Care Home: Claremont House

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What the care home does well The admission practice ensures that residents are fully assessed before an admission is considered, and only progressed if appropriate for the prospective resident and the home. Claremont House provides an individualised provision of care and support, and accepts people for who they are, without any judgements being made. Feedback from all sources about the care, services and staff was positive and comments included `the food is always good` `They bend over backwards for you` `They do so much with the residents if they are going anywhere in the day they take one of the residents with them` `staff are very caring and practical`. The care provided was focussed on mainatining a normal and as happy life as possible, and observation confirmed that residents have a good level of autonomy, choosing how and where they spend their time. The atmosphere in the home is relaxed with a very good rapport being noted between staff, residents and visitors. The location and layout of the home are suitable for its stated purpose. All areas of the home are very clean and accessible What has improved since the last inspection? This is a new service that has not been inspected before. Karon Crouch has been the manager of Claremont House since May 2005, and now as the Director of the Company that owns the service, continues to work at improving the service and facilities. She is now able to plan an ongoing financial investment in the home for the benefit of residents. What the care home could do better: Although no requirements have been made following this inspection the manager has agreed to action a number of shortfalls, to ensure the home is run in accordance with the Care Home Regulations 2001. These are documented within this report. Key inspection report Care homes for older people Name: Address: Claremont House 40-42 Claremont Road Seaford E Sussex BN25 2BD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Melanie Freeman     Date: 2 0 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 25 Information about the care home Name of care home: Address: Claremont House 40-42 Claremont Road Seaford E Sussex BN25 2BD 01323893591 01323893591 claremontrest@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Karlex Care Ltd Name of registered manager (if applicable) Ms Karon Jane Crouch Type of registration: Number of places registered: care home 19 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 suers who can be accommodated is: Nineteen (19) The registered person may provide the following category/ies of service only: Care home only - PC To service users of the following gender:Either whose primary care needs on admission to the home are within the following caegory/ies: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home Claremont House is registered to provide personal care and support for up to 19 older people who are frail and need assistance. The registered Proprioter is Karlex Care Ltd which has owned Claremont House Rest Home since July 2009. Karon Crouch is the company Director and the registered manager of the home. Care Homes for Older People Page 4 of 25 Over 65 19 0 Brief description of the care home Claremont House is situated in a residential area of Seaford it is within walking distance of the high street and the railway station, with the library, GP and dental surgeries easily accessible. It is just off the main road and parking close to the home is imited, although availble in local roads. The home is on four floors with a shaft lift that enables residents safe access to all parts of the home. It provides an attractive ienvironment for the residents that includes a ground floor lounge, separate dining room and front area conservatory. Most bedrooms have en suite facilities an assissted bathing facillities are availble to all residents. There is a sheltered patio and garden at the rear of the home and this provides an attractive seating area for residents to use when weather permits. Weekly fees range from the funding supplied from the placing authority to £450. These fees do not include hairdressing, chiropody or any outing costs, newspapers and magazines are charged for. Care Homes for Older People Page 5 of 25 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: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term service user to describe those living in care home settings. For the purpose of this report, those living at Claremont House will be referred to as residents. This was a key inspection that included an unannounced visit to the home on Wednesday 20 January 2010. It was its first inspection since its change of ownership in July 2009. Claremont House is now owned by Karlex Care Ltd, the Director of this company is Karon Crouch who is also the registered manager, and will be referred to as the manager within this report. The allocated inspector spent approximately five hours in the home in total and was able to discuss matters with the manager, who received the inspection feedback at the conclusion of the visit. Care Homes for Older People Page 6 of 25 A tour of the premises was undertaken and a range of documentation was reviewed including the homes statement of purpose and service users guide, pre admission assessment procedures, the systems in place for handling complaints and protecting residents from harm, staff recruitment files, quality assurance systems and some health and safety records. The care documentation pertaining to two residents were reviewed in depth and each of these residents were met with. The required Annual Quality Assurance Assessment (AQAA) was completed when requested and information provided within this has been used to inform this report. Care Homes for Older People Page 7 of 25 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 following this report, you can contact them using the details 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 8 of 25 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 9 of 25 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. Prospective residents receive sufficient information on the home to enable them to make an informed decision over whether the home is the right place for them. The admission procedure allows for the needs of prospective residents to be assessed by a competent person before admission. Evidence: The home has a suitable service users guide and statement of purpose. These were available along with other useful information in the front entrance hallway. The registered manager confirmed that all prospective residents are given a copy of the service users guide before admission. Information within these documents was both full and informative. Discussion took place with the manager about ensuring all residents have their contractual arrangements clarified, with regard to the change of the homes ownership. She confirmed that this matter was in hand. Care Homes for Older People Page 10 of 25 Evidence: An assessment of the admission process included a review of the documentation used in respect of the last two admissions to the home. This confirmed that all prospective residents are assessed by the registered manager before admission. The assessment process was thorough, although it was highlighted that the assessment documentation could be further improved by reflecting and recording where the assessment is completed. Some residents stay in the home for respite care, and all residents are welcome to stay in the home for a trial period, so that they can decide if the home meets their needs. Once the assessment is completed the manager writes to the prospective resident. A review of this letter identified that it needed to be amended to confirm the outcome of the assessment, and if the home is able to meet the prospective residents assessed needs, in accordance with the associated regulation. Intermediate or rehabilitative care is not provided at Claremont House. Care Homes for Older People Page 11 of 25 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. The individual plans of care set out the residents personal and health care needs, which are met with the advice and support of community health care professionals. The homes practice ensure residents medicines are stored and administered safely. Care is delivered in such a way that promotes and protects the residents privacy, dignity and individuality. Evidence: The care documentation pertaining to two residents were reviewed as part of the inspection process, and each of these residents were met with during the inspection visits to the home. The plans of care were found to be individualised and focused on the person, however specific guidelines for staff to follow were not full, and need to be further developed to ensure care is specifically tailored. There was evidence to confirm that the care documentation is reviewed regularly and updated when changes occur. Although the manager said that residents are involved in the planning of their own care there is no system to to record this consultation, and this was discussed with the Care Homes for Older People Page 12 of 25 Evidence: manager for her to address. A number of routine risk assessments are completed and include those associated with outings, moving and handling, medication, scalding and access to money. Work has also been completed on nutritional screening including training from the Dietitian. All residents are weighed and screened, and if necessary a full nutritional assessment is now completed. These assessments are used to promote residents independence and to identify any health problem early. Risks associated with pressure damage however are not assessed and this was raised with the manager for her to address. All feedback about the care provided was positive and comments received included they bend over back wards for you I am extremely happy here One professional shared that two of her clients are delighted with their care in the home. The home has a well equipped area for the storage of medicines. The Medicine Administration Records (MAR) charts evidenced that medicines are administered safely and in accordance with prescriptions. Staff who administer medicines are suitably trained, and practice seen during the inspection confirmed that medicine administration is completed in a safe way. During the visit it was noted that a warning sign that the medicines room contained oxygen was ion the door, although there is no oxygen in the home. The manager was asked to remove the sign and she said that this would be actioned. Some medicines are prescribed on an as required basis and discussion took place with the manager around providing written individual guidelines to ensure staff administers these in a consistent way. She advised that a new supplying pharmacist has been sourced and that they are currently reviewing the homes procedures equipment and facilities to promote best practice throughout. It was clear from direct observation that residents are treated in a respectful manner, with their views and choices being taken into account at all times. Staff were seen to be sitting and chatting with residents both enjoying each others company. One residents shared how her room was decorated while she was in hospital in a colour that she had admired earlier. She said that she thought it was a lovely thing to do. Care Homes for Older People Page 13 of 25 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. Residents are supported to lead their lives how they choose. Residents benefit from a relaxed atmosphere where some regular activity is arranged, and residents are supported in maintaining relationships with their families and friends. The meals in the home are good offering both choice and variety, and catering for special diets. Evidence: Claremont House has a relaxed atmosphere with residents able to move around the home as they wish. During the inspection visit some resident chose to stay in their own rooms coming to the dining room for meals, others preferred to mix with each other, in small groups. During the visit residents were asked if they wanted to go for a ride in the car and have a coffee stop. Residents looked forward to this, and said that they enjoyed any outing arranged. One professional spoken to commented on the way the home maintains activity They do so much with the residents if they are going anywhere in the day they take one of the residents with them. The AQAA confirmed that the home works hard to respond to what the residents Care Homes for Older People Page 14 of 25 Evidence: would like to do, with a variety of activity including a motivation to music session provided every week, and other regular activity organised by staff. Interaction with staff is very important to the residents, and this was seen to be positive and proactive. Visitors are very much encouraged and are able to stay for lunch if they wish. Links with the local community are good, most of the residents are from the Seaford area, or have families living close by. The manager confirmed that she and the staff have received training on Deprivation of Liberty and the Mental Capacity Act, and that the appropriate policies and procedures will be provided to underpin the practice in the home. A meal was eaten with residents and this was well presented and was of a good standard. Most residents chose to eat in the dining room, which was attractive and staff were at hand to help, and respond to any comments or requests. The food provided focuses on home cooking and the tables were set out attractively, and had the necessary condiments. Mealtimes are not rushed and are seen as a social event that residents can spend as long as they want completing. Residents talking to each other during the meal said how much they liked the food in the home and that it was always good. Care Homes for Older People Page 15 of 25 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. Residents benefit from an open culture where they are able to express their views, and are confident that any complaint made would be listened to, and responded to appropriately. The managers overview of the home would ensure that any safeguarding issue raised would be responded to quickly and appropriately. Evidence: A clear complaints procedure is displayed in the entrance area and a copy is available within the service users guide. The AQAA recorded that there had not been any complaint since the change of ownership of the home. Residents spoken with had no concerns, and felt able to talk to the staff and manager if they did. There are written policies covering adult protection and whistle blowing. These need to be updated to accurately reflect the most recent local policies and procedures on Safeguarding Vulnerable Adults. The manager confirmed that the home has a copy of the most up to date local procedures and that the homes procedure will be updated accordingly. The manager has a good understanding of safeguarding matters having worked with social services on investigations before. Staff recruitment files confirmed that staff have the required Protection of Vulnerable Care Homes for Older People Page 16 of 25 Evidence: Adult check completed along with a Criminal Records Bureau check (CRB) before they are employed. Care Homes for Older People Page 17 of 25 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 a comfortable, clean and homely environment, that is well decorated and maintained. Evidence: The home is a converted premises located in a residential area in central Seaford. The environment is attractive and furnished to a good standard, with evidence of ongoing redecoration and furniture replacement. It is well maintained and has a good standard of cleanliness throughout. The home provides residents with comfortable individual rooms that many have personalised with their own ornaments and small pieces of furniture. The rooms are individually heated and furnished appropriately. Communal rooms include a lounge on the ground floor with a large television, a separate dining room and a small conservatory at the front of the property. A shaft lift enables residents to access all parts of the home safely and residents are mobile enough to ensure they are able to use all areas of the home. Laundry facilities are situated separately from the kitchen and training is provided for staff regarding infection control. Care Homes for Older People Page 18 of 25 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. Staffing numbers and skill mix provides a well motivated staff team that meets residents health and personal care needs. Although the recruitment practice on the whole is good associated record keeping needs to be improved. Evidence: At the time of this inspection visit 16 residents were living at Claremont House. Staffing arrangements provide three carers working in the morning with two working in the afternoon from 3pm to 10 pm in the evening. There is one carer working at night. The manager also works in the home most weekdays and cleaning and catering staff are employed in addition. Discussion with the manager confirmed that the staffing arrangements are flexible with extra staff provided throughout the day and night, if the dependency and activity in the home indicated the need for further staff. On call facilities are well established with senior staff able to reach the home quickly if necessary. General feedback about the staffing levels from staff and residents reflected that they were appropriate, and met the needs of the current residents. The manager advised that she has discussed the staffing arrangements with the Care Homes for Older People Page 19 of 25 Evidence: Firebrigade, and a lone working policy for the night staff is in place. The recruitment files pertaining to two staff were reviewed as part of the inspection process and on the whole were found to be comprehensive. They included an application form, evidence of two references and the required Criminal Records Bureau (CRB) and POVA checks on all staff. It was however noted that a health check is not completed and an up to date photograph is not retained. Employment letters and job descriptions are not within the files, and there was no evidence that induction training is completed. These shortfalls were identified to the manager, who said that these matters would be addressed. All feedback received about the staff working in the home was very positive, and observation confirmed relationship between staff and residents were positive and productive. A visiting professional commented on the huge effort that is made particularly by the manager, to engage with the residents, and also commented on the very caring and practical approach of staff. Staff training is well developed and co-ordinated through a training consortium. A training programme is developed for each year and staff are required to attend mandatory training, that includes fire training, health and safety, moving and handling and safeguarding vulnerable adults. The AQAA confirmed that all staff have completed a National Vocational Qualification in care at a level 2 or above. Care Homes for Older People Page 20 of 25 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 benefit from and experienced and competent manager who ensures a clear ethos for the home, that enables staff to provide good quality care to residents that responds to their views and preferences. Residents financial interests are safeguarded. The health, safety and welfare of residents and staff are generally well promoted. Evidence: Karon Crouch has been the registered manager of Claremont House since May 2005 and is the Director of Karlex Care Ltd, which purchased Claremont House in July 2009. She has continued to manager the home and is well motivated and committed to promoting the best possible care for residents. She is working to develop the service and a comment from a visiting professional confirmed since the purchase of the home things have only got better. She has the registered managers award and a National Vocational Qualification in care at level 4, and provides a high level of supervision and support to the staff working in Care Homes for Older People Page 21 of 25 Evidence: the home. The managers approach is open and encourages residents, relatives and staff to be involved in developing the services offered. The manager still maintains a high profile in the home and continues to have close positive relationships with residents, focusing on promoting a healthy happy life for people living in the home. The systems for monitoring the quality of care and services in the home needs to be re-established and the manager is aware of this. She continues to progress any required works in the home to ensure high standard of health and safety. The home does not take any responsibility for any of the residents finances and most residents have family, friends or representatives who protect their financial affairs. If residents want to purchase anything or need a private service, this is financed by the home and then invoiced for separately in the monthly accounts. The AQAA confirmed that all the necessary safety checks are completed, and the manager was able to confirm that all the required fire training checks and risk assessments have been completed. Environmental risk assessments are completed regularly and there was evidence that these are actioned as necessary, to promote a safe environment for staff and residents. Care Homes for Older People Page 22 of 25 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 23 of 25 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 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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. 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