Care Home: Clairleigh Nursing Home

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What the care home does well Providing residents with a clean, comfortable and relaxing environment to live in. Making sure residents` personal care needs are met in ways they prefer, and that they have ready access to health care services. Maintaining residents` dignity and treating them with respect. Making visitors welcome and enabling them to feel relaxed in the home and when communicating with staff. Offering residents choice and flexibility in daily routines, choice of food, bedtimes and getting up times. Meeting residents` varied dietary needs. Managing the home well and having effective arrangements for the provider to monitor the quality of services that the home provides. Ensuring staff have received training they need to carry out their work in the home. What has improved since the last inspection? They have improved the format for pre-admission assessments and more detailed assessments are now being carried out to make sure the home can meet the needs of people referred for admission. They have met our previous requirement to obtain all the recruitment information required before new staff members start work in the home. What the care home could do better: More could be done in terms of activities provision and they are already taking action to improve this aspect of their service, for example, by recruiting for a new activities coordinator. The monthly reviews of all care plans could be improved by recording evaluative comment that would show outcomes for residents. They should review the arrangements for lunch to ensure residents are not hurried to finish their meals. Some bathroom flooring needs attention and more appropriate storage areas for equipment could be identified. It would be good for all residents if direct access to the gardens could be made easier. The frequency of staff supervision sessions should match the expected standard. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Clairleigh Nursing Home 104 Plaistow Lane Bromley Kent BR1 3AS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: David Lacey     Date: 2 0 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Clairleigh Nursing Home 104 Plaistow Lane Bromley Kent BR1 3AS 02084601527 02083133815 clairleigh@britishlibrary.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Carmen Mary Grech Type of registration: Number of places registered: Palmgrange Limited care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 30 The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Clairleigh is a care home that provides nursing care for up to 30 older people including those requiring palliative care. It is a detached property with accommodation provided on two floors. There is parking space to the front and an attractive, well maintained Care Homes for Older People Page 4 of 32 Over 65 30 0 Brief description of the care home garden to the rear of the home. There are eighteen single and six shared bedrooms, all having en-suite facilities. The home is near local amenities, public transport links and Bromley town centre. The fees for this home range from 880-960 pounds sterling each week (this information given to the CQC in July 2009). Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: During this unannounced visit, the inspector toured the premises, observed experiences of residents and spoke with residents, visitors, staff members and the homes manager. The inspector spent nine hours in the home and also examined samples of documentation such as care plans, staff recruitment files and medication charts. An expert by experience was invited to take part in the inspection process and accompanied the inspector on the site visit. An expert by experience is a person who has a shared experience of using services and who can help an inspector get a better picture of what it is like to live in a care home. The expert spent four hours engaging with a number of people who live at the home and with some of their visitors. The report compiled by the expert has been used as evidence to support the judgements about the quality of services provided. Care Homes for Older People Page 6 of 32 Before undertaking the site visit, we sent out ten residents comment cards, four relatives comment cards, four staff members comment cards, and five visiting professionals comment cards. By the time of writing this report, completed surveys had been received from eight residents, four relatives, and two members of staff. All of the residents who responded indicated they had received help in completing their survey forms, which was given by either relatives or friends. The responses we have received are summarised in this report and have been taken into account in reaching our judgements. Information from the homes Annual Quality Assurance Assessment (AQAA) received in May 2009 and the findings of our Annual Service Review in September 2008 have also been used to inform the inspection process. The last inspection of this service was completed on 26/09/2007. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 32 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are admitted to the home based on the outcome of a pre-admission assessment. People thinking of moving in are encouraged to visit the home to help them decide if it is the right place for them. Evidence: Four of the eight residents who responded to our survey stated they had received enough information to help them decide if this home was the right place for them, before they moved in. Two residents stated they did not receive enough information and two did not know whether they had received this. Three of the four relatives who returned our questionnaire stated they always get enough information about the home to help them make decisions, and one stated this is usually the case. A resident who had chosen the home with help from her representatives said she had visited the home to see what it was like before making the decision to move in. She said the choice had worked out well, as her room is very comfortable, the home is always clean, the food is good and visitors are always welcome. A visitor spoke about helping Care Homes for Older People Page 11 of 32 Evidence: a relative choose a care home. The relative was not able to visit care homes because of illness so the visitor looked at a number of homes on her behalf and recommended she choose Clairleigh. The visitor said they were pleased with this choice, as the care has been good. It was evident that residents are assessed before admission so it can be determined whether the home is suitable to meet their needs. Personal files relating to four people were viewed, and all contained pre-admission assessments and profiles of the individual person. A nurse explained the pre-admission assessment documentation had been expanded by the new manager and more detailed assessments are now being carried out. Peoples ethnicity and religion are recorded on front sheets but it was suggested the home may wish to record this on pre-admission assessments also. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident the home will ensure their health and personal care needs are met, and that their privacy and dignity will be respected. All residents have care plans and good access to health care services. The administration of residents medication is carried out according to the homes procedures. Evidence: People appeared well groomed and appropriately dressed for summer weather. In general, people provided positive feedback about the care provided and said that staff looked after them well, for example, in treating them with dignity and respect while giving help with their personal care. Three of the eight residents who responded to our survey stated they always receive the care and support they need, with four stating this is usually the case, and one resident stating s/he sometimes receives this. A resident commented that something the home does well is that Generally, the care provided is very good. Another said, the home is very caring and has a happy atmosphere. One resident said the home could pay more attention to detail, for example, the call bell push is sometimes out of reach. Two of the relatives we surveyed stated the home always meets the needs of their relative, and two stated Care Homes for Older People Page 13 of 32 Evidence: this is usually the case. Two of the relatives stated the home always gives the care to their relative that they expected or agreed, one said this is usually the case and one relative did not answer this question. One relative commented that the home, looks after my fathers total needs. Another stated they take care of my mum at all times, the staff are so friendly and considerate. A person visiting someone who had not been living in the home long commented, So far we are happy with her care level and treatment, staff are friendly and cooperative. Each of the two staff members who responded to our survey stated they always receive up to date information about residents needs, for example, in the care plan. Of the four relatives responding to our survey, two stated the home always responds to the different needs of individual residents and one stated this is usually the case. One relative did not answer this question, which asked respondents to consider needs relating to disability, gender, age, race and ethnicity, faith and sexual orientation. Staff members we surveyed were asked a similar question, one replying s/he usually has enough support, experience and knowledge to meet the different needs of residents and one stating this is sometimes the case. The four care plans sampled for inspection had information about the individuals needs. The risk assessments seen were up to date and included guidance for staff on how to reduce risks in relation to, for example, moving and handling, pressure sore care and prevention, and meeting nutritional needs including, where required, tube (PEG) feeds. There were good records of the delivery of healthcare and the monthly recording of peoples weight, blood pressure and urinalysis were up to date. For one resident, a wound care plan from the tissue viablity service was being followed by staff and kept under review, with evidence of liaison with the PCT care homes nursing team. Monthly reviews were being carried out but some of these were repetitive and did not offer any evaluative comment. For example, safety care plan reviews for three residents case-tracked just stated safety maintained. The sleeping care plan review for one resident stated sleeps well most nights, without suggesting what might be done to help that resident sleep well every night (see recommendations). Residents were registered with a GP and supported by staff to receive regular dental, optical and podiatry care. Other healthcare such as dietician, physiotherapy and tissue viability support were obtained as needed to meet individual residents needs. Four of the residents we surveyed stated they always receive the medical care they need, three stated they usually receive this, and one that s/he sometimes does. One of the staff members and one of the relatives responding to our survey commented that the medical care available needs improvement. The GP was visiting the home during the day of inspection, and told the inspector he was seeing residents as part of a routine Care Homes for Older People Page 14 of 32 Evidence: monthly visit as well as particular residents who the staff had asked him to review. The visits of health care professionals had been recorded on the residents files seen. From information given in the homes AQAA and in notifications received from the home, it was noted the death rate at Clairleigh had been comparatively high compared with previous years. This information was discussed (separately) with one of the nurses and with the manager during the inspection visit. Both said they were aware of the death rates and that the manager had been monitoring closely but no unusual patterns had been identified. They said residents dependency levels have been higher than previously, mainly because the home has been providing services to more people referred with palliative care needs. At the time of this inspection, none of the residents were managing their own medicines thus all were relying on staff for assistance with this aspect of their care. Policies and procedures for medicine management were available to staff. Medicines were correctly stored although, during a tour of the premises with the manager, the medication trolley for the upper floor was seen stored in an unlocked room opposite the nurses station. The trolley was locked but not chained to the wall even though a chain was available. The manager rectified this and undertook to remind staff about the importance of secure storage at all times. The medication trolley for the ground floor was in use at that time so was out on the floor with a nurse in attendance. The medication fridge was within safe temperature limits, and it was noted the temperature is monitored and recorded daily. There was overstocking of eyedrops for one resident but this was not generally evident . There were no controlled drugs (CD) being stored in the home at the time of inspection but procedures were in place for CD administration. Homely remedy medicines were provided and a list of these had last been formally agreed with the GP in June 2009. Records were kept for receipt, administration and disposal of medicines. Medicines were supplied in blister packs or individual containers and were provided by the chemist with pre-printed administration charts. The medication administration records (MAR) of four residents were sampled for inspection. All had photos of the resident, their date of birth, and information about any known allergies. None of the MARs had any unexplained gaps in medication administration. The feeding regime for a resident on a tube (PEG) feed and nil by mouth was filed with the MAR. The MAR for a recently admitted resident showed she was on oral anticoagulant therapy. The nurse in charge of the floor stated the home was still waiting for the anticoagulant dose booklet from the hospital so the resident was being given the same dosage as on admission. The home had last collected blood from the resident and sent it for testing Care Homes for Older People Page 15 of 32 Evidence: on 06/07/09 and results were awaited. The nurse confirmed the anticoagulant dose would be changed if necessary in accordance with the blood test results. The managers audit of medication for July 2009 was seen and she informed the inspector she completes annual competency assessments for staff who manage medicines. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good arrangements are in place to support residents continued contact with their families and friends. The provision of social activities needs improvement and the home is taking steps to address this. Where possible, residents are enabled to make personal choices. Residents are provided with a balanced and nutritious diet. Evidence: At the time of the inspection visit, the home was temporarily without an activities coordinator. The post had recently become vacant and it was understood the home was recruiting to fill the vacancy. In the meantime, the activities programme was not being delivered as planned. One of the eight residents who replied to our survey stated there are always activities arranged by the home that s/he can take part in if they want, three said this is usually the case, two residents stated there are sometimes such activities available, and two stated this is never the case. Three residents commented that something the home could do better is providing more social activities. Another resident stated there had been a lack of activities since the person coordinating this service had left. A residents file seen as part of case-tracking had no entries on the social activities sheet since December 2008. A relative said that a recent choir and concert had been a welcome change from residents from being sat in front of TV and suggested there should be more of these events as the residents Care Homes for Older People Page 17 of 32 Evidence: really responded positively. Our expert by experience noted the home is currently waiting for a new activities coordinator. Residents told her about the previous coordinator and how they missed the activities. It was mentioned more than once to our expert that staff were too busy to carry out activities. However, the home did have books, tapes, televisions and radios for residents use. Two people told our expert about a music group that has recently visited Clairleigh to give a concert. This was much appreciated and the residents said they would like more entertainment like this. As we were assured by the manager and by one of the registered providers that the home was already taking action to re-establish its activities provision, we have not made any related requirements at this time. Our expert by experience spoke with many of the residents about their choices. They were all positive about the flexibility available to them. For example, if they wished to stay in bed or change where they ate, this was not a problem and staff were said to be very flexible. The inspector saw a carer come into a residents room to ask her if she would like to go downstairs for lunch. The resident said she did not want to do this so the carer asked if she would prefer to take lunch in her room. The resident said she would so the carer brought a small table and made sure the resident was comfortable and ready for her meal. Of the four relatives replying to our survey, two stated the home always supports people to live the life they choose, one said this is usually the case, and one did not answer this question. One relative commented, Residents are allowed to remain independent - they are not forced to join in activities at the home. Three of the four relatives responding to our survey stated the home always helps their relative to keep in touch with them, if that was applicable, and one did not answer this question. One relative commented, Visitors are welcome at all times of the day and night Two residents responding to our survey stated they always like the meals at the home, five stated they usually do and one stated s/he sometimes likes the meals provided. One of the staff members we surveyed commented that the diet provided to residents needsimprovement but did not offer any specific comments about their diet. Our expert by experience observed that the lunch served during the inspection visit was of good quality. The cook served the meal on warm plates, in a professional manner, and made sure the portion sizes were appropriate. Our expert judged the chef to be an asset to Clairleigh, commenting that his demeanour is outgoing and pleasant, his cooking skills praised by all residents I spoke to. Everyone our expert spoke with enjoyed the food and said if they have any special needs or requests this is catered for without any problems. Our expert did suggest that the removal of plates at lunch time was too hurried, and this is something the home will wish to review (see recommendations). There were some Care Homes for Older People Page 18 of 32 Evidence: people still eating the main course as they were offered a cup of tea to finish their meal, and plates were often removed before the person had finished their last mouthful of food. Our expert noted the main dining room was well coordinated in decoration, with flowers in vases matching the table mats. The single large table was neatly laid and seven people were sitting around it for the meal. Lunch is the only meal time that residents socialise, and other meals are taken in their rooms. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home addresses any complaints raised, in accordance with its procedures. The home has procedures in place to safeguard its residents, and relevant training in this respect is available to staff. Evidence: The home has a complaints policy and procedure that is prominently displayed in the home. The homes complaints file was seen and the records of complaints received since our last visit were sampled for inspection. All information had been recorded and filed, with all relevant correspondence available. The information included details of each complaint and the findings. Dates had been recorded, so it was possible to determine the home had addressed complaints within the timescales set out in its complaints procedure. The commission is aware of a complaint about medication storage. This had been recorded and the manager confirmed nursing staff had been provided with medication booklets and annual competency test for nurses had been implemented. Seven of the eight residents returning our survey questionnaire stated there is someone they can speak to informally if they are not happy, and one stated this is not the case. Six residents knew how to make a formal complaint but two did not. Of the four relatives who returned our questionnaire, three stated they knew how to make a complaint about the care provided if they needed to and one relative did not answer this question. Three relatives stated the home always responds appropriately if they have raised any concerns and one did not respond to this question. A staff member replying to our survey confirmed s/he knew what to do if Care Homes for Older People Page 20 of 32 Evidence: someone has concerns about the home. Three staff members spoken with had understanding of their role in referring any suspicion of abuse to the person in charge. A carers response to a scenario showed she could take appropriate action if a safeguarding incident occurred. The carer said she had undertaken training about safeguarding adults and showed awareness of the lead role of social services in this respect. The commission is aware of two safeguarding alerts made to the local social services department since our last key inspection. There was an investigation by social services following a safeguarding alert in November 2007. Their investigation concluded that the deterioration in the particular residents health did not result from any lack of care by Clairleigh. Another safeguarding alert was made in July 2008 following an allegation the home did not provide the appropriate pressure-relieving equipment to a resident who developed pressure ulcers. We have not been made aware of the outcome although we found no evidence during our present inspection that any residents were suffering detriment in this way. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a comfortable and safe environment. Evidence: Six of the eight residents who responded to our survey stated the home is always fresh and clean, and two stated this is usually the case. Two residents commented that something the home does well is making the garden look beautiful and keeping the house well. We received positive comments from residents about the environment during our visit. Our expert by experience reported she was impressed with the homes environment. Her overall impression was that Clairleigh is a pleasant environment in which to live and to visit. She found no unpleasant odour, clean carpets obviously well cared for, and good clean decoration. The conservatory is bright, warm and sunny. It is useful on most days of the year but cannot be used in the extreme heat according to residents who spoke with our expert. The home has several smaller lounges spread across the two floors of the building, also used as dining areas at meal times. All were neatly presented, clean, with appropriate decorations, one had an organ. Books and audio books were on display for use. Two residents who share a room said they had not known each other before moving into the home, one saying, we just ended up sharing a room. They said the room is comfortable and they have reasonable privacy, as there are screens in the room and there is an en-suite toilet. They said they like the view from their room over the gardens. Care Homes for Older People Page 22 of 32 Evidence: The manager and provider are aware the home could improve its storage arrangements (see recommendations). For example, a communal bathroom on the upper floor was being used to store wheelchairs that needed repair. The manager assured us this was not having adverse impact on the availability of bathing facilities for residents and that the bathroom will be brought back into use when the wheelchairs are fixed. Our expert noted the floors in two bathrooms were looking grubby through age. The home should replace the flooring in the bathroom on upper floor (opposite Parker bathroom) as it is stained around the base of the bath and toilet (see recommendations). We were told that this bath is not often used, as it is easier to use hoists in the Parker bathroom. We noted the home does not have a communal shower, so residents do not have this choice of bathing facility. Our expert saw that the seat of a toilet off the downstairs lounge was incorrectly fitted but this was fixed promptly by the homes maintenance technician when brought to the managers attention. The garden is very well kept with neatly mown lawns and small areas set away from the main garden for private meetings or resting. Our expert found the garden has some lovely features, such as a pergoda and a green house with growing vegetables, and it was only spoilt by an old wheel chair being used as a barrow to transport rubbish to the bins. Several residents told our expert they loved the garden and would like to spend more time outside. However, both the expert and the inspector noted the only easy access to the garden is through a front entrance and then down a sideway where many would be needing a wheelchair because of the distance. Residents would benefit from easy access designed at one of the rear entrances and, in view of imminent building work to extend the home, this is an improvement to consider (see recommendations). Our expert noted that the kitchen is visible from the garden. It has fly screens to the window areas, effectively catching the flies, however these could be brushed off on a daily basis to not only improve appearance but increase light into the kitchen. Appropriate infection control strategies were in place, with disposable aprons and gloves accessible to staff. The laundry on the upper floor was visited and its equipment was found to be in good working order. The home has satisfactory sluice facilities, including a disinfector. In May 2009, the water authority for the area had issued the home with a certificate of non-compliance with water regulations. The manager confirmed the home had now complied with the water authoritys requirements. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are met by suitably trained and competent staff members. The homes recruitment practices are robust, and protect and support residents. Evidence: On the day of inspection, there were two qualified nurses and four carers on duty to support the twenty-seven people in residence. The manager was in charge of the home and there were also two cleaners, a laundry assistant, two catering staff and a maintenance technician on duty. Three of the eight residents who returned our questionnaire stated staff are always available when they need them, with four stating this is usually the case and one person saying that staff are sometimes available. A resident commented that something the home could do better is to have more staff sometimes. A relative commented it is important for the home to make sure staffing levels do not drop too low and that staff have enough time to talk to residents. Another relative said there had been long periods Nov-April with very few staff. Each of the two staff members who responded to our survey stated there are sometimes enough staff to meet residents individual needs, with one offering comments on the need for more staff because of the dependency levels of the people living in the home. Staff members spoken with during the inspection said staffing levels had been low during last winter but new staff had been recruited so that the home was properly staffed now. A staff member said the home was currently recruiting for another nurse, which s/he saw as a positive development that would benefit residents and staff. Care Homes for Older People Page 24 of 32 Evidence: Our expert by experience spoke with many of the residents and with one visitor to the home. The comments made were generally that people were pleased with their care and had no complaints, although there are staffing issues which were causing concern for some residents. It was said by more than one person that the staff whizz in and whizz out as they are so busy. This rushed approach made more than one person feel anxious about using the call alarm at night as staff might be too busy to attend or would not be pleased. However, staff did attend if the alarm was used. Residents told our expert they had to wait for personal care such as assistance to the toilet when staff had their breaks, as often only one staff member was available. When two staff were needed the resident was told to wait, sometimes up to an hour for care. On the day of our inspection, our expert observed some of the beds were not made until after lunch. Although this is not necessarily a problem in itself, one of the beds was soiled and had been missed by staff earlier in the day. One person requested our expert change the library books that had been read three times, as it was said the staff were too busy to be asked to change them. The inspector and the expert by experience discussed the staffing arrangements with the manager as part of giving feedback from the inspection visit. The manager stated that the home has enough staff at the present time and that staffing levels are kept under review. She confirmed she was aware the home must be staffed according to the dependency needs of its residents. She confirmed the home was recruiting another qualified nurse and a new activities coordinator to enhance the levels of service provided. The manager said she had become aware that some staff members have been telling residents the home is short of staff. She said this may sometimes be offered as an excuse for not spending time to chat with residents, which she said staff will be reminded is not acceptable. Two of the eight residents who responded to our survey stated staff always listen to them and act on what they say, five residents stated staff usually do this, and one stated that they sometimes do. A resident commented that something the home does well is that staff have a friendly and caring attitude. Three staff files sampled for inspection had the recruitment information required and it was evident that our requirement to obtain information about an applicants previous work history had been met. Each of the two staff members who responded to our survey confirmed their employer had carried out checks, such as references and Criminal Records Bureau disclosures, before they started work in the home. Of the four relatives responding to our survey, one stated staff always have the right Care Homes for Older People Page 25 of 32 Evidence: skills and experience to look after people properly, two stated they usually do and one relative did not answer this question. One of the two staff members who returned our questionnaire stated their induction had covered everything very well what they needed to know to do the job when they started, and one stated the induction had mostly covered everything. Each of the two staff members stated they were being given training that is relevant to their role, helps them understand and meet peoples individual needs, keeps them up to date with new ways of working, and gives them enough knowledge about health care and medication. Three staff members were spoken with during the inspection and each discussed the training they had undertaken. A nurse said she gets support with professional development, and had completed study events on first aid, CPR, dementia, and end of life care. Two carers spoke about their NVQ programmes. One had recently completed level 2 and the other was undertaking this programme. Both said their they had been able to apply various aspects of their training in their work with residents. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives may be assured the home is being run well. Processes for assuring the quality of service provision are good. The home promotes the health and safety of its residents, visitors and staff members. Evidence: It was evident the home was being managed well by the acting manager, who has worked at Clairleigh in the past and has managed a similar care home elsewhere. The managers registration application was being processed and the outcome was awaited. She had just had an interview with the commission in this respect. Of the four relatives responding to our survey, three stated they are always kept up to date with important issues affecting their relative, and one did not answer this question. One commented that, Clairleigh is a very well run nursing home. Each of the two staff members returning our questionnaire stated the ways in which they share information about residents with other carers and the manager sometimes work well. Care Homes for Older People Page 27 of 32 Evidence: The annual quality assurance assessment (AQAA) provided to us by the homes manager was clear and contained relevant information. The AQAA told us about changes made and also identified where the home still needs to make improvements. The home has strategies to assure the quality of its services, in which the views of residents, their representatives and staff members are taken into account. The homes regulation 26 file that was seen during the inspection showed that visits had been undertaken each month and reports produced. The manager holds client/resident meetings and minutes were seen for the most recent of these in May 2009. Twelve residents had attended and various aspects of service provision had been discussed. The manager carries out regular quality audits of care plans and medication administration. The manager confirmed the home pays for services such as hairdressing in advance and an invoice is then sent to the family or other representative of the resident asking for reimbursement. Residents either look after their money or, where preferred, their families provide residents with small amounts of money for expenditure on items such as newspapers or toiletries. Of the two staff members responding to our survey, one stated the manager gives them enough support and often meets them to discuss how they are working, the other stating this is sometimes the case. It was evident most staff were receiving supervision but this was not the case for two staff members who had not been working in the home long. The manager stated she has met informally with these staff but accepted the evidence for their supervision needed strengthening (see recommendations). Health and safety documentation and maintenance records were sampled and, with one exception, were found to be up to date and within the appropriate timeframes. The sample included documentation about gas and electrical safety, lifting equipment, disposal of waste, and fire prevention. This documentation, together with a tour of the premises, discussions with the manager and with the homes maintenance technician, provided evidence that the home continues to promote the health and safety of its residents, staff and visitors. The only documentation not evident was that for the fiveyearly electrical installation check, which the manager said would be forwarded when available. She has subsequently confirmed the check is not due until January 2010. The homes fire risk assessment was available for inspection, the fire alarm had last been checked in June 2009, and fire drills had been recorded for March and June 2009. As noted above under standard 26, the manager confirmed the home had complied with requirements from the water authority. The most recent food hygiene Care Homes for Older People Page 28 of 32 Evidence: inspection from the local authority in May 2008 had resulted in an excellent rating, with the environmental health officer finding no actions that the home needed to take. Care Homes for Older People Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The registered person should ensure the monthly reviews of all care plans offer evaluative comment as well as confirming the plan has been reviewed. The registered person should review the arrangements for lunch to ensure residents are not hurried to finish their meals. The registered person should consider replacing the flooring in the upper floor bathroom. The registered person should consider making direct access to the gardens easier for all residents. The registered person should review the storage provision for aids and equipment, including wheelchairs. The registered person should ensure it is evident that all care staff receive supervision in line with the frequency set out in the standard. 2 15 3 4 5 6 19 19 22 36 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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