Care Home: Clarence House

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What the care home does well The service offers a well planned package of care to people living in the home, and ensures that before admission full details are obtained. The service provides a good level of accommodation, with a building set on the cliff top, with views of the sea. Communal facilities are good, with a spacious lounge area and a separate large dining room with sea views. The service offers people living in the home a range of activities, and events, and varied menu is provided, with a choice of meal every day. What has improved since the last inspection? Since the last inspection, new procedures have been introduced to ensure that medication records are up to date. The service have carried out considerable improvements to the garden, \with a new pond and decking feature just completed. Further improvements to the building, in addition to ongoing redecoration have included new windows to part of the home, which will continue this year, and new carpets and fittings. What the care home could do better: During our inspection, we looked at the individual care plans, and discussed with the registered manager changes that were required. We also discussed current supervision arrangements, which do not currently meet the requirements of the regulations. The home continues to make improvements to the facilities, and intend improving the access road to the home which is currently in a poor state of repair, and restricts opportunities for people living in the home being able to get out. CARE HOMES FOR OLDER PEOPLE Clarence House 40 Sea View Road Mundesley Norwich NR11 8DJ Lead Inspector Alan Buttery Unannounced Inspection 17th June 2008 10:00 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 Clarence House DS0000066780.V366623.R02.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. Clarence House DS0000066780.V366623.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clarence House Address 40 Sea View Road Mundesley Norwich NR11 8DJ 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) 01263 721490 kthomas@inhcare.com Integrated Nursing Homes Limited Integrated Nursing Homes Ltd Mrs Karen Lesley Thomas Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Clarence House DS0000066780.V366623.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One service user, named in the Commission’s records, who is under the age of 65 years may be accommodated. 27th June 2006 Date of last inspection Brief Description of the Service: Clarence House is a care home providing personal, nursing care and accommodation for up to 41 older people. Integrated Nursing Homes Limited has owned the home since 25 January 2006. The home is located in the seaside village of Mundesley, close to shops, pubs, the post office and other local amenities. The home has 35 single bedrooms and 2 shared bedrooms. All except 1 single bedroom have en-suite facilities. The majority of communal space is located on the ground floor, however there is a communal lounge located on the 1st floor. There is a passenger lift to all floors. There is car parking to the side and front of the building and gardens are located at the rear of the building. Copies of previous inspection reports are available in the entrance hall, or from the office, and the home currently charges between £299 and £500 a week, depending on individual needs. A copy of the last inspection report was in the entrance hall of the home, and copies are available from the office on request. Clarence House DS0000066780.V366623.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality Rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced visit and during the inspection we looked at the key minimum standards for older people. During our visit the manager and deputy manager were available to assist with information, and we were able to talk to people living in the home while we looked round. We were sent an Annual Quality assurance assessment prior to the inspection, and information from this is contained in the report. What the service does well: What has improved since the last inspection? Clarence House DS0000066780.V366623.R02.S.doc Version 5.2 Page 6 Since the last inspection, new procedures have been introduced to ensure that medication records are up to date. The service have carried out considerable improvements to the garden, \with a new pond and decking feature just completed. Further improvements to the building, in addition to ongoing redecoration have included new windows to part of the home, which will continue this year, and new carpets and fittings. What they could do better: 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. Clarence House DS0000066780.V366623.R02.S.doc Version 5.2 Page 7 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 Clarence House DS0000066780.V366623.R02.S.doc Version 5.2 Page 8 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): Standards 3, 5 and 6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Before anyone new moves into the home, a full assessment is carried out, ensuring that the person moving into the home can be confident that the home are able to meet their identified needs. EVIDENCE: The service receives a number of enquiries from prospective residents through the local authority social work and hospital teams, Age Concern, who maintain a register of available beds in the area, and from private individuals looking for a suitable home for themselves or a member of their family. Any enquiry is dealt with in the same manner, and if a suitable vacant room is available, the manager or deputy manager would carry out an assessment, visiting the prospective resident either at their home or in hospital, liaising with professionals involved with the support and with family members. Clarence House DS0000066780.V366623.R02.S.doc Version 5.2 Page 9 This enables the service to ensure that they are able to meet the needs of an individual, and to identify whether any special equipment or adaptations are necessary. An initial care plan is then prepared in readiness for the person to move into the home. The service does not offer intermediate care. Clarence House DS0000066780.V366623.R02.S.doc Version 5.2 Page 10 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): Standards 7, 8, 9 and 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Although individual plans are in place more detail is required to ensure that both health and social care needs are met, and in a way the person prefers. Procedures and training measures are in place to ensure medication is administered safely. EVIDENCE: As discussed earlier, prior to an individual moving into the home, and initial individual care plan is written, based on the information contained in the assessment carried out. Once the person has settled in, the care plan is thoroughly reviewed, ensuring that an individuals likes and dislikes are recorded, and from this point the manager of the home said a monthly review is carried out. Clarence House DS0000066780.V366623.R02.S.doc Version 5.2 Page 11 Although on some of the files examined as part of our visit the reviews were recorded, it was noted on one file that a particular care plan to meet a need identified in the assessment for a resident to spend more time sitting in a chair, rather than in bed, had` not been reviewed for four months, and on this review it was noted ‘still refuses’ Clearly this needs to be addressed to ensure that important needs such as this are met, or if not adequate evidence of what has been tried is available. It was also noted that the care plans did not detail outcomes for the person they concerned, and largely covered the medical side of their care with little or no detail around social aspects of their life or activities. The individual plans included details of health visits, weight and chiropody. Wherever possible a resident would be encouraged to take responsibility for their own medication, which would be risk assessed to ensure it was a safe practice, and monitored on a regular basis. Lockable storage facilities are available in the rooms. Qualified nursing staff are responsible for administering all medication, and the service uses the Boots monitored dosage system. Clarence House DS0000066780.V366623.R02.S.doc Version 5.2 Page 12 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): Standards 12, 13, 14 and 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. A range of activities and events are available to people living in the home who are able to choose what they wish to take part in. EVIDENCE: People living in the home have a wide range of activities and events arranged for them, including weekly bingo, videos and movies, ball and balloon games, entertainment, some trips out as well as everyday activities including television and radio, newspapers and magazines, hairdressing and aromatherapy. An activities co-ordinator works part time to arrange the events and activities, supported by care staff. Relatives and friends are encouraged to visit the home and to take part in some of the events, and an open day was being planned while we were there to celebrate the new garden facilities, which have recently been completed. Clarence House DS0000066780.V366623.R02.S.doc Version 5.2 Page 13 Regular residents meetings are held which allow the residents to discuss events and activities, menus and any changes planned, and to ensure that their views are taken into account. Meals are served in a spacious dining room overlooking the sea, and a good choice is offered, including a cooked breakfast at weekends, choices of the main lunchtime meal, and a variety of teatime meals and suppers. Clarence House DS0000066780.V366623.R02.S.doc Version 5.2 Page 14 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): Standards 16 and 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Procedures are in place to ensure concerns or complaints are listened to, and any allegations managed in accordance with local authority guidance and procedures. EVIDENCE: The service has a complaints procedure, which is detailed in the current service users guide, a copy of which was provided during our visit. The Aqaa indicated that the home had received 4 complaints in the past year, all of which had been dealt with within their policy and concluded. The CSCI has not received any complaints. The service follows the local authority safeguarding adult procedures, and ensures that all staff receive regular adult protection training. There have been no issues of a safeguarding nature in the last year. Clarence House DS0000066780.V366623.R02.S.doc Version 5.2 Page 15 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): Standards 19 and 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. A good range of comfortable facilities are available for people living in the home, and the home is kept clean at all times. Continues renovation work is improving the facilities each year. EVIDENCE: The service runs from a large imposing building on the cliff top, and since the last inspection, a programme of installing replacement double glazed windows has begun, which will continue. A number of rooms have been refurbished, and again this will continue in the coming year, and one of the bathrooms has been refurbished this year complete with a spa bath. On the day of our visit, the home was clean and free from offensive odours. Clarence House DS0000066780.V366623.R02.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. A well trained staff team is on hand to provide the care and support necessary for the people living in the home, and recruitment procedures ensure that required information is obtained for all staff. EVIDENCE: Staffing in the home was discussed during our visit, and from the information given, and from observations during the inspection, there appear to be sufficient staff available to meet the needs of the people living in the home. There is a mix of qualified nursing staff and care assistants, and the service generally has a total of 5 staff in the mornings and for the remainder of the day and night. The staff in the home all receive a good level of training, and evidence of this was seen on the files examined during the inspection. The staff team were seen to be attentive to the needs of the residents, and treating them with dignity and respect at all times, for example knocking on residents doors before entering their room. Clarence House DS0000066780.V366623.R02.S.doc Version 5.2 Page 17 Recruitment procedures are in place and the files that were examined during the inspection all contained the required information. Although a more planned schedule of supervisions is needed to ensure that the requirements of this standard are met in full. Clarence House DS0000066780.V366623.R02.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed, and people living in the home are involved in decisions and changes affecting them. Policies and procedures are in place to ensure the health and safety of people living and working in the home. EVIDENCE: The service is well managed, with regular support provided to the home by the regional manager, who previously managed the home herself. The registered manager is experienced and appears to have a good rapport with staff and residents and together with the deputy manager provides good leadership. Clarence House DS0000066780.V366623.R02.S.doc Version 5.2 Page 19 Regular residents meetings are held to ensure that the views of the residents are taken into account and among the comments made by people living in the home or their relatives in recent surveys were: ‘They provide good friendly care at all times’ ‘The food is excellent and I can visit whenever I wish’ ‘The standards of this home continue to improve with different alterations and decoration going on’ Procedures are in place to ensure all health and safety issues are dealt with and staff receive training in matters relating to health and safety. Clarence House DS0000066780.V366623.R02.S.doc Version 5.2 Page 20 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 X X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Clarence House DS0000066780.V366623.R02.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? 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 OP7 Regulation 15(1) Requirement Individual plans must contain details of identified social care needs as well as health needs, and be kept under review in accordance with this regulation to ensure changes in need are identified. Arrangements must be in place to ensure all staff are regularly supervised so that any issues can be identified and dealt with. Timescale for action 31/08/08 2 OP36 18(2) 30/09/08 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 Clarence House DS0000066780.V366623.R02.S.doc Version 5.2 Page 22 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 Clarence House DS0000066780.V366623.R02.S.doc Version 5.2 Page 23 - 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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