmed that they have St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 Page 11 contributed to the plans and many have provided background information, which is included in the plan. All health needs are recorded in the service user plan. The District Nurse, Continence Nurse when required, supports the home and the Community Psychiatric Nurse visits on a regular basis. The dentist and chiropodist also visit the home and service users are accompanied to the hospital for appointments. The home must ensure that details of accidents/incidents is monitored and recorded in the daily contact sheets to ensure the health needs of the service user are met. A requirement has been made in this report. The medication policy has been reviewed and senior trained staff administers the medication. The home has implemented a system to ensure that senior staff administer the medication when agency staff are on duty. Records of the administration of medication are completed in a satisfactory manner however the home must ensure that written hand entries are countersigned by another member of staff. A requirement has been made in this report. St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,15 The home provides activities promoting service users preferences and choices. The home provides a balanced menu and nutritional diet to meet the needs of the residents. EVIDENCE: The home now has a full time Day Care Co-ordinator and all activities are monitored on an individual basis. Activities are arranged around service users interests, which are recorded in the care plan. Entertainment is provided each month and details are posted on the notice board and relatives are also invited to attend. Activities, outings were discussed at the relatives meeting and planned to the end of the year. One relative said she had visited at the weekend and the owner was provided musical instruments for the residents who were enjoying the activity. There is a choice of menu each day and details are posted on the notice board in the dining room. The menu is on a four weekly basis and reviewed each season. A nutritional assessment forms part of the care plan and the home has now ensured that drinks are available when service users are getting up as well as throughout the day. Some service users eat in the dining room and St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 Page 13 new chairs and tables have been ordered for service users who prefer to eat in the lounge upstairs. Special diets are provided and all recorded in the kitchen. St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The home has a satisfactory complaints system with some evidence that relatives or representatives will express resident’s views. Arrangements for protecting residents are in place however the lack of information in the Adult Protection Policy with regard to protocols may put residents and staff at risk of harm. EVIDENCE: The Commission received an anonymous complaint in October with regard to ratios of staff especially at night. Due to night and day staff leaving the home, agency staff are currently working in the home. There was no evidence to confirm that the numbers of staff were not adequate and although there were four agency staff on night duty arrangements had been made to identify a senior responsible for the shift. Arrangements are also in place to ensure a permanent trained senior member of staff also carries out the administration of medication. The complaint was therefore not upheld to the ratios of care staff. The home has responded to the investigation and is in the process of recruiting permanent staff. The complaints procedure is on display and one relative stated that he did not have any complaints. Relatives confirmed that they would complain but did not have anything to complain about at the moment. The new owner of the home is an Adult Protection Trainer and is ensuring that all staff has receive the training and is in the process of providing the training to new recruits. The home is required to amend the Adult Protection Policy to ensure that all staff is clear of the process of adult protection. There is one on going adult protection, which the home has responded to appropriately. St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The Manager has a clear understanding of the areas in which the home needs requires improvements to the environment which will enhance the residents quality of life. Laundry facilities have improved and policies and procedures are in place to control the risk of infection. EVIDENCE: The new owners acknowledge that the home requires a development plan with regard to the redecoration and has started to address some of the issues. Some replacement windows have been fitted, four rooms have had the carpets replaced, and the upstairs lounge on the second floor has been redecorated. The home is hoping to start redecorating the hallway and reception area and all doors are to be painted white and personalised to brighten up the corridors. The home is also replacing some of the fire doors to comply with the St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 Page 16 recommendations of the fire risk assessment. Maintenance is ongoing and recorded. The home has implemented a cleaning programme and has the carpets cleaned on a monthly basis. There are separate laundry facilities with hand washing facilities. A new laundry system is in place and is working well. Relatives comments were very positive with regard to the laundry facilities and say the laundry service has improved. Sluicing facilities are provided and there is a laundry person and two domestics on a daily basis. The home has a policy on infection control and infection control training is being provided to all staff. St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The permanent staff together with the consistent use of the same agency staff has the skill mix and qualifications to meet the needs of the service users. Arrangements are in place to ensure that residents are supported and protected by the homes recruitment policies and procedures. The arrangements for the induction of staff are in place with the staff demonstrating a clear understanding of their roles. EVIDENCE: There has been a considerable amount of agency staff being used in the home. However the home has ensured that the same staff is requested in order to provide consistent care to meet the needs of the service users. Permanent staff members confirmed the agency staff know the service users and work well as a team with the homes own staff. There have been occasions when four agency night staff have been on duty and the home has ensured that a senior member of staff is identified on the rota and is at qualified NVQ 2 or above. A trained senior permanent member of staff comes into home in addition to the staff on duty to carry out the administration of medication. At the time of the inspection the Registered Manager, Deputy Manager, three permanent staff, three agency staff and one day activity co-ordinator. There are six carers on duty in the afternoon and four waking night staff. There is St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 Page 18 one cook, one kitchen assistant, two domestic staff, one laundry person and one maintenance person. The home has four full time vacancies for care staff and has recruited overseas workers together with three carers scheduled to commence employment pending satisfactory checks and references. If all applicants are successful there will be ten overseas carers and the owners are ensuring that the staff work well as a team by covering shifts on the rota and providing direct care to the residents. There are six members of staff who have NVQ 2 or above and three currently completing NVQ2. The agency staff have the relevant qualifications ensuring that there is a 50 ratio of trained members of staff in the home. A thorough recruitment process is in place and all relevant checks and references are in place prior to employment of staff. Overseas staff are recruited through an agency and all relevant documentation is in place. The home ensure that all overseas carers receive a copy of the General Social Care Council code of practice in their own language. The home is continuing to update and arrange mandatory training. The Registered provider Mrs Permall is a trainer for moving and handling, health and safety, adult protection and will be providing some of the training for staff. The home has ensured that the agency staff has received the appropriate training. Induction training for new recruits is in place and is being reviewed to commence the new Skills for Care induction. The home has a training matrix in place. St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,36,38 The home regularly holds relatives/representative meetings to ensure that residents are represented and have the opportunity of having their overall care discussed. Staff supervision is in place ensuring that staff are valued and supported. The lack of recording and monitoring of accidents/incidents in the daily contact sheets does not ensure that health care needs of service users are being met. EVIDENCE: A quality assurance survey was carried out in August, summarised and discussed at the relatives meeting. All of the issues raised were discussed with the relatives and any actions required were carried out by the home. Relatives at the meeting at the time of the inspection are aware of the quality monitoring system and voiced their opinions on the home and the care being St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 Page 20 provided. Overall comments were positive and they were happy with the care being provided. Staff confirmed that supervision is taking place. The Manager, Deputy Manager and Team leader carry out the supervision and appraisal for all staff, which is signed and recorded. Mandatory training and updates are being arranged for all new staff. Environmental risk assessments are in place and all chemicals are stored securely. All certificates and checks with regard to electricity, gas, lifts, hoists, and fire equipment have been carried out. The fire book was checked and found to be up to date and recorded appropriately, and fire drills are taking place. Accidents and incidents were recorded and tracked through to care plan daily record sheets. Although the accident/incidents are recorded the home needs to ensure on going recording and monitoring of the health care needs. St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 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 3 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X X 3 X 2 St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 Page 22 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 OP7OP8OP 38 Regulation 15,12,13 Requirement Further detail is required in care plans in order that care staff is able to meet residents needs. The moving and handling risk assessments require further detail to minimise the risk to residents and staff. Accidents and incidents must be recorded accurately and the health care needs monitored together with any action required. The home must ensure that all hand written entries in the MAR sheets are countersigned to minimise the risk of errors in medication recording. The home must review the Adult Protection Policy to ensure that staff are clear of the protocols to follow Timescale for action 31/12/05 2 OP9 13 30/11/05 3 OP18 13 31/12/05 St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 Page 23 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 OP19 Good Practice Recommendations The home needs to continue with the refurbishment/redecoration of the premises and implement a programme of maintenance to address these issues. St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 St Claires Care Home DS0000064519.V254492.R01.S.doc Version 5.0 Page 25 - 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. 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