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Inspection on 20/01/06 for The Carnarvon Nursing Home

Also see our care home review for The Carnarvon Nursing Home for more information

This inspection was carried out on 20th January 2006.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home pervaded a relaxed friendly atmosphere. Service users said that staff were very supportive, one comment received from a service user was " its beautiful here". There was good staff interaction with service users observed throughout the inspection and staff were happy with the support they received from the management.

What has improved since the last inspection?

Two requirements were highlighted in the last inspection and both have been addressed at the time of this inspection. One was that medication administration records needed to be kept fully completed and the other issue was that residents` wishes regarding procedures to be followed upon their death should be documented. With respect to the premises, some new furniture had been purchased for the top floor of the building and new windows had been put in on two of the floors.

What the care home could do better:

Some boxes of medication viewed at the inspection could not be reconciled with the medication administration record sheets in terms of number of tablets left. Thus more regular audits of boxes of medication thus ensuring the start date of boxes are recorded, is required. Sampled service users` records indicated that visits to or by dentists and opticians were not recorded on a regular enough basis. With respect to the premises, some areas of improvement needing carried out were indicated and these are detailed in the report.

CARE HOMES FOR OLDER PEOPLE The Carnarvon Nursing Home 22-24 Carnarvon Road Clacton on Sea Essex CO15 6QF Lead Inspector Steven Boyd Unannounced Inspection 20 January 2006 09:00 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 The Carnarvon Nursing Home DS0000015320.V275189.R02.S.doc Version 5.1 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. The Carnarvon Nursing Home DS0000015320.V275189.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Carnarvon Nursing Home Address 22-24 Carnarvon Road Clacton on Sea Essex CO15 6QF 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) 01255 426628 01255 426628 ANS Homes Limited Ms Carol Anne Johnson Care Home 57 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability (14), Physical disability of places over 65 years of age (57) The Carnarvon Nursing Home DS0000015320.V275189.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 57 persons) Persons of either sex, aged 45 years and over, who require nursing care by reason of a physical disability (not to exceed 10 persons) Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 20 persons) One named person, aged 21 - 45 years, who requires nursing care by reason of a physical disability Persons of either sex, aged between 60 - 65 years, who require nursing care by reason of a physical disability (not to exceed 3 persons) The total number of service users accommodated in the home must not exceed 57 persons 3rd May 2005 Date of last inspection Brief Description of the Service: The Carnarvon Nursing & Residential Home is in the seaside town of Clacton on Sea and is accessible via public transport that passes the front of the premises. The home is a former Victorian hotel that has been extended and modified. The nearest railway station is Clacton, which is within easy walking distance, as is the seafront. The home has a small amount of car parking spaces to the front of the home. The home provides care for older people of both sexes, who need both personal and nursing care. The home is also registered to provide nursing care, for up to 14 service users, aged 45 years and above with a physical disability, within the total bed compliment of 57. There are three floors accessible by stairs and a lift. All rooms are well furnished and pleasantly decorated. Bedrooms are all 10sqm or over. There is a large combined lounge/ dining room leading out onto small, but well maintained garden. Various outings and shopping trips are organised for service users and regular entertainment is provided. The proprietors are a national company known as ANS Homes Ltd. The Carnarvon Nursing Home DS0000015320.V275189.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place in one day in January 2006. The inspector spoke to three service users in private and others in general. A range of staff were spoken to both in private and in general including nursing staff, carers and auxiliary staff. The manager and head of care was spoken with and assisted during the inspection. A tour of premises took place and various records and policies were also looked at. Twenty-one of the National Minimum Standards were assessed at this visit of which seventeen were fully met. What the service does well: What has improved since the last inspection? Two requirements were highlighted in the last inspection and both have been addressed at the time of this inspection. One was that medication administration records needed to be kept fully completed and the other issue was that residents’ wishes regarding procedures to be followed upon their death should be documented. With respect to the premises, some new furniture had been purchased for the top floor of the building and new windows had been put in on two of the floors. The Carnarvon Nursing Home DS0000015320.V275189.R02.S.doc Version 5.1 Page 6 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. The Carnarvon Nursing Home DS0000015320.V275189.R02.S.doc Version 5.1 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 The Carnarvon Nursing Home DS0000015320.V275189.R02.S.doc Version 5.1 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): 3. Service users have their needs assessed prior to moving into the home and these are met when they do. EVIDENCE: Pre-admission assessments are carried out by the manager or deputy manager. Full admission assessments are based on the activities of daily living and are used to formulate care plans. One service user who had been at the home for a couple of months was happy that her needs were being met. The Carnarvon Nursing Home DS0000015320.V275189.R02.S.doc Version 5.1 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 & 10 Service users’ holistic needs are set out in an individual care plan. Records generally show healthcare needs and medication needs being met. Service users are treated with respect and their privacy is upheld. EVIDENCE: The care plan format had not changed since the last inspection and a number were sampled during this inspection. Plans were found to have clear needs identified with instructions for staff on how to meet the needs. Plans were reviewed on a monthly basis with changes being made if necessary. Within service users’ files, records were kept of when they had visited or been visited by various healthcare professionals. However, sampling suggested that visits by or to dentists and opticians were not always recorded on a regular basis. The home operates a monitored dosage system of medicine administration. Some service users are assessed as able to self administer medicine and do so. The inspector noted some difficulty in auditing boxes of medication where The Carnarvon Nursing Home DS0000015320.V275189.R02.S.doc Version 5.1 Page 10 these are used. One service user had more of one tablet left than the records indicated that he should have and less of another. The inspector recommended start dates be recorded for all boxes and bottles of medication and for nursing staff to undertake regular audits. Observation during the inspection indicated service users were treated with respect and their privacy given high regard. In conversation with service users, they were complimentary about the staff and the way they were treated, some saying they were not subject to any rigid routine. The Carnarvon Nursing Home DS0000015320.V275189.R02.S.doc Version 5.1 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): 12, 14 & 15 Service users enjoyed a lifestyle within the home which offers them a range of choices. EVIDENCE: Service users enjoyed their meals in an unhurried manner. The home employs three part-time activity workers to engage with service users in various individual and group activities. These include music, craftwork, bingo, dominoes and outings to shops, bowling arcades etc. Service users can exercise choice as much as possible. They could choose to engage in activities if they wished and confirmed they were not subject to any rigid routines, for example over what time they could get up and also go to bed. Service users spoken with during the inspection, were complimentary about the quality and quantity of food on offer at the home. Menus seen at the time of inspection indicated a good balance and choice of good was available. Service users are asked in advance what they would like for meals and alternatives to the planned choices on the menu were normally available. The Carnarvon Nursing Home DS0000015320.V275189.R02.S.doc Version 5.1 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): 16 & 18 Service users know they can raise complaints and have them dealt with appropriately. They are also protected from abuse by the home’s policies and procedures. EVIDENCE: The home was found to have an appropriate policy and procedure in respect of complaints made by service users or their relatives / representatives. In discussion with service users they felt confident that any concerns they raised would be dealt with in a satisfactory manner. One complaint which had been made since the last inspection was seen to have been dealt with appropriately. Policies and procedures for dealing with the protection of vulnerable adult issues were in place. PoVA training is covered as part of the staff induction programme and also by those following the national vocational qualification training. The Carnarvon Nursing Home DS0000015320.V275189.R02.S.doc Version 5.1 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): 19, 22, 23 & 26 Service users generally live in a safe and well maintained environment with appropriate facilities both in communal and individual rooms. The home was pleasant in order and clean in appearance. EVIDENCE: A tour of the premises revealed that the home was in generally in good condition. Since the previous inspection some new windows had been installed on the top and middle floors. As with any large home there is always areas where improvements can be made and some were noted on the top floor of the building, these were :(a) (b) The dining room floor was very stained in places and would need specialist cleaning or replacing. A bathroom was identified as having a drainage problem with water collecting on the floor and not running away, thereby posing a potential safety hazard. DS0000015320.V275189.R02.S.doc Version 5.1 Page 14 The Carnarvon Nursing Home Service users bedrooms seen during the inspection were clearly personalised to their own individual tastes and were suitable to their needs. There was lots of evidence of photographs, pictures, ornaments etc., in rooms and also TV’s, music and computer equipment. During the inspection, communal areas, bathrooms and bedrooms were all seen to be clean and there were no obvious odours to create an unpleasant atmosphere. Service users confirmed their rooms were regularly cleaned. The Carnarvon Nursing Home DS0000015320.V275189.R02.S.doc Version 5.1 Page 15 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, 29 & 30 Service users’ needs are met by adequate numbers of staff who are appropriately recruited and trained to do their jobs. EVIDENCE: Staff levels allow for three qualified nurses and eight carers on morning shifts, three nurses and six carers on afternoon shifts and five awake staff at night time. The home also has a range of support staff including domestics, cooks, laundry staff and an administrator. Service users said they felt well supported by staff and raised no concerns about the levels of staff available. Recruitment of staff was seen to be undertaken in a professional manner, with prospective staff filling in application forms, attending for interview, if successful having references taken up, CRB checks made and on appointment, going through an induction period. Over half the care staff at the home had achieved national vocational qualifications at level 2 or above. Since the last inspection, staff had also participated in moving and handling training, palliative care training, fire safety, nutrition and pressure sore care. Each staff member has an individual training record, detailing what they have accomplished. The Carnarvon Nursing Home DS0000015320.V275189.R02.S.doc Version 5.1 Page 16 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, 33, 36 & 37 Service users continue to live in a home which is well managed by a suitably qualified and experienced person for the best interests of service users. EVIDENCE: Ms Johnson has been the manager of Carnarvon Nursing Home for a number of years and clearly displayed a professional attitude and manner. From discussions with service users, they stated the home was well run and that they could engage with the manager and staff over issues about the operation of the home if they chose. Staff said they felt well supported by the manager and head of care, confirming they received regular supervision sessions as part of that support. The home’s policies and procedures were sampled and found to be appropriate at the time of inspection. Record keeping was generally good with some exceptions as indicated earlier in the report. The Carnarvon Nursing Home DS0000015320.V275189.R02.S.doc Version 5.1 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 2 3 X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 3 X The Carnarvon Nursing Home DS0000015320.V275189.R02.S.doc Version 5.1 Page 18 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 OP8 Regulation 13(3) Requirement The manager must ensure healthcare records for all service users are updated in respect of periodic visits to or by dentists and opticians. The manager must ensure audits of boxes and bottles of medication are undertaken on a regular basis to uphold the integrity of the medicine administration system. With immediate effect The registered providers must take remedial action as indicated in the report on two aspects of the premises relating to the top floor. Timescale for action 28/02/06 2. OP9 13(2) 20/01/06 3. OP19 23 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Carnarvon Nursing Home DS0000015320.V275189.R02.S.doc Version 5.1 Page 19 1. OP22 The manager should consider having an occupational therapy assessment carried out throughout the home by an appropriately trained professional. (This is a repeat recommendation.) The Carnarvon Nursing Home DS0000015320.V275189.R02.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. 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