Care Home: Claremont Nursing Home

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What the care home does well The home carried out a well organized and comprehensive quality assurance review and used it to address areas for improvement and address issues raised by residents, their relatives, staff and external quality assurance facilitators. The home had an admission process that exceeded minimum standards. They improved the initial assessment form and ensured that all information was collected prior to admitting a new resident. They recorded where specific information came from, for example from a resident, or their relative or from a social worker. The assessment was different for general nursing residents and those that suffered from dementia for the new dementia unit. They did not limit or restrict time for a user to leave, after moving in for a trial period and deciding that the home was not what they wanted. Once in, they enjoyed flexibility and respect for their individuality. The staff knew them well and, working as a team, they communicated all relevant details, thus enabling all staff to provide a consistent and appropriate approach to care. Well organized and written daily records helped this process. Since opening a new unit, specialized in dementia care, the home appropriately addressed different needs of people with dementia and those with physical and general health problems. What has improved since the last inspection? In their self assessment, the home reported on improvements since the last inspection: "We have continously improved facilities and amentities within the home for the benefit of the residents. We have increased the training opportunities for all staff. We have strengthened links with the local community We have improved the operational effectiveness of our home. We have improved the meaningful occupation for residents. We have developed our staff team. We have looked at alternative ways to retain independence for our residents." This statement was double checked by talking to the residents, by observing care practices and checking specific areas addressed through requirements on a previous inspection that had now been met. The manager was in the process of creating a contingency plan for potential flooding, as the home`s location and past experience indicated a high risk. This action showed how thoughtful the management team was regarding the safety of residents. What the care home could do better: The home identified areas for improvements themselves. For example, the activities scored low in their quality assurance review and the home created a plan on how to improve this aspect of provisions and already started implementing their plans. The bungalow style of the building required some kind of blinds on the windows facing the car park, or those facing the communal garden, to ensure better privacy, in addition to the existing curtains that would restrict daylight if closed. The manager admitted that the supervision programme was slightly behind schedule, as the staff files also indicated, but explained that there was a plan to "catch up", as she stated. Key inspection report Care homes for older people Name: Address: Claremont Nursing Home 20a Yarmouth Road Caister-on-Sea Gt Yarmouth Norfolk NR30 5AA     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: Dragan Cvejic     Date: 2 3 0 7 2 0 0 9 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 26 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 26 Information about the care home Name of care home: Address: Claremont Nursing Home 20a Yarmouth Road Caister-on-Sea Gt Yarmouth Norfolk NR30 5AA 01493377041 01493377022 manager@clarementnursinghome.healthcareho mes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Healthcare Homes Limited care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 50 The registered person may provide the following categories of service: 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 categories: Old age, not falling within any other category - Code OP, Physical disability - Code PD, Dementia Code DE Date of last inspection Brief description of the care home Claremont is a purpose built care home providing both personal and nursing care for up to 26 service users. It is owned by Healthcare Homes ltd. The home is situated in the centre of Caister on Sea and is close to shops, post office and other amenities. The home was purpose built and opened in 1996. It is a single storey building surrounded Care Homes for Older People Page 4 of 26 50 0 50 Over 65 0 50 0 Brief description of the care home by extensive grounds that are easily accessible with extensive parking. New extension expanded facilities provided, as the home got a new unit, mainly for people who suffered from dementia. This new unit instigated re-development of the kitchen, laundry room and several new communal areas for residents. The current range of weekly fees is presented in their welcome documents. Care Homes for Older People Page 5 of 26 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 quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. After reviewing the service through an annual service review last year, the home continued to provide very good service for the people that were cared for and supported in Claremont Nursing home. The inspection showed that the home was moving towards an excellent rating and has achieved excellent outcomes for service users in some areas, only needing the time to show consistency in quality to achieve an overall excellent rating. This was an unannounced inspection. It was carried out by link inspector Dragan Cvejic who also provided this report. This site visit lasted for 7 hours and the inspector spoke to five service users, to two visitors, to the staff members, to the manager and to the dementia unit manager. Documentation related to three case tracked service users was checked, as well as Care Homes for Older People Page 6 of 26 three staff files. A self-assessment form was filled in by the home and was used to inform this report. The comments from some relatives and visitors were also considered when the evidence was collected. The tour of the home provided information about the environment. We observed staff while working and helping residents to get a picture of residents satisfaction, interactions with staff, to check respect for dignity and to check how the staff followed set working procedures. We checked medication storage, administration and records, as well as records of money kept on behalf of residents. Care Homes for Older People Page 7 of 26 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 26 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 9 of 26 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 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home exceeded minimum standards in this group by providing an excellent admission process and allowing users to make a fully informed choice of home. Evidence: The home was in the process of updating their statement of purpose and service users guide, not only to include information about the new unit, but, as they stated in their AQAA: We have improved our website and updated our Statement of Purpose and our Service Users Guide to give more detailed information about the home. This has included the addition of an insert which gives photographs of key team members and a description about them and photographs of some areas of the home. We have done this to avoid only having corporate information about our service. We have prepared some of our documentation in large print and spoken word to assist people. A new form was used for initial assessments. This resulted in a full and comprehensive assessment, as was seen in some of the checked files. The form used to collect initial information was reviewed and a new one developed for Care Homes for Older People Page 11 of 26 Evidence: general care residents. Different approach to initial assessment was in place for the residents suffering from dementia. Forms were checked in 3 files for the general care residents and in two, for dementia sufferers. All forms were appropriate and were used to create very detailed care plans. Observation during the visit showed that staff worked in an organized way and met the residents needs. Care Homes for Older People Page 12 of 26 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. Very detailed care plans, well organized and used daily records and other evidence collected during the site visit demonstrated that the home ensured good personal and healthcare for residents. Evidence: Three checked files in general care unit and two in dementia unit, with care plans, risk assessments and other relevant monitoring tools were effectively used to organize residents care. One of the files indicated potential nutritional problems and MUST tool was used from the admission to ensure safety and good care for the resident. The example in another file that contained a detail description of the residents preferences stated: likes curtains closed and bedroom door half open, lights on. Daily records were kept in a separate folder to facilitate easy access for staff to record their activity and elements of care for each individual. This file easily demonstrated how a resident progressed from not having any bath, to a weekly regular bath that also recorded now likes having a bath and using the sling to get in. The dates in records showed regular reviews, both of care plans and risk assessments, Care Homes for Older People Page 13 of 26 Evidence: were carried out and two residents asked about it confirmed that they were consulted about their care plans. In the entrance hall there was a leaflet with contact details for a manicurist, in addition to what staff provided for residents. Two visitors noticed that their relative had her nails manicured and she explained that staff did that for her. Separate records of any nursing, or external medical professionals visits were kept for each individual. One of the checked files showed how the home successfully addressed risk of falls. After recording two falls, a special mat was obtained to alert staff and reduce the risk to the resident. Pressure sores were also appropriately addressed and the home included the district nurse team in pressure sore prevention. Medication was checked. All records checked for 5 residents were accurate. Storage was improved by installing an air conditioner to maintain appropriate temperature. A new safe box was installed for controlled drugs. Although there were no residents who self medicated their medication, there was a plan for one trial where a social worker was also involved in this process. The list of staff signatories who deal with medication contained the agency staff signatures, too. New procedure instructed senior staff to administer medication undisturbed while another staff member was designated to respond to phone calls or deal with other tasks arising at the time when medication was administered. Observing staff working with residents showed a high respect for their dignity. This was particularly well conducted in dementia unit, where nothing was too demanding for staff and they repeatedly and patiently talked and listened to residents. Care Homes for Older People Page 14 of 26 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. The home provided various activities and listened to residents suggestions in planning and conducting these sessions, thus showing that they respected residents wishes and wanted to ensure that everyone in the home was stimulated and positive. Evidence: This area of provisions scored the lowest in the homes quality assurance review, but this did not mean that residents did not have sufficient choice to join in and take part in the existing activities. A flexible but structured daily routine helped staff respond appropriately to the assessed needs. A resident spoken to stated: They call me to join activities, but it is up to me to decide if I want to or not. They have different things happening here, but I prefer to stay here to watch my TV and read. I love reading and they get me the books and magazines I ask for. An activity took place during the site visit and the 6 present residents enjoyed this rememberance session, provided comments and laughed together. The home was open to visitors and four visitors came during the inspection. Two of them commented that the home was excellent; always keeping them informed and making them feel welcome. Two different religious representatives were regularly coming in allowing residents to Care Homes for Older People Page 15 of 26 Evidence: take part in these activities. A local vicar also helped the manager create a flood contingency plan, as the home was under the risk of flooding and the vicar had knowledge of local weather conditions and how the community was affected by it. Autonomy and choice were promoted and residents were encouraged to remain as independent as possible. Help the aged awarded a certificate of recognition to the home for their successful work. A new kitchen made it much easier for staff to organize cooking and meal times. A new practice to start using the MUST tool as soon as any nutritional problem was identified for residents helped both staff and residents work towards set goals in care plans. Care Homes for Older People Page 16 of 26 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 were protected by clear and easily available complaints procedure and the homes attitude to concerns and complaints, as well as staff awareness of the safeguarding procedures. Evidence: The accessible and clear complaints procedure was displayed at various places around the home. Records of complaints were kept separately, depending on the seriousness and formality. Concerns, suggestions, and grumbling, as the manager called it were recorded in one book and any formal complaints in another. However, both were given appropriate attention and outcomes were sought for all. The manager explained a POVA process after an allegation was made. The Adult Protection Team investigated the allegation and did not substantiate elements in the allegation. However, this process demonstrated how the home took any claims seriously and reacted in an appropriate way. Care Homes for Older People Page 17 of 26 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. This purpose built home provided a nice, appropriate and homely environment for residents, apart from the new dementia unit that was more clinically designed, but still made more homely with appropriate memorable items used to decorate it. Evidence: The location of the home in the centre of the local community was advantaged in terms of access to the local shops, post office and other communal facilities. However, the area was prone to flooding and, regardless of all precautionary measures the risk still existed. In the light of the past flooding, the manager negotiated the best way to reduce risk and was in the process of creating a contingency plan, to ensure protection and safety of residents. The new dementia unit was purpose built. It had long and wide corridors, which were institutional by design, but the home decorated them with elements that stimulated memory and made it more homely. A special adaptation: marking the toilets and bathrooms with yellow doors, helped residents orientation, as two residents were seen finding their way independently. The kitchen was relocated to a more appropriate new room and created better working conditions for staff, making it easier to organize meal times from this new location. Changing the location of the laundry room also improved environmental provisions. The new laundry room had two doors, next to each other and the laundry staff explained: dirty washing was coming through the one door and the clean washing was Care Homes for Older People Page 18 of 26 Evidence: leaving the laundry through the other door. The other infection control measures were also in place. Care Homes for Older People Page 19 of 26 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. An organized and devoted staff team ensured good care for residents. Evidence: The total number of staff of approximately 60 and properly planned shifts ensured that residents needs could be met. The morning shifts were considered as peak times and 5 staff were present in the general unit and 3 in the dementia unit. The rota showed that 4 staff were in the general unit and 2 in the dementia unit for the afternoon shift. A separate night care plan addressed the needs of residents and the home employed 3 and 2 staff in the two units, ensuring that residents needs were met at this time too. The manager reported in their AQAA: We have achieved accreditation as an Investor in People. The Home has an appropriately qualified workforce with 12 staff having achieved NVQ 2 and 12 working towards this qualification. The home has recruited 30 new staff between January 2008 and March 2009. All residents spoken to staded that staff were very good. Three staff files checked contained all required documents confirming a robust and respected recruitment procedure, staff training and supervision records. The AQAA also reported: The home now uses the passport to care workbooks for induction training. A staff member was spoken to and confirmed that she received the training she wanted and needed for her job, and that she felt well supported and generally happy Care Homes for Older People Page 20 of 26 Evidence: working here. Care Homes for Older People Page 21 of 26 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. Good management ensured that the home provided good care to residents, that residents were respected and listened to and that the staff were clear of their roles, worked as a team and felt happy and committed to the home. Evidence: The manager had the skills and experience to manage the home successfully. She stated that she felt well supported by the newly appointed consultant and by sharing management responsibility with the dementia unit manager. Quality assurance programme was used to analyse positive and negative aspects of the home and provided an opportunity to residents, staff and external professionals working with residents to present their views and give suggestions for further improvement. The manager stated that a new set of questionnaires was distributed in June and will be analysed when returned. Records of 4 residents money were checked and were correct. Two residents confirmed that they chose to and had some small money amounts with them, showing that there were no restrictions for them to control their money if they wanted to and Care Homes for Older People Page 22 of 26 Evidence: were capable of doing so. Only the manager and the administrator had access to residents small amounts of personal money securely kept in the home for those who lacked the capacity. Staff supervision was slightly behind schedule, but the management was aware and the plan was in place, as the manager stated to catch up. A new supervision tool: observation of their work with a resident, was used to help and lead both the management and staff in preparing staff personal development plans. Safe working practices were in place, all checks of gas, electricity, equipment etc were carried out as planned and the manager monitored and ensured this. Records were also accurate of water checks and temperatures in the kitchen were checked during the site visit. Accidents/incidents were also regularly recorded, reported when appropriate and monitored to ensure action was taken to minimize further risk when appropriate. Care Homes for Older People Page 23 of 26 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 24 of 26 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 19 Some kind of blinds or would improve privacy of residents rooms facing the car park and other communal area surrounding the home. This would improve residents privacy. Supervision should be conducted in a planned way to avoid delays for staff and to ensure that staff were appropriately supported to meet the residents needs. 2 36 Care Homes for Older People Page 25 of 26 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. 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