Care Home: Claremont Nursing Home

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What the care home does well We observed some very good interaction between staff and people who live at the home. People were complimentary about the quality of staff. One person said, "They couldn`t have a nicer set of girls." Another person said, "They deserve a medal, they are good with people in the nursing home. You can`t fault them." People live in a pleasant, comfortable and clean environment. What the care home could do better: Routines should be reviewed to make sure people are not getting up too early on a morning and people don`t spend excessive amounts of time in wheelchairs. Better systems should be in place to make sure people`s nutritional needs are met, and people consistently receive nutritionally balanced and varied meals. Systems should be further developed to make sure care plans accurately reflect people`s needs and daily records have sufficient information to show if and how their needs are being met. Care staffing levels should increase so the management team can focus on improving the quality of the service. The management team said they have identified that staffing levels should increase but these have not yet been implemented. On the day of our visit people who live at the home were receiving support from carers and from the management consultant and the project manager so there was sufficient staff. However, if the management team had not been providing personal care there would not have been enough staff to meet people`s needs. The home should provide a more consistent service to people. Systems are introduced to address concerns but these are not always maintained. The management team could be more open and transparent with the systems they have in place to manage the home. Random inspection report Care homes for older people Name: Address: Claremont Nursing Home New Street Farsley Leeds Yorkshire LS28 8ED one star adequate service 15/01/2010 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Carol Haj-Najafi Date: 2 4 0 8 2 0 1 0 Information about the care home Name of care home: Address: Claremont Nursing Home New Street Farsley Leeds Yorkshire LS28 8ED 01132360200 01132360472 clmont@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: Conditions of registration: Category(ies) : Park Homes (UK) Ltd care home 63 Number of places (if applicable): Under 65 Over 65 0 63 dementia old age, not falling within any other category Conditions of registration: 10 0 The maximum number of service users who can be accommodated is: 63 The registered person may provide the following category of service only: Care Home with Nursing (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 - maximum number of places is 63 Dementia, Code DE - maximum number of places is 10 Date of last inspection 1 5 0 1 2 0 1 0 Care Homes for Older People Page 2 of 11 Brief description of the care home Claremont is a converted, extended, detached property, situated near the centre of the village of Farsley. The home is close to local bus routes and within easy access of a mainline railway station and the main roads to Leeds and Bradford. The home was first registered in September 1991. Park Homes UK Limited owns it. The home is registered to accommodate sixty three older people who can have nursing needs. Accommodation is offered in a combination of forty seven single and eight double rooms; all bedrooms but one has en-suite facilities. Twenty six single rooms have a walk in shower. The communal facilities are four bathrooms and ten toilets. People have a choice of three lounges, and there are two spacious dining rooms. Gardens are available consisting of lawns and an enclosed garden to the rear, with level access from one of the lounges. Car parking is provided to the front of the property. At the inspection in January 2010, the manager told us the fees range from £551.77£781.50. Information about Claremont Nursing Home, including the last inspection report and up to date fees is available at the home. The homes Statement of Purpose and Service User Guide is available on request. Care Homes for Older People Page 3 of 11 What we found: We carried out this random inspection in response to information we received about Claremont Nursing Home. Some concerns were raised through safeguarding vulnerable adults about nutrition (food intake), hydration (fluid intake), moving and handling, personal care, record keeping and medication. Before we carried out this inspection we looked at; - Relevant information from other organisations and what other people have told us about the service. - Information we have about how the service has managed any complaints or safeguarding incidents. - What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. - Previous inspections. Two inspectors carried out an unannounced visit to the home on 24 August 2010. We spent five and a half hours at the home and spoke to people who live at Claremont, visitors, staff, the area manager, regional manager, a management consultant and a project manager. We also looked at some records. At the end of our visit we provided feedback to the area manager, regional manager and management consultant. In July 2009 admissions to the home were suspended by the local authority because the home was not providing a safe service. At our inspection in January 2010 we found that the home had made some good improvements. In June 2010 concerns were raised again about the service. At this inspection it was evident that the provider has brought in additional management support to address the issues at the home but we found that there is still a lot of work that needs doing before we can feel confident that people will receive a service that consistently meets their needs. One person said, The problem is, its up and down. Another person said, Its a yo-yo service. At the inspection in January 2010 the management team explained that they had split the home into two units and the staff were working in two teams, which had improved allocation of duties and made workloads more manageable. This has not been maintained because the management team told us at this inspection they still have this to do, and are planning to split the units in the next few weeks because this will improve the service. At the key inspection in January 2010 we found that people who live at the home were happy with the quality of staff that support them although staff did not always have sufficient time to meet peoples needs at the appropriate time or spend quality time with them. We made a requirement that there must be enough staff available at all times to meet the assessed needs of the people living in the home taking into account the size, the layout and purpose of the home. When we visited on 24 August seven care staff and two qualified nurses were on duty. Care Homes for Older People Page 4 of 11 The manager, a management consultant and a project manager were also at the home when we arrived at 8.30am. The area manager had been spending most of her time working at Claremont and arrived shortly after 8.30am. The area manager informed us forty five people were living at the home at the time of our visit. We asked people about staffing. The majority of people said the quality of staff are good but they thought staffing levels could be better. One relative said, They dont have enough staff. This is the main problem. The area manager confirmed that they have identified that staffing levels should increase and are taking steps to address this by recruiting some additional staff. They told us that they are increasing care staff to eight during the day and six care staff on an evening (one person also has a carer allocated to work with them on a one to one basis). There is also a two hour period during the evening when only one qualified nurse works at the home but they are going to increase the qualified hours so two nurses work from 8am to 8pm. We looked at staffing rotas. The area manager said they had not yet implemented their identified staffing levels but the rotas showed us that on occasions the home has operated with only five care staff on an evening. When we spoke to the project manager, who is responsible for arranging staffing, she informed us that she and the management consultant sometimes work as carers during the week so are sometimes included in the care staffing numbers. She said they do not work weekends. After discussing weekend cover, we asked to look at a previous weeks rota. We were told these had been filed away but this was given to us a short time after our request. The rota showed us that eight care staff had worked during the evening on Sunday 15 August, which was higher than the usual staffing numbers. Because this was unusual, we asked for the staffing costings which showed us that two staff had not worked the hours that were recorded on the rota. The management team could not explain the discrepancy between the staffing costs and the rota. We observed practices at the home during our visit and noted that staff were pleasant and courteous and talked to people when they were supporting them. We observed some very nice interaction from staff. People were also complimentary about staff. One person said, They couldnt have a nicer set of girls. Another person said, They deserve a medal, they are good with people in the nursing home. You cant fault them. When we arrived at 8.30am, fifteen people were in the dining room. By 8.45am eighteen people were in the dining room. A dining room assistant, the management consultant and the project manager were supporting people with their breakfast. Care staff were helping people to get up and then assisting them to the dining room for breakfast. On arrival people were offered a hot drink and a choice of cereal, toast or a cooked breakfast. Staff confirmed that most people who live at the home need two staff to support them with personal care and are unable to walk unaided. The majority of people were in wheelchairs when they were in the dining room and were then wheeled into the lounge after breakfast, however they were not transferred into lounge chairs for some considerable time. From 9.10am we observed that people started being taken to the lounges and were parked near lounge chairs. Some people had their backs to the television. At 10.10am one staff turned on the television but did not move people so they could see the screen. In one lounge managers asked staff to start doing transfers at 10.10am and 10.15am. At 10.25am staff started transferring people into lounge chairs. Care Homes for Older People Page 5 of 11 During our visit we were concerned that a lot of people were up early and that people had been in wheelchairs for long periods of time. We could not establish what time people were up but some people must have been up for quite some time considering that fifteen people were up at 8.30am. At 8.45am we observed that four people were asleep at the dining tables. One person was asleep with their head on the table. We received mixed feedback about the timing that people get up on a morning. Some people said it was unusual that fifteen people were up at 8.30am. Other people said it was common practice. One staff said, Night staff get up about half from each side. We observed that two people were still in wheelchairs at 11.35am. Staff said that one person didnt like to sit in an easy chair and can get aggressive and the other person was difficult to transfer. We looked at the care records for both people but they did not have any information about difficulties in transferring or not liking to sit in easy chairs. We looked at four months of daily records for one person and three months for the other person and these had no reference to any difficulties in transferring. One persons care plan said they have a history of falls, they are unable to walk and try to stand up unassisted. When sitting in the wheelchair they will sometimes undo their wheelchair strap and occasionally will rock the wheelchair over whilst sitting in it. The care plan said they must be supervised at all times and a telecare mat should be placed near their feet. The person was not supervised and there was no telecare mat in place. One of the qualified staff discussed management of people who are at risk of under nourishment. She said they weigh some people weekly, complete fluid and food intake forms, and at the time of our visit they did not have any serious concerns about any individual. One visitor whose relative is at risk of under nourishment said, Since she arrived she has picked up tremendously. Another persons care plan showed a steady increase of weight since April 2010. We looked at the fluid and food intake charts. These were filled in on a regular basis but the charts were not totalled which is part of the process to establish if people are receiving enough food and fluid. The charts were stored in various offices in the home, were disorganised and did not appear to have been audited. Records for each person were not kept together. One visitor raised a concern because they had been asking for over two weeks for their relatives nails to be cut because they were long and had scratched their face. We looked at the persons nails which were dirty and very long, and they had a scratch on their face. The area manager agreed to make sure the persons nails would be cut on the day of our visit. We were informed that the home is only using one dining room. One staff said this was because it had just been decorated, another staff said it was because one of the hot trolleys to keep food warm was broken. The area manager said they found using one dining room worked better but they would revert back to using both dining rooms when the proper staffing arrangements are in place. The area manager confirmed that the hot trolley had been condemned and a new hot trolley was on order although during feedback the regional manager pointed out that a hot trolley was not required for one of the dining rooms because it is next to the kitchen. The main chef was on annual leave at the time of our visit and the kitchen assistant was doing the catering. He usually cooks two days a week so has experience and knowledge Care Homes for Older People Page 6 of 11 of preparing and cooking meals at the home. People have their main meal at lunch time which on the day of our visit was chicken pie, potatoes and mixed veg, and rice pudding. We were told they had not yet decided what was a second choice because they were not following the menu. We found out later that people were being offered sausages as a second option. We were also told they did not record the meals served when the menu was not followed and confirmed that the day before our inspection people had sausages or burgers or fried eggs, chips, peas and sweetcorn, and fruit pie and custard. At the feedback, the management team said food was recorded and produced a food record although this confirmed that the menu is not always followed. We observed sandwiches being made at 9.10am which were being prepared for teatime. We asked about special diets/requirements, such as liquidised meals, fortified (high calorie)or diabetic meals. We were informed that eight people had liquidised meals but there was no information in the kitchen about any other special diets. At 1pm we walked into the dining room that was not in use and saw a notice displaying a change in menu for the day. We expressed our concerns during feedback and said we did not believe this was usual practice and had only been displayed for the benefit of our inspection. During our visit we observed regular drinks of tea and juice being offered to people, and staff assisted to drink when appropriate. We spoke to staff about the care that is provided at the home. Staff said they did not have any serious concerns about the home, they said people get good care and everyone works well together. They said management deal with issues appropriately and they receive good training. Every staff we spoke to said they have received up to date moving and handling training and safeguarding vulnerable adults training. We spoke to one of the moving and handling assessors/trainers. She confirmed that staff received regular training and good systems are in place to make sure people are transferred appropriately. We observed staff using hoisting equipment, which they did with confidence and competence. We observed medication administration and looked at medication records. Medication was administered appropriately and we did not note any omissions in the medication administration records. The management consultant and area manager informed us that a medication inspection was carried out by the Primary Care Trust shortly before our inspection. They said no serious concerns were raised and all the recommendations from the visit had been implemented. The provider has brought in a management team to address some of the concerns that have been raised through safeguarding investigations. The management team talked about recent improvements that have been made at the home which includes better medication systems, more external entertainers visiting the home, better staff interaction with people who live at the home, better routines for personal care, and more information in care records about what people like to eat and drink. They said relatives are happier with the care that is being provided at the home and they are receiving more positive feedback. The management team said generally they thought the home has made good progress. The area manager said they are working with a dietician to further improve systems to meet peoples nutritional needs. At the inspection we identified some areas of concern that do not appear to have been identified by the management team such as, times that people are getting up on a Care Homes for Older People Page 7 of 11 morning, people sitting in wheelchairs for long periods of time, care plans that do not reflect peoples needs and care plan guidance that is not followed, inadequate systems for monitoring food and fluid intake, inadequate systems for consistently providing nutritionally balanced and varied meals and specialist diets, inappropriate preparation of food. During feedback the management team acknowledged that the inspection had highlighted areas where the home still needs to develop and said they would take action to address the key issues. What the care home does well: 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 set out on page 2. Care Homes for Older People Page 8 of 11 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 11 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, 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 1 14 12 Routines must be reviewed 30/09/2010 to make sure practices at the home meet peoples individual needs. This will make sure peoples individual needs are met. 2 15 12 People must receive 30/09/2010 nutritionally balanced and varied meals that meets their individual dietary needs. This will make sure peoples nutritional needs are met. 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 2 7 27 Care plans should be further developed to make sure peoples needs are properly identified Care staffing levels should increase so the management team can focus on management tasks and responsibilities. Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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