Care Home: Clarence House Nursing Home

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What the care home does well Staff are very welcoming and friendly and appear to have a good knowledge base and understanding of the needs of the people they look after. They had been sufficiently vetted prior to commencing their employment so people could be assured they were safe to look after them. Once employed checks were made to ensure they were trained to do their jobs and were aware of the latest research based training. People in the home appeared well cared for and the records staff keep were up to date and showed the current needs of each person. Their views are sought to ensure the home is being run for their benefit and all their personal expectations and needs are being met. Quality rating checks are made to ensure the home is a safe place to live and work. The home is comfortable, clean and well kept. The Company ensures that a business plan is in place, which looks at a continual refurbishment programme and action plan to replace items when required. Robust policies are in place to ensure people know how to raise concerns and where necessary investigations are carried out in confidence and as quickly as possible. What has improved since the last inspection? Since the last visit to the home the staffing levels have improved under the new ownership, ensuring sufficient staff are on duty to meet the needs of people living there. What the care home could do better: The Company must ensure that all staff have received updated training in the safe guarding of adults so they know how to recognise abusive situations and how to quickly pass this information on to the right authorities. A couple of recommendations were made regarding the storage of medication, which is in a cramped area, and could impede good practise of staff administering medication. The staff are also not monitoring the room temperatures so they are unable to tell whether medication is stored at the right temperature which could put people at risk. For the time the new owners had taken over this home there was suffiecnt evidence to show that their initial quality auditing was having an effect in the home, but it is recommended they continue to develop this and expand the areas looked at. CARE HOMES FOR OLDER PEOPLE Clarence House Nursing Home Albert Street Brigg North Lincolnshire DN20 8HS Lead Inspector Theresa Bryson Key Unannounced Inspection 17th December 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 Nursing Home DS0000072081.V373414.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. Clarence House Nursing Home DS0000072081.V373414.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clarence House Nursing Home Address Albert Street Brigg North Lincolnshire DN20 8HS 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) 01652 650 950 01652 657 662 Dasa Care Homes Limited Paula Teal Care Home 33 Category(ies) of Dementia (33), Old age, not falling within any registration, with number other category (33), Physical disability (33) of places Clarence House Nursing Home DS0000072081.V373414.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: 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. Dementia - Code De Physical Disability - Code PD The maximum number of service users who can be accommodated is: 33 This is a newly registered service. 2. Date of last inspection Brief Description of the Service: Clarence House is a set in the centre of the market town of Brigg and has good access to the town centre, which is in walking distance and is also on a bus route to the larger towns of Scunthorpe and Grimsby. There is some car parking in the streets around the home. The building is a mixture of an older Victorian style house and a modern extension. Some rooms have ensuite facilities and there are different lounges and a large dining room, which can be accessed by all people living in the home. There are ample bathrooms and toilets and the first floor is accessed via a passenger lift and stairs. Gardens surround the home and there is a quieter secluded garden, which is accessed from inside the building. The fees are reviewed annually and the Statement of Purpose and Service Users Guide detail what services the home can provide and what the charges cover. Clarence House Nursing Home DS0000072081.V373414.R01.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 stars. This means the people who use this service experience good quality outcomes. This inspection took place over one day in December 2008. Prior to the site visit surveys were sent out to relatives and staff and a good quantity were returned. We also looked at the service history and what information had been sent to us in the last year. The Company also sent us their Annual Quality Assessment Audit, which was received prior to the site visit. On the day we looked at a number of records and documents and also spoke to a number of people living in the home and staff. The manager was present throughout the visit and the one of the owners joined us for part of the day. What the service does well: Staff are very welcoming and friendly and appear to have a good knowledge base and understanding of the needs of the people they look after. They had been sufficiently vetted prior to commencing their employment so people could be assured they were safe to look after them. Once employed checks were made to ensure they were trained to do their jobs and were aware of the latest research based training. People in the home appeared well cared for and the records staff keep were up to date and showed the current needs of each person. Their views are sought to ensure the home is being run for their benefit and all their personal expectations and needs are being met. Quality rating checks are made to ensure the home is a safe place to live and work. The home is comfortable, clean and well kept. The Company ensures that a business plan is in place, which looks at a continual refurbishment programme and action plan to replace items when required. Robust policies are in place to ensure people know how to raise concerns and where necessary investigations are carried out in confidence and as quickly as possible. Clarence House Nursing Home DS0000072081.V373414.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 Nursing Home DS0000072081.V373414.R01.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 Nursing Home DS0000072081.V373414.R01.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): Quality in this outcome area is good. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards 1, 2, 3, 4, 5 and 6 were checked. Comprehensive information is available to ensure people are aware of the services the home can provide and are assessed to ensure the home can meet their needs. EVIDENCE: A new brochure was being developed so that the home can provide a shortened version of its Statement of Purpose and Service Users Guide to give to prospective people who may wish to use the home. The current documentation is very comprehensive and gives a good over view of the type of services the home can provide and what people can expect for the fees they are charged. Clarence House Nursing Home DS0000072081.V373414.R01.S.doc Version 5.2 Page 9 Prior to admission the senior staff assess each person to ensure the home can meet their needs and a new pre-admission tool had been developed to give a holistic assessment of each person. This is then used as the format for developing the fuller care programme. Opportunities are offered to enable people to visit the home prior to admission to see if they like it. People said how when they arrived to live at the home the details the staff had on them made them feel immediately at home and assured that their care needs were going to be met. The home does not give intermediate care and therefore Standard 6 is not applicable. Clarence House Nursing Home DS0000072081.V373414.R01.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): Quality in this outcome area is good. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards 7, 8, 9, 10 and 11 were checked. Peoples care needs are recorded and evaluated regularly to ensure their current needs are being met and staff observe good care practises in the delivery of care and the administration of medication. EVIDENCE: Prior to the site visit we sent out surveys to people living in the home and a number were returned. A couple of people asked to see an inspector and this was achieved on the site visit day. Also during that day a number of people were spoken to in person who were resident as well as some relatives. Many positive comments were made about the care people are receiving. Some said how well they were looked after. Making comments such as “staff always do what we ask of them” and “staff help me a lot which I am grateful for and comforted by”. Clarence House Nursing Home DS0000072081.V373414.R01.S.doc Version 5.2 Page 11 We looked at a number of records during our visit day and also tracked 3 care plans in depth. Some changes had been made to the care plan documentation, which staff said they were still learning how to use. The records seen however gave a very comprehensive history of each person’s needs, the involvement of other health care professionals and had been updated regularly to ensure current needs were being met. There was good follow through when specific needs had to be addressed. For example if the accident records showed a series of falls, a falls risk assessment was completed and a bed rail assessment. And if necessary other health professionals such as the local hospital falls coordinator or equipment specialist was called upon for advice. Each part of the process was well documented. This ensures staff are addressing peoples needs as soon as they occur and regularly keep the care notes up to date to ensure all staff are aware of the person’s needs. Documentation is in place for people who may be reaching the end of their lives but on the site visit day there was no one at this stage of life. Staff could how ever describe what they would do for an end of life programme, so were ready in case the need arose. During the course of the day staff were observed delivering personal care to people, having interaction with relatives and other health professionals and facilitating activities. Each task was completed in a calm manner showing dignity and respect to the people they were looking after. Safe practises were also observed in the administration of medicines and all records appeared to be in order. It is recommended that the storage area be reviewed as this is now very cluttered and could lead to staff having access to an area they are not qualified to accept responsibility for and there were no temperature recordings so staff could not tell whether medication was stored according to guidelines set by the Royal Pharmaceutical Society. Peoples current needs appeared to be being met and some positive comments included “staff are brilliant” and “I am well looked after”. Clarence House Nursing Home DS0000072081.V373414.R01.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): Quality in this outcome area is good. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards 12, 13, 14 and 15 were checked. People’s social, cultural and religious expectations are being met with a varied programme of activities. EVIDENCE: When speaking to people in the home and on the surveys returned it was clear that everyone has access to a variety of activities and events in the home, if they wish to take part. One person stated “I don’t take part in much because I would rather watch my TV and do crosswords, but that is alright with the staff”. Each person had a social needs assessment completed, which was part of the care plan, as well as activities records of when events take place and how a person took part. Staff members use the symbol of smiling, sad or quizzical faces to express how people took part. This is then used as a basis for planning what that person wants and if events work within the home. Clarence House Nursing Home DS0000072081.V373414.R01.S.doc Version 5.2 Page 13 Although there was a variety of events such as art and craft, entertainers, games and reminiscence sessions as well as one to one sessions where staff have recorded where they have for example read a newspaper to someone ill in bed. There was little evidence to support that effort had been made to involve the local community, except the odd outing or visit from the Church. This should be expanded up to ensure people do not feel isolated and if they cannot go out, then the outside Community brought into the home. Only a brief tour of the kitchen area took place as the local Environmental Health Officer had recently visited and had given the home a 4-star rating. Food was being prepared in a clean and safe environment with knowledgeable staff developing the 4-week cycle of menus, which people living there said was “varied” and “plentiful”. Staff were observed assisting people at a meal time, which they did in a calm and dignified manner and were encouraging each person to eat and drink, which will help their health and well being. Clarence House Nursing Home DS0000072081.V373414.R01.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): Quality in this outcome area is good. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards 16, 17 and 18 were checked. A robust policy is in place to ensure people are free from harm and staff are aware of how to refer possible abusive situations. EVIDENCE: Since the new ownership of this home there have been no complaints or concerns raised to us and the home’s own complaints log also showed no issues had arisen. People spoken to said they felt confident in the management team and all staff to pass on any concerns they may have and that they would be dealt with promptly. The policy manual was checked and all polices had been reviewed and included those on safe guarding adults and the complaints process. Staff still need to complete update training in safe guarding adults to ensure they are fully up to date with the latest referral process should the need arise, to prevent people from being harmed. Clarence House Nursing Home DS0000072081.V373414.R01.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): Quality in this outcome area is good. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards 19, 20, 21, 22, 23, 24, 25 and 26 were checked. People live in a comfortable and safe environment suited to their needs. EVIDENCE: Prior to the site visit the home had submitted their Annual Quality Assessment Audit, which detailed what they hoped to achieve, regarding a refurbishment programme for the home. During the visit one of the owners arrived and was also able to detail some elements of what they felt was required to make the home more comfortable and “fresh looking”. We were able to walk around the home with the manager and on our own and it appeared clean, tidy and comfortable. Some new dining room furniture and Clarence House Nursing Home DS0000072081.V373414.R01.S.doc Version 5.2 Page 16 curtains had been purchased, as well as a number of items for the kitchen area. People made comments to us about the high standard of cleanliness in the home and also said they felt comforted that they could bring in items from their previous homes to personalise their rooms. Where necessary, and according to the care plans which were checked, some people had special equipment in their rooms such as special beds, special mattresses and special chairs. This ensures that each room has been adapted to meet their special needs. The garden areas were clean and tidy and free from hazards and chairs positioned, where possible, to look over the gardens or street areas. This as one person stated “makes me feel part of the outside world”. Clarence House Nursing Home DS0000072081.V373414.R01.S.doc Version 5.2 Page 17 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. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards 27, 28, 29 and 30 were checked. A robust system of recruitment is in place to ensure staff are safe to work with people they look after and are then trained to do their jobs. EVIDENCE: Some staff surveys were returned to us when we sent them out and we had opportunity to speak to a number of staff during our site visit. Since the last inspection the home had changed ownership and also had a new manager, but many positive comments were made about the home’s current management and staffing arrangements. Comments were also made that moral had improved and they felt more accountable for the work they do. Staff commented on “better staffing level” and felt this enabled them to meet the needs of people living in the home in a more relaxed manner. As one staff member said “we are not so fraught, especially in the mornings which means we can spend more time with people”. The rotas seen showed that staffing levels had changed and the dependency levels are checked regularly to ensure suffiecnt staff are on duty to cover everyone’s needs. Clarence House Nursing Home DS0000072081.V373414.R01.S.doc Version 5.2 Page 18 Robust systems are in place to ensure staff are safe to work with people prior to commencement of employment and then that they receive suffiecnt induction training to enable them to begin their jobs, under supervision. 5 staff personal files were tracked in depth and found to have sufficient evidence to support the systems in place. They are then monitored to see if they require further training. Each individual training programme is included on the major training matrix. A variety of sources are used for example an outside company, local resources and some distance learning. This will ensure that staff can do their jobs using the latest research based practise. Clarence House Nursing Home DS0000072081.V373414.R01.S.doc Version 5.2 Page 19 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. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards 31, 32, 33, 34, 35, 36, 37 and 38 were checked. The Company ensure the views of people are sought to ensure the home is running for their benefit and it is a safe place to live. EVIDENCE: Since the last inspection of this home it has changed ownership and has a new manager. No concerns had been raised since the take over and people spoken to and who returned surveys were very complimentary about how approachable the senior management were and felt confident the home could improve in some areas. Clarence House Nursing Home DS0000072081.V373414.R01.S.doc Version 5.2 Page 20 The new owners and management team had not had suffiecnt time to show how it was developing its quality assurance audits and monitoring of the home, but there was a system seen to be in place, such as the Quality Management System for Registered Nursing Homes and the Mulberry list of training, audits and supervision of staff. People living in the home said they had been asked their opinions on a variety of issues already such as décor for the dining room, special equipment and if there were sufficient staff to meet their needs. All made positive responses, as did staff, who felt able to contribute to the running of the home. Documentation such as fire check books, safety certificates monthly room check audits, accident records and the policy and procedure manual were seen, which showed how well the home is monitoring the running of the building and ensuring people live in a safe environment. Clarence House Nursing Home DS0000072081.V373414.R01.S.doc Version 5.2 Page 21 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 18 2 3 3 3 3 3 3 3 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 3 3 3 3 3 3 3 Clarence House Nursing Home DS0000072081.V373414.R01.S.doc Version 5.2 Page 22 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 OP18 Regulation 13.6 Requirement The responsible person must ensure that all staff have received updated training in the safe guarding of adults to ensure people living in the home are free from harm. Timescale for action 18/06/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP9 OP9 OP33 Good Practice Recommendations The storage areas for safe keeping of medication should be reviewed to ensure there is suffiecnt space for good practise to continue. To ensure people are given medication which has been stored correctly the senior staff should monitor the temperature control of the drug storage area. The senior management staff should ensure that the quality auditing system continues to ensure the home is being run for the benefit of the people living there and is a safe place to live and work. Clarence House Nursing Home DS0000072081.V373414.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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