Care Home: Claremont Parkway Nursing & Residential Home

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What the care home does well What has improved since the last inspection? What the care home could do better: The management have identified improvements that need to be made to the plans of care to make sure that information is constantly recorded in a timely, detailed and accurate way so that they are able to demonstrate that all of the residents needs are consistently met. The management need to make sure that residents have consistent access to their call bells. Appropriate arrangements need to be made to ensure that people are able to manage their own medication should they wish to do so. Formal consent to administer medication should be obtained from people, or their representative who require or wish to have the staff manage their medication. Care plans need to provide guidance to staff about how to support those residents who might not be able to request a snack, especially if they have not eaten their meals. Staff files need to contain evidence that the right pre-employment checks have been conducted and that this evidence remains available for inspection purposes.0 CARE HOMES FOR OLDER PEOPLE Claremont Parkway Nursing & Residential Home Holdenby Kettering Northants NN15 6XE Lead Inspector Stephanie Vaughan Unannounced Inspection 9th June 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Claremont Parkway Nursing & Residential Home Address Holdenby Kettering Northants NN15 6XE Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01536 484494 01536 524262 claremont@averyhealthcare.co.uk Avery Healthcare Limited Wendy Dent Care Home 66 Category(ies) of Dementia (4), Old age, not falling within any registration, with number other category (66), Physical disability (66) of places Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Provider may provide the following categories of service only: Care home with nursing - Code N To residents 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 and Code PD(E) of the following age range: 35 and over Dementia - Code DE and Code DE(E) (maximum number of places 4) The maximum number of residents who can be accommodated is 66. 2. Date of last inspection 21st May 2007 Brief Description of the Service: Claremont Parkway is a large purpose built facility on the outskirts of Kettering. It has recently been further extended to provide accommodation in 66 single rooms. It is Registered to provide both Personal Care and Nursing Care. Its location in the town makes it easily accessible by private or public transport, being close to the main A14 road. Local amenities in close proximity include a cinema, supermarket, gym, pubs and restaurants. The home is spacious and well equipped. All rooms have telephone facilities, ensuite wash and toilet facilities and TV points. There are pleasant grounds, easily accessed by wheelchair users. The provider makes information available to prospective residents through the Statement of Purpose and Service Users Guide. The Commission for Social Care Inspection Reports are displayed in the home and people who may wish to use the service are also directed to the Commission for Social Care Inspection website. The Commission for Social Care Inspection reports are included within the Statement of Purpose. Fees at the present time are between £ 417:66 & £ 1030:00 per week, with other variable charges for hairdressing, aromatherapy, chiropody, escort services, transport, outings, holiday’s newspapers and personal items such as clothing and toiletries. Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 5 Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is a 2 star. This means the people who use this service experience good, quality outcomes. Prior to this statutory inspection, a period of four hours was spent in preparation. This comprised reviewing the previous inspection reports and associated requirements, the service history, the Annual Quality Assurance Assessment and other documentation. Two comment cards were returned from residents, three from their representatives and three from staff. In general feedback was positive and the comments have been used to inform our inspection activity. Specific comments are addressed in the main body of the report. The Commission have received two concerns about this service and these have been referred to the provider for investigation, one was found to be unsubstantiated another investigation is ongoing. However the information received has been used to inform this inspection and issues are addressed in the main body of the report. There have been no Safeguarding Adults allegations about this service. The Commission have a focus on Equality and Diversity and issues relating to this are also included in the main body of the report. This site visit to the home was conducted over a period of seven and a half hours during which the inspector made observations, reviewed records and documentation and spoke to residents, relatives, visiting professionals staff and management. Case tracking is the method used during inspection where of a sample of three residents were selected and all aspects of their care and experiences reviewed, including individual plans of care and associated documentation. All of the residents selected for case tracking purposes had limited abilities to recall and communicate their views and experiences in these circumstances observations are used to inform the inspection process. A limited tour of the premises was conducted which involved viewing the communal areas and a selection of the private accommodation. The Acting Manager was present throughout this visit and the Operations Manager was also present during the afternoon and also for the presentation of the inspection findings. Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 7 What the service does well: Admissions to the home are managed well; the staff make sure that they have the right information to be sure that they can care for the residents properly. People who use the service are provided with information and opportunities to visit the home so that they can make decisions about whether they or their relative would like to live there. One relative commented ‘ I am very happy with all aspects of care received, settled well into new home mum is much better in every way since the move – it’s a wonderful place’. Each resident has a care plan which sets out how the resident needs and wishes to be cared for these are generally of a good standard and show that the residents health, personal and social care needs are met. Residents have access to appropriate heath services and specialist nursing services. A senior Dietician was present during part of the inspection and was able to confirm that she was confident in the care that residents received at Claremont Parkway Nursing Home. Medication systems are managed well, management have responded to incidents where medication errors were identified and two care staff are now doing the residential care medication together to eliminate further errors. Privacy and dignity is managed well, Residents were able to confirm that the staff were nice to them and that they felt well cared for. Routines are flexible and residents routines and preferences are known to staff. The service has a varied activity timetable and individual activities are also available. One relative commented ‘They treat residents as individuals and act accordingly’. Visiting times are flexible and residents are able to access the ground and the local community. The menu is varied and offers a choice of well-presented, adequately proportioned meals. Snacks are available on request. Residents were able to confirm general satisfaction with the standard of the food provided and the dining arrangements. One relative commented ‘the cakes are wonderful’. Complaints and the protection of residents are both managed well, the service has the right policies, procedures and guidance in place and staff know what to do in either situation. Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 8 The standard of the environment is excellent and provides residents with a safe, clean, comfortable, spacious and comfortable place to live. All rooms are single with ensuite facilities and are furnished to a high standard. Tea and coffee making facilities can be provided in the resident rooms. There are various communal areas and quiet areas for people to have privacy and space. Al areas are accessible to wheelchairs and the grounds are safe and well maintained. The home is generally well staffed throughout and most of the feedback from residents and their relatives was favourable. Comments include ‘we are very impressed with one senior staff member in particular we have had a lot of contact with her as we are new’ and Another commented ‘Some of the residents can be very demanding I am impressed with the way in which they are handled’. Staff training is managed well, staff files and records showed that staff have access to all of the required training, training specific to the needs of individual residents and specific to their individual roles. The service is proactive in encouraging staff to undertake National Vocational Qualification training at all levels. One staff member commented ‘ The training programme is very good and there are opportunities to attend relevant training sessions’. What has improved since the last inspection? A new manager has been appointed to run the home and she has been registered with the Commission for Social Care Inspection. A new deputy manager has also been appointed with responsibility for clinical development. In addition the manager operates an open door policy so that residents, relatives and staff are able to express their concerns as they arise. The new manager also aims to have a high visible profile in the home to ensure the consistency of all aspects of quality within the home. Staffing levels have been reviewed to increase the number of skilled permanent staff to cover staff sickness and leave and to enable the reduction of the use of agency staff. Thereby improving the quality and consistency of care for people using the service. One relative commented ‘things seem to be running much more smoothly under the new management’. A staff member commented ‘ the new management in situ who is very good and approachable’ Staff supervision has also be commenced and is being cascaded throughout the team to ensure that staff are clear about their roles, the needs of residents and expectations of the management. A new holistic therapist is now available once a week and offers varied massages to residents. The home has recently obtained a Nintendo Wii system, which enables residents to participate in a wide range of computer game Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 9 activities, internet access and access to additional television channels through the provision of a digital aerial. Relatives commented ‘The environment is lively and interesting – not just sitting around’. ‘Outings to the local park and theatre are good and especially welcomed’. Following a flood during last summer the home has been restored to its previous high standard. A member of staff has been appointed to look after the resident laundry to make sure that items are not lost or damaged and returned promptly. One relative commented ‘it is a very efficient laundry service’. A new quality assurance policy has been developed to ensure that regular checks are conducted to ensure that the service is safe, continuously improves and is responsive to the needs of the people who use it. Improvements have been made to the fire safety systems within the home in response to a recent Fire Officers inspection. What they could do better: The management have identified improvements that need to be made to the plans of care to make sure that information is constantly recorded in a timely, detailed and accurate way so that they are able to demonstrate that all of the residents needs are consistently met. The management need to make sure that residents have consistent access to their call bells. Appropriate arrangements need to be made to ensure that people are able to manage their own medication should they wish to do so. Formal consent to administer medication should be obtained from people, or their representative who require or wish to have the staff manage their medication. Care plans need to provide guidance to staff about how to support those residents who might not be able to request a snack, especially if they have not eaten their meals. Staff files need to contain evidence that the right pre-employment checks have been conducted and that this evidence remains available for inspection purposes. Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 10 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 11 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 12 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 Quality in this outcome area is good. Resident’s needs are appropriately assessed prior to moving into the home, ensuring that their care needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has a Statement of Purpose and Service Users Guide these have been reviewed to provide information about recent changes to the management of the home. This means that people who use the service have access to accurate and up to date information. A further review is planned to ensure that the information is available in a more, user-friendly format, other languages and formats suitable for those with visual disability. Existing Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 13 residents are all white western European with a good command of the English language. Individual plans of care evidenced that prospective residents have comprehensive preadmission assessments conducted, by senior and experienced staff to ensure that the service is able to meet the needs of the individual. These are used to form the basis of the individual plans of care. Where appropriate the service obtains a copy of the assessment conducted by the funding authority, which is also used to inform the care planning process. The Annual Quality Assurance Assessment confirms that people are encouraged to visit the home before deciding whether they would like to live there and that there are opportunities for people to meet other residents and staff and to have a meal there. It also confirms that residents have appropriate contracts in place. Residents were unable to comment on their experiences regarding the admission procedures, however one relative commented ‘ I am very happy with all aspects of care received, settled well into new home mum is much better in every way since the move – it’s a wonderful place’. The service does not offer intermediate care. Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. Residents have an individual plan of care, which demonstrates that their health, personal, and social care needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each resident has an individual plan of care, which provides staff with instruction about how the individual is to be cared for. In general these contained good information about the heath personal and social care needs of the individual. In addition there is evidence that the care is individualised and that residents preferences regarding their care is documented. Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 15 In general residents have appropriate risk assessments in place for the prevention of risks associated with pressure, nutrition, falls, falls from the bed and Movement and Handling. There is evidence that residents dependency levels are recorded as part of the assessment process and that these are reviewed periodically. Residents have access to identified key workers. Case tacking of a new resident identified that most of the necessary care plans are in place soon after admission in however in this instance the assessment of risks associated with nutrition, pressure and falls had been delayed due to a staff member having been on leave. In addition daily records, although regularly maintained are basic and do not provide sufficient detail or show how residents are supported to exercise choice within their daily lives. There is also some evidence that individual plans of care have not been consistently reviewed on a monthly basis to ensure that staff always have up to date information about the residents needs. However following the appointment of a new manager the service has identified these shortfalls and have confirmed the appointment of a senior clinical nurse to the position of Deputy Manager who has responsibility for developing the care planning process, including the development of person centred care plans, risk assessments, improving daily records, ensuring consistent regular review and greater involvement of either the resident or their representative. Individual plans of care contained good detail about residents personal care needs including oral health, bathing preferences, care of nails and the management of continence. Residents appeared well presented and well cared for. There was evidence that resident’s general health was monitored on a regular basis including weight and blood pressure. Individual plans of care evidenced that residents have access to hospital services, general practitioners, dentists, podiatrists, dieticians, physiotherapists, holistic therapists and specialist nurses such as the Macmillan Nursing Service and the Community Psychiatric Nursing Services. A senior Dietician was present during part of the inspection and was able to confirm that she was confident in the care that residents received at Claremont Parkway Nursing Home. Feedback form relatives provided varied satisfaction with the way that health care appointments were managed, one stated ‘There is always good communication about hospital admissions and excellent communication’ Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 16 another stated that ‘Communication about hospital appointments has not always been satisfactory, I am not always aware of the appointment’. The new manager has been in post since February 2008 and is currently reviewing working practices and also recruiting additional staff to ensure sustained staffing levels and the reduction in the use of agency staff. Residents are assessed for the management of pressure and have access to appropriate pressure-relieving equipment, for use whilst in bed. Several residents were seen to mobilising in wheel chairs, which enabled them to access the communal areas and the grounds, and they also had access to pressure relieving equipment for use in wheelchairs. Residents appeared relaxed and content. Staff were seen to be responsive to the residents needs, call bells were answered in a matter of seconds. However one resident on the first floor was noted to not have access to a call bell. This was discussed with management who agreed to make appropriate arrangements to ensure that all residents have access to the appropriate means to summon staff when needed. Concerns raised by a relative regarding a resident who was said to have been left in the lavatory for over an hour and on another occasion had to wait for assistance to use the lavatory were discussed with both staff and management. It was confirmed that this would be viewed and unacceptable although acknowledging that human error can occur. Staffing levels have recently been reviewed ensure that the use of agency staff is minimised and that there are always sufficient staff on duty to cover sickness and annual leave. Staff supervision has also been commenced to ensure that staff are clear about their roles, the needs of residents and expectations of the management. Medication systems were reviewed and seen to be in good order. The service used a monitored dose system supplied by a local high street chemist and is also able to access guidance and support from the pharmacist. Each resident has a Medication Administration Records a sample of these were seen to be in good order and to demonstrate that medication is administered as prescribed. There has been some concern raised about the administration of medication to the residents receiving personal care and possible medication errors. This was discussed with management and staff and it was confirmed that there had been some incidents however these medication rounds are now being conducted by two senior carers working together to ensure that further errors are not made. Controlled medication was seen to be stored appropriately and to be in general good order however the dosage of one medication had been increased by a Macmillan Nurse on the day of inspection and this information had not been Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 17 fully transferred on the new Medication Administration Record- this was corrected during the inspection. There was some evidence that residents are assessed for their ability to self medicate, however there was no evidence that consent for staff to administer medication had been sought from either the resident or their representative. This was discussed with management who have agreed to implement this, in order to comply with the Mental Capacity Act 2005. Staff with responsibility for administering medication were able to confirm access to appropriate training in the Safe Administration of Medication. Individual plans of care evidenced that privacy and dignity is required in all aspects of care. Staff were seen to treat people with respect and to be mindful of their privacy at all times. Residents were able to confirm that the staff were nice to them and that they felt well cared for. Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Social activities and meals are both managed well, are creative and provide daily interest for people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Individual plans of care demonstrated that routines are flexible in the home. Resident’s routines and preferences are recorded including times of rising and retiring to bed and preferred terms of address. Residents are able to opt out of activities should they wish to do so and choose where they wish to spend their time. One relative commented ‘They treat residents as individuals and act accordingly’. However one relative referred to occasions when their relative had been unable to attend activities or residents meetings because staff had not been available to take her to the communal areas. Staffing levels are currently being reviewed following the appointment of the new manager and agency usage is being reduced, with the intention of improving the consistency and quality of care. In Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 19 addition staff supervision has been implemented to ensure that staff are competent in their roles and responsibilities, are sensitive to the needs and wishes of residents and also to enable individual performance to be monitored. The service employs a dedicated activities coordinator who plans group and individual activities and outings. A programme of activities is displayed which demonstrates that there is at least one organised activity scheduled for each day. Activities include individual holistic therapies such as massage, musical workshops, art workshops, entertainments, bingo and celebrations such as a recent St Georges day event. One relative commented ‘The environment is lively and interesting – not just sitting around’. Another commented ‘Outings to the local park and theatre are good and especially welcomed’. Recent developments include the provision of a Nintendo Wii system, which enables residents to participate in a wide range of computer game activities, Internet access and access to additional television channels through the provision of a digital aerial. Individual plans of care evidenced that information is recorded about residents previous lifestyles, interests and family events these enable staff to identify with and to support residents to maintain their interests and contacts. Following changes to the management it is evident that more residents are being encouraged to utilise the communal areas and activities. Also some residents were seen to be accessing the grounds to enjoy the fine weather independently or with support from relatives or staff. Individual plans of care evidence that residents religious beliefs are recorded, those case tracked were of traditional English denominations. The service supports residents to maintain their faith by either attendance at the monthly Communion services held at the home or by individual arrangements according to the individual’s wishes. Visiting times are also flexible; residents are able to receive their chosen visitors in any of the various communal areas or in the privacy of their own rooms. Visitors were able to confirm that they were made welcome. Advertisements are displayed in the main entrance regarding residents meetings and attendance is encouraged, in addition the new manager operates an open door policy to ensure that she is available to residents, relatives and staff whenever possible. The menu is traditionally English which is reflective of the culture of the existing residents. The meal times are flexible and residents are able to select their preferred option from the menu, which includes a vegetarian option and other alternatives. Food appears to be varied, nutritious and of adequate proportion. Meals can be served in the dining areas or can be received in Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 20 resident’s rooms. Staff were seen to be available to offer discrete assistance to those who required assistance with feeding. Both the lunchtime and teatime service were viewed both appeared well presented, wholesome and appealing. Residents were able to confirm general satisfaction with the food provided at the home. Staff are also provided with lunch when they work a long day, they were seen to be eating in the dining room alongside residents and were able to confirm a high level of satisfaction with the food provided. One relative expressed concern that there had been occasions where the domestic staff had placed food out of reach only to return within the hour to remove uneaten food. Staff spoken to were clear about the arrangements for supporting residents with feeding and access to their meals. The domestic staff are expected to place the food and cutlery on the table and move it within reach of the resident. Should the resident be lying down or asleep the domestic staff are expected to alert the carers who will ensure that the resident is repositioned in order to eat their meal. Arrangements are also in place to ensure that snacks are available if residents have missed a meal. Staff expressed some concern that more vulnerable residents may not be able to express their wish to have snacks between meals and senior staff have agreed to review these arrangements to ensure that the staff are instructed within the individual plans of care to offer a snack to those who may not be able to initiate a request. Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. Comprehensive procedures for handling complaints and abuse are in place ensuring residents are fully protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has robust complaints procedures in place, the policy is included within the Statement of Purpose and is available within the home. The policy provides appropriate contact details and timescales. Through discussion with management it was established that the service welcomes complaints as a way of making improvements to the service delivery. The service has received nine complaints during the last twelve months, one of which was upheld. The Commission have received two complaints since the last inspection the first referred to Management, staffing levels and competence issues, which was referred to the provider for investigation the outcome was that there was no evidence to support the allegations. Another more recent concern, also relating to staffing issues, staff training, skill mix and attitude of some staff has also been referred to the provider for Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 22 investigation. The Operations Manager was present during the inspection to conduct a timely and independent investigation into the concerns raised, the outcome of the investigation is to be forwarded to the Commission for review and will be used to inform future inspection activity. Residents, relatives and staff were able to confirm that they would feel able to raise concerns with management should they wish to do so and that they had confidence in that the new manager would respond appropriately. Residents were also able to confirm that they felt safe living at the home and that the staff were nice to them. There have been no Safeguarding Adults allegations about this service, staff spoken to were able to demonstrate an understanding of their responsibilities regarding the protection of the vulnerable as well as access to appropriate policies, procedures and guidelines. The staff-training matrix indicates that there is a rolling staff-training programme to ensure that staff receive appropriate and timely training including the training in the Safeguarding of Adults. Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is excellent. The standard of the environment is excellent, providing residents with a safe, comfortable and flexible place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The premises are spacious, modern and purpose built and are suitable for their stated purpose. There are several communal areas including the main lounge offering a bar, wide screen television and piano, conservatory, separate dining areas and several quiet areas located throughout the premises. All areas are clean, hygienic, well lit and well ventilated. Low surface temperature radiators are installed throughout and no hazards were identified. All areas are Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 24 accessible to wheel chair users, doors and corridors are of an appropriate width and passenger lifts are available. Staff were able to confirm that there were adequate supplies of hot water and that all equipment is in good working order. The grounds are pleasant, well maintained and accessible for wheel chair users. The individual accommodation for those case tracked were seen to offer a comfortable and pleasant environment. In general appropriate fixtures and fitting were in place, such as call bells, lockable storage and privacy locks, appropriate furnishings and ensuite facilities. Residents are able to have tea and coffee making facilities in their rooms if they are assessed as being safe to do so. Rooms evidenced that residents are able to personalise their rooms with their own possessions. One relative commented ‘It is a lovely environment despite meeting many and varied needs’. The premises were clean hygienic and free from odour throughout. Following changes to the management there is now a dedicated member of staff responsible for the management of resident’s laundry to ensure an efficient service and minimise loss or damage to personal items of clothing. One relative commented ‘it is a very efficient laundry service’. Following the last inspection the service was flooded when the banks of the canal burst. The service successfully evacuated the residents who were affected and provided a safe and continuous service under difficult circumstances. The management have totally refurbished the affected areas and residents have since returned to the home. The management have also liaised with the Environment Agency and have found that on this occasion there was a delay in initiating the local flood defences and that the future risk is minimal. Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 & 30 Quality in this outcome area is good. The home employs appropriate numbers of inducted and well-trained staff to ensure that residents are in safe hands and that their needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing rota demonstrates that there are two registered nurses on duty at all times, with twelve care staff during the morning and seven during the afternoon and evening. There is a total of six staff on duty throughout the night. In addition there are four administrative staff on duty throughout the day, including the newly Registered Manager, a new deputy manager an administrator and one maintenance staff. There are also good levels of domestic staff and kitchen staff and one staff member with responsibility for the laundry. Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 26 The staff group is in the main reflective of the gender and culture of the existing residents, most are female, white European speaking English as their first language, however there are adequate numbers of male staff to ensure that residents are able to access carers of the same gender if preferred. Since the appointment of the new manager there has been some increased staff turnover due to the reduction of agency staff and the recruitment of skilled staff with the right ethos to promote the quality and continuity of care to residents. The new manager is also mindful of the need to ensure that staffing levels are based on the assessed dependency of the existing residents needs. Formal staff supervision has also been introduced and is to be cascaded throughout the service. In addition the manager operates an open door policy so that staff are able to express their concerns as they arise, the new manager also aims to have a high visible profile in the home observing care practices, staff deployment and interactions between residents and staff. Relatives commented that ‘we are very impressed with one senior staff member in particular we have had a lot of contact with her as we are new’. Another commented ‘Some of the residents can be very demanding I am impressed with the way in which they are handled’. Three staff files were in general good order and evidence appropriate written references from previous employers. Each member of staff had an appropriate Criminal Records Bureau Clearances, however when the start dates were compared with the Criminal Records Bureau Clearances clearance dates it appeared that some staff had commenced employment before the clearances had been obtained. One staff member had been appointed under the management of the previous providers. However following further enquiry it was established that guidance had been issued by senior management within the organisation that sensitive personal information should not be retained indefinitely on staff files. Staff had been instructed to destroy the povafirst check once the full Criminal Records Bureau Clearance had been obtained. As such the evidence that povafirst checks had been obtained has been destroyed. The provider is required to review their practices to ensure that they comply with the Policy and Guidance for Service Providers and CSCI Staff on Criminal Records Bureau Checks dated 12 May 2008. The service has identified a senior staff member to plan and coordinate staff training to ensure that all staff have access to appropriate and timely training. Training records are now computerised and a training matrix is produced to identify which staff member needs training in a specific area. There is evidence that staff have access to mandatory training such as induction training, Health and Safety, Movement and Handling, First Aid, training in the Safeguarding of Adults, Basic Food Hygiene, Fire Safety and in the Control of Substances Hazardous to Health. Staff files also evidenced that staff have specific training Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 27 according to the identified needs of residents such as Dementia Awareness, the Management of Challenging Behaviour, Parkinson’s Disease, the Gold Standard Framework for terminal care. They also have training according to their individual responsibilities such as the Safe Administration of Medication, taking blood samples, Symptom Management and Pain control. The Annual Quality Assurance Assessment indicates that staff have received training in equality and diversity and that further training is planned. In addition information is displayed in the home to inform residents, relatives and staff about matters associated with equality and diversity. There is also evidence that the service is proactive in the developments of staff, new staff are encouraged to obtain the National Vocational Qualification in Care level 2 and senior experienced staff are supported to obtain their National Vocational Qualification level 4 and Registered Managers award. One staff member commented ‘ The training programme is very good and there are opportunities to attend relevant training sessions’. Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. Appropriate leadership, guidance and direction means that the home is managed in the best interests of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following the last inspection a new manager was appointed in February of this year. She is a Registered General Nurse with several years of experience in managing nursing Homes and is currently undertaking her National Vocational Qualification in Care level 4 and Registered Manager Award. She has submitted Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 29 an application for registration with the Commission for Social Care Inspection. The registration application has now been processed and approved. Since her appointment she has implemented a programme of staff recruitment to reduce the number of agency staff used and to ensure greater continuity of care for the residents and to compensate for staff sickness, annual leave and maternity leave, staffing levels are good and recruitment continues. She has also introduced an open door policy so that she is easily accessible to residents, their representatives and staff. She also aims to be proactive in service delivery by spending time with staff and residents during the course of the day. One of the relatives commented ‘the home coped admirably when flooded, communication is very good’. Another commented ‘things seem to be running much more smoothly under the new management’. A staff member commented ‘ the new management in situ who is very good and approachable’ Following the appointment of the new manager a new post of deputy manager has been initiated, the deputy will be responsible for clinical development such as the further development of the individual plans of care and their content and will provide support to the Registered Manager. Discussion with management indicated that a new quality assurance policy has been issued and is currently being introduced by the new management. Activities include the following audits – Environmental, Health and Safety, medications, individual plans of care, residents, monthly returns regarding specific indicators such as the number of pressure sores, complaints and falls. The findings of these audits are used to inform service development. Staff sickness is also being monitored. The service does not hold any money on behalf of residents any items required are bought on behalf of the resident and an invoice is sent to their representative. Following the appointment of the new manager formal documented staff supervision is being implemented and cascaded throughout the service to ensure that staff are aware of the expectations of the management and are able to fulfil the role for which they are employed. The fire officer conducted a recent inspection of the home in January 2008 and the findings were that significant improvements were needed. Evidence was seen during this inspection that the appropriate action had been taken to address these shortfalls. There have been two outbreaks of diarrhoea and vomiting in the home since the last inspection, in both circumstances appropriate action was taken to control the spread of the infection and to involve the local Environmental Health Officer both outbreaks were identified as being of viral origin. Information supplied during the inspection identified that Basic Food Hygiene Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 30 training has been provided to the kitchen and care staff involved in the handling of food. No Hazards were identified during the inspection, appropriate risk assessments are in place and there is no evidence of a significant numbers of falls or incidents affecting the well being of residents. Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP29 Regulation 17 & 19 Requirement Staff files must contain evidence that either a povafirst check or a Criminal Records Bureau Clearance has been obtained before staff commence employment within the home and comply with the Policy and Guidance for Service Providers and CSCI Staff on Criminal Records Bureau Checks dated 12 May 2008. To ensure that residents are protected from abuse and that records required for inspection purposes are available when required. Timescale for action 01/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Claremont Parkway Nursing & Residential Home DS0000066165.V366091.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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