Care Home: Clarence Park Nursing Home

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What the care home does well Clarence Park provides a homely and comfortable environment for residents. It is decorated and furnished to a good standard and there are many homely touches. There is a relaxed atmosphere where residents support one another.Clarence Park Nursing HomeDS0000040907.V375645.R01.S.docVersion 5.2The outcome for the residents is good. For example nine residents spoken with said "the home is lovely, the staff are kind and caring and do what they can to help me". The routines in the home are flexible to suit the needs and wishes of people who use the service. The staff work hard to ensure the well-being and comfort of the residents and treat them with respect and kindness. Staff were described as "kind and helpful"; "very caring and keep the place clean". Residents feel that if they had something to complain about they would speak to a member of staff. Eight residents spoken with said they had nothing to complain about. Three relatives told us "the staff are always friendly and approachable". " Staff feel well supported and are encouraged to undertake training to ensure they have the skills and knowledge to meet the residents needs. What has improved since the last inspection? Since the last inspection the home has worked hard to improve the service provision for the health, well being and safety of residents. A new documentation system has been introduced and staff trained in the importance of record keeping to ensure good care provision for the benefit of residents. Pre assessment information is now well recorded and relevant information obtained to show how the home has assessed they can meet the prospective resident`s needs. Risk assessments in the care records are now well written and provide clear guidance to staff as to how identified risk are to be managed for the safety of residents. Issues relating to the respect and dignity of residents` have been addressed through staff supervision and training. The home now has a `Dignity Champion` to promote dignity and respect within the staff team. We are told this is working well and feedback from residents` supports this. Staff have received safeguarding training since the last inspection and all staff interviewed had a good knowledge of abuse and would feel able to report any suspicions of this, to protect residents. The provision of specialist training has been limited and not all staff feel they have been able to obtain the knowledge and skills to help them provide the most appropriate care for residents`.Clarence Park Nursing HomeDS0000040907.V375645.R01.S.docVersion 5.2 What the care home could do better: The home have worked hard to meet the requirements and recommendations since the last inspection, as seen above and throughout the report, thus enhancing the quality of life for residents. Having made the above changes residents would benefit from the continuity and stability of the good practices that have been implemented. Key inspection report CARE HOMES FOR OLDER PEOPLE Clarence Park Nursing Home 7 / 9 Clarence Road North Weston Super Mare North Somerset BS23 4AT Lead Inspector Patricia Hellier Key Unannounced Inspection 5th August 2009 09:30 DS0000040907.V375645.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clarence Park Nursing Home Address 7 / 9 Clarence Road North Weston Super Mare North Somerset BS23 4AT 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) 01934 629374 01934 626207 info@notarohomes.co.uk www.notarohomes.co.uk N Notaro Homes Limited Manager post vacant Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Clarence Park Nursing Home DS0000040907.V375645.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 either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category- Code OP The maximum number of service users who can be accommodated is 50. 15th July 2008 Date of last inspection Brief Description of the Service: Clarence Park provides care and support to older people who have nursing needs. It comprises of two houses joined together and extended close to the seafront in Weston-super-Mare and opposite Clarence Park. Local shops and amenities are close by and the town centre is just under a mile away. Inside, the home is well laid out, level throughout with ramps and lifts giving access to the upper floors. Twenty one of the single, and all four of the shared bedrooms have en suite facilities. The home has a small garden at the front; the rear has been laid as patio around a central water feature. The provider makes information available through a company leaflet and service specific booklet about the home. CSCI/ CQC reports are displayed in the entrance to the home and available for all to read. The fees range from £545.86 to £725.00 per week with additional charges being made for hairdressing, chiropody, newspapers and toiletries. This information was provided in August 2009. Clarence Park Nursing Home DS0000040907.V375645.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 star. This means the people who use this service experience good quality outcomes. This inspection took place over seven hours on one day and the manager was present throughout. To gather enough evidence to support our judgments for this inspection we (The Commission) asked the service to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met the people using the service. It also gave us some numerical information about the service. We also reviewed all correspondence and regulatory activity since the last key inspection. We sent surveys to people living in the home, staff who work there and healthcare professionals. We received eight surveys from people in the home and the replies indicated that responsive staff meet their care needs and they are provided with all that they need. Comments from the residents were the staff are very aware of my ever changing needs. “Staff are always well trained and knowledgeable”. “Many of my friends are so impressed with what they have seen they would consider coming here if they need care”. Comments were received regarding the inefficiency of the laundry systems e.g. “my relatives coat was lost and has never been found”. In discussion with the manager we were told the laundry systems have been improved. Feedback from surveys sent to staff told us: “Home is clean, tidy and well maintained”. “We look after resident’s physical needs and ensure they are warm and well fed”. “Clarence Park has improved immensely in the last year there have been real efforts to improve the service.” Clients rights are now being put into effect e.g. in respect of privacy and dignity”. The staff told us that they thought the service could be improved through “recruitment of staff that understand care provision and will stay – to provide continuity for residents. We did not receive any survey responses from Healthcare Professionals consulted. What the service does well: Clarence Park provides a homely and comfortable environment for residents. It is decorated and furnished to a good standard and there are many homely touches. There is a relaxed atmosphere where residents support one another. Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 6 The outcome for the residents is good. For example nine residents spoken with said the home is lovely, the staff are kind and caring and do what they can to help me. The routines in the home are flexible to suit the needs and wishes of people who use the service. The staff work hard to ensure the well-being and comfort of the residents and treat them with respect and kindness. Staff were described as kind and helpful; very caring and keep the place clean. Residents feel that if they had something to complain about they would speak to a member of staff. Eight residents spoken with said they had nothing to complain about. Three relatives told us the staff are always friendly and approachable. “ Staff feel well supported and are encouraged to undertake training to ensure they have the skills and knowledge to meet the residents needs. What has improved since the last inspection? Since the last inspection the home has worked hard to improve the service provision for the health, well being and safety of residents. A new documentation system has been introduced and staff trained in the importance of record keeping to ensure good care provision for the benefit of residents. Pre assessment information is now well recorded and relevant information obtained to show how the home has assessed they can meet the prospective resident’s needs. Risk assessments in the care records are now well written and provide clear guidance to staff as to how identified risk are to be managed for the safety of residents. Issues relating to the respect and dignity of residents’ have been addressed through staff supervision and training. The home now has a ‘Dignity Champion’ to promote dignity and respect within the staff team. We are told this is working well and feedback from residents’ supports this. Staff have received safeguarding training since the last inspection and all staff interviewed had a good knowledge of abuse and would feel able to report any suspicions of this, to protect residents. The provision of specialist training has been limited and not all staff feel they have been able to obtain the knowledge and skills to help them provide the most appropriate care for residents’. Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 7 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 8 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 Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive the information they need to make a well informed choice about living at the home. The homes assessment process is thorough and ensures that it is able to meet residents’ needs. Prospective residents and relatives benefit from being encouraged to visit the home to assess its suitability. Residents are not provided with intermediate care at the home. EVIDENCE: Prospective residents are provided with a comprehensive Service User Guide containing the Statement of Purpose and all necessary information to ensure they, or their relatives, know about life in the home at all times. Each resident has their own copy. It is also readily available in the reception area of the home. The Statement of Purpose is well written and informs people about Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 10 what the care home can and cannot provide. It also states the fees - what is included, with a list of extra charges clearly mentioned. Resident files inspected showed that all privately funded residents receive a contract of Conditions of Admission and Terms of Business, and those who are publicly funded receive a copy of the Terms and Conditions document which forms a contract of agreement. The contract documents supply residents with clear information about the breakdown of fees, outlining the contributions to be made and by whom, to make up the weekly chargeable amount. We read three residents assessment records to see how well needs are being assessed. The assessment records we saw contained a good level of information and showed that residents’ needs had been assessed. One resident was asked about the admission process and said that the manager had visited them in hospital to make an assessment. She told us she was settling into the home well and that the staff are looking after me well. Care practices observed showed that staff are aware of the residents needs as stated in their assessments. In discussion with the manager she told us she visits the person either at their home or in hospital and talks to them, a relative or advocate and staff at the hospital, as well as the social worker involved to help her to get a clear picture of the individuals needs, and how they could be met. The actions taken to support the individual had also been recorded in the assessment records. The assessment records we read were being regularly reviewed and updated to ensure they have accurate information to provide appropriate care and support, to meet the residents needs. We talked to the manager about how residents needs are reassessed or reviewed, and she explained that the home has a key worker system and a registered nurse is allocated to take responsibility for residents nursing assessment and care plans. Information from hospitals following transfer to the home is used in care planning and is held on the file. Assessment is made of skin integrity on admission from hospital, or home, and well recorded to provide a clear picture in relation to any skin damage or pressure sores. This is good practice. Prospective residents are encouraged to visit the home and assess the quality and facilities of the home for themselves. One resident told us that she and her relatives had been given opportunity to see the home, meet the staff, and discuss any queries with the staff and management prior to her moving in. In the AQAA we are told “the home benefits from a number of staff members from various countries, cultures and backgrounds which has led to the home coming under the influence of a range of cultural identities which has been Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 11 welcomed and enjoyed”. Evidence of this was seen and experienced during the inspection through observation and discussion with staff and residents. Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from care plans that give clear information regarding personal and specialist health care and support, to enable staff to meet their health and social care needs in a person centered manner. Risks to residents are fully assessed and actions to minimise these planned, for the safeguarding of residents. Residents benefit, and are protected, by the homes management of medicines. Respect and dignity are well maintained by kind and caring staff. EVIDENCE: In the three care plans inspected we saw clear and informative information about choices and preferences to daily life, food and the individuals preferred form of address. The care plans contained good information about the individual’s life history, family and contacts. Information also described a persons hobbies, sociability and preferred activities to enable staff to provide person centered care. Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 13 All care plans contained manual handling, nutrition, falls and pressure sore risk assessments, with the outcome being used to inform the provision of care. The risk assessment clearly stated regular change of position for those at risk of developing pressure damage to the skin, and staff told us about doing this and that records are kept in residents rooms. We did not see these records; however two residents confirmed that staff do assist them in this way. Other personal and environmental risk assessments were present to ensure the safety of the resident while promoting independence as far as the individual is able. Pressure relieving equipment was seen in use in a number of areas in the home, and staff were able to describe the principles of pressure relief management for the benefit of residents. All other identified risks had been translated into the care plans to meet their needs and reduce the risks. Daily records were up-to-date and written in a respectful manner that tended to focus on physical needs. In one record we looked at, psychosocial issues were identified and suggested actions as to how to assist the individual to find their equilibrium and a positive quality of life. No reference in the daily records was made to this individual’s psychosocial needs, only their physical needs. Since the last inspection staff have developed a greater understanding and awareness of the need for activities to assist resident’s health and well being, however it is not always translated into care records and provision. It is recommended that staff build on their understanding of psychosocial needs and integrate them more fully into care provision for the health and well being of residents’ People living at home have access to healthcare specialists and care plans showed that specialist Health Care Professionals are consulted when the home feels expert advice is necessary. Records indicated good Interprofessional working relationships for the benefit of individual residents. Records and residents spoken with confirmed they are also helped to attend outpatients’ appointments, the dentist, optician and chiropodist. Staff spoken with said they knew each of the individuals preferred way of being looked after, and residents spoken to said they thought the staff understood what they wanted. Surveys received told us that residents feel the staff are very aware of my ever changing needs; staff are always well trained and knowledgeable; “many of my friends are so impressed with what they have seen they would consider coming here if they need care.” Three residents spoken with told us the staff are very kind and caring. They are always ready to help. Several other residents told us the staff are always friendly and polite. Two residents told us some staff “can be a bit off”, and one person told us of an incident of poor practice that had happened to them. When we spoke to Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 14 the manager she was already aware of this incident and was taking steps to address the issues to ensure that it would not recur. This is good practice and benefits the health and well being of residents. Care practices observed showed caring interactions and good communication skills from staff. While talking with residents in the lounge area we noted members of staff who came into the lounge, or who passed residents in the corridors, took time to speak to residents and have a meaningful interaction with them. The atmosphere in the home was happy and relaxed during the inspection. Staff activity was observed to be purposeful and unrushed ensuring respect and dignity for residents. Residents benefit from the homes clear policies and procedures for the management of medication. We looked at records kept by the home for medication and the way the medication is stored. We saw all procedures were being carried out correctly. Since the last inspection regular medication audits are undertaken by the management of the home to ensure the safe management of medication. We looked at the audit trail of medicines for three people and in one case the tablets and records seen did not tally. The deputy manager was present and she and the manager have outlined clear actions that will be taken to ensure continued safe management of all medicines. All residents spoken with felt that kind and caring staff respect their dignity and privacy. In the AQAA we are told “a Dignity Champion has been appointed who takes the role seriously” and has implemented some beneficial practices. During the inspection staff referred to this person and their role and how they had learnt from it. The manager also spoke of developing the role for a member of night staff to ensure continuity of practice throughout the 24 hour period. As we went round the home we saw evidence of the “Do Not Disturb” signs that have been developed for resident’s doors when personal care is being provided. However during the inspection they were not always in use. The full implementation of this development would benefit residents. The home has an Equality and Diversity policy that recognises the cultural and social needs and differences that are present in society. The staff team is international and has experience of equality and diversity issues. Both management and staff demonstrated clear knowledge and desire to meet cultural and diversity needs of residents as and when they should arise. Care plans inspected demonstrated good implementation in regard to individuals needs and wishes in this area. Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents in the home benefit from the development of meaningful activities which recognise their diverse needs, enabling them to maintain some control over their lifestyle. Continued contact with family, friends and the local community is encouraged to provide a quality of life. Menus are flexible and seek to provide a balanced nutritional diet. EVIDENCE: An excellent range of activities is provided with posters displaying information of forthcoming events throughout the home. Residents spoken with said there is a wide variety of choice and activity. Two residents spoken with in their rooms showed us their own copy of the activity programme for the coming month, thus providing them with opportunity to plan their lives and involvement according to their wishes. On the notice board in the dining areas of the home a programme of activities was displayed, showing the variety of activities. Evidence was seen that many local residents, schoolchildren and family members are encouraged to attend Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 16 events provided. There is also a minibus to take residents out on daytrips and one resident told us of the forthcoming trip to Minehead. Residents spoken with told us they enjoyed the day trips and would like more, but opportunities are limited due to the size of the minibus. Since the last inspection the activities organiser and staff have worked hard to develop a greater awareness and understanding of the psychosocial needs of residents, and how activities can be integrated as part of this for the health and well being of residents. Records inspected showed good attendance at the many activities provided. The activities coordinator is employed full time and works hard to provide this programme of varied activities. We were told by staff that since the last inspection “there has been a lot of improvement in this area and there is good team works and communication”. The activities staff feel they are supported by better management. Spiritual needs are catered for and local clergy, and other religious leaders, as requested, visit when required. Several visitors were seen coming and going during the inspection. Relatives spoken with said they could come any time and felt their relatives were looked after by friendly and competent staff. Two relatives told us they could have a meal at the home if they chose. Residents we spoke to told us they are able to choose what time to get up and go to bed. They told us they are asked about their meal options, including their likes and dislikes. There was evidence of a good rapport between residents and staff, and care records contained clear information about resident’s preferred daily routines. We reviewed the residents menu to find out if residents are provided with a well balanced diet. The meal options seen were nutritionally well-balanced and varied. Four residents spoken with told us “the food is good and we get a choice”. Survey response received told us “Meals lack variety”. In the AQAA we are told “the quality and variety of meals has improved”. On the day of inspection the choice of meals looked appetising and well balanced. The kitchen was clean and tidy on the day of inspection. The home was inspected by the Environmental Health Officer (Food) in May 2009 and a number of requirements and recommendations were made. In discussion with the cook were able to evidence that these have been met for the safety and well being of residents. We noted that special diets are well catered for and there are a variety of special meals provided for residents who need them. The cook and kitchen staff will well aware of individual’s dietary needs. Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are confident that they are listened to and requests acted upon. Knowledgeable and competent staff protect residents. EVIDENCE: All residents are given their own copy of the homes comprehensive complaints procedure. A copy of this was seen in resident’s rooms and ensures they have the information they need to make a complaint. There have been nine complaints since the last inspection, which have all been fully resolved. A record of these complaints and their investigation was seen. Action taken to resolve the issues were clearly recorded and the complaint investigation showed a clear focus on the outcome for the resident and meeting their needs. This is good practice. All residents spoken with stated if they were not happy about anything they would speak to the manager. We saw a number of compliment cards that told us the staff are sensitive and wholehearted in the way they care for residents. Staff and residents told us the manager is very approachable and understanding. Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 18 Residents are protected by a comprehensive policy and procedure that is available for responding to allegations of abuse, and staff demonstrated a working knowledge of this. The home also has a Whislteblowing policy and staff said they would report any concerns to the manager. Evidence was seen that staff have received training in the recognition and handling of abusive situations for the safeguarding of residents. This was verified through the inspection of training records and in discussion with staff. Care records seen showed that consent for the use of bed rails and other forms of restraint had been obtained from the resident, or through a best interests meeting under the guidance of the Mental Capacity Act 2005. All residents spoken with said the staff are kind and do their best. One resident reported an issue of concern and this was raised with the manager. She immediately investigated and identified the issue and outlined an action plan, while recognising the equality and diversity needs of individuals involved. Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with homely, safe and comfortable surroundings. Outdoor space is attractive and accessible for residents to enjoy. The home has suitable equipment to maximise resident independence. Robust Infection Control practices are followed for resident’s protection. EVIDENCE: The home is nicely decorated and well maintained with a welcoming atmosphere, and made comfortable with homely communal spaces. Staff have worked hard to reduce the impact the size of the home may have on residents by making it welcoming. One area of the home is in need of major refurbishment and we are told this is planned to commence later this month. During the inspection we were made Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 20 aware of the planning and sensitive manner in which the manager is dealing with the need for some residents to move or share rooms, for the duration of the refurbishment. Residents’ rooms are personalised and comfortable. All rooms are provided with en-suite facilities. The décor, fixtures and fittings are in good order in the main. On the day of inspection the home was clean and free from offensive odours throughout. The laundry facilities were well-organised, however it was noted that the main laundry room is in need of redecoration. The second laundry room was observed to pose a risk of cross infection as the washing machine stand has cracks in the linoleum covering where we observed damp and caked washing power, which would provide a breeding ground for infections. We also noted some chemicals that are hazardous to health were stored in this open area. All chemicals must be stored in locked cupboards. In discussion with the laundry lady and the manager we were told that refurbishment of these areas is planned to begin in a couple of weeks. This is part of the major refurbishment programme mentioned above. Staff interviewed and observed demonstrated good understanding of infection control procedures and practices and maintained a clean and hygienic environment. Staff told us they had received training in this aspect of care since the last inspection which had enhanced their understanding. The home has good facilities for ensuring that staff can maintain good hand washing practices, between caring for residents. Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes staffing levels are sufficient to manage the care needs of residents. Staff recruitment procedures are robust and provide the safeguards required for residents’ protection. Resident’s needs are met by well-trained staff. EVIDENCE: The staffing rotas seen showed that there is sufficient staff in the home with an appropriate skill mix to support the diverse needs of people living there. They showed that staffing is flexible and extra staff are brought in to cover busy times, sickness or holidays. A good team of ancillary staff supports them. In the survey responses from staff we are told “staff morale is much better and things have improved since the last inspection”. Staff were seen to approach residents with directness, openness and consideration. Residents spoken with told us the staff are very good and kind. They come when they can though they are sometimes busy and I have to wait. One resident did say that it probably isn’t all that long a wait, but when waiting for assistance to the toilet it seems a very long time. Two residents who we spoke with, and a survey response, told us most of the staff are very good. Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 22 Some of the staff team employed at the home are from overseas and they told us they felt welcomed and part of the team. Residents told us they fit in well and are good workers, but communication can sometimes be a difficulty. The manager told us she is aware that for some staff whose first language is not English they need assistance, and has accessed training for them. The personnel files for three people who had recently been employed showed that the home had followed their robust recruitment practices and all the relevant checks to safeguard residents had been completed before the person started work. The new staff confirmed they had a good induction and written records to support this were seen, thus ensuring staff have the appropriate skills and knowledge with which to meet residents’ needs. The home provides regular in-house mandatory training with clear records of attendance and renewal dates. In the AQAA we are told that the home has improved in the last 12 months by “introducing the 12 week Skills for Care induction programme for all new staff”. Evidence of this was seen in staff files and staff interviewed told us the induction was good. Three staff interviewed told us they did not feel there was enough access or availability of specialist training to meet residents’ needs. One person gave an example about dementia training, which was provided but they were not able to attend as they were working, and no other opportunity for them has arisen. We saw evidence that some specialist training e.g. dementia and dealing with challenging behaviour has been provided and some staff had been able to access it. Other staff told us they had accessed their own training in specialist areas. The home views training as very important and the manager told us staff are encouraged to advance their skills and knowledge by undertaking National Vocational Qualifications (NVQ), and is planning more specialist training sessions. Survey comments from staff told us Clarence Park has improved immensely in the last year - there have been real efforts to improve the service.” “As there are a lot of new staff experience and knowledge will improve with time.” “Staff morale is much better.” Six staff when interviewed told us they the home has improved since the last inspection. Communication systems are good and the home is well managed”. In the survey responses we were told “residents’ rights are now being put into effect e.g. in respect of privacy and dignity”. “We have recently changed the system of care plans and they have all been updated”. Three staff interviewed told us the new care plans are good and provide more comprehensive information which enables them to meet residents’ needs more fully. During the interviews with seven staff we verified that they felt they had been provided with all the required mandatory training and had good knowledge and skills with which to meet residents’ needs. Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a well-run home with an appropriately qualified manager and supervised staff. Residents can be confident the management processes ensure consultation with them, their families and visiting professionals to ensure they have a say in the running of the home. Residents can be confident that monies handled for them, by the home, are well managed. Health and safety issues are monitored in the home to ensure that issues identified and addressed when they arise. EVIDENCE: Since the last inspection the deputy manager has become the manager, and is currently in the process of registering with the Commission. Staff feel she has Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 24 good communication skills and knowledge. They tell us she provides clear leadership, guidance and direction to staff, to enable them to provide a good all round care service to residents. Staff survey responses told us “the home is heading for better care provision”. Residents told us she is approachable, available and seeks to ensure all their needs are met. Two residents told us she gets things done. One resident told us the manager is very good and responded well to my concerns. Staff interviewed stated they felt well supported by an approachable manager. They told us the manager has an open door policy and is always available to provide support and assistance. Policies, and practice guidance, are provided in the home. These ensure staff are provided with current good practice advice for the benefit of residents. Staff are aware of the policy folder and can access it as needed. Records inspected were well maintained in the main, but attention to detail in dating and signing records is recommended as good practice. Systems are in place for people using the service, visitors and relatives to comment on the running of the home. Residents and relatives meetings are held regularly to provide a forum for exchange of ideas for the development of the service provision, and to share information from the company, that affects the running of the home. Residents and relatives told us that they are always encouraged to express their view and to “air their grumbles. An annual questionnaire is provided for residents and relatives to complete and return as part of their opportunity to have a say in the running of the home. The results of these questionnaires are in the process of being collated into a report, for feedback to residents and staff and the Commission. This report will demonstrate the good practices of the home and how it will incorporate comments for improvement. The Notaro group maintains a secure system for safeguarding residents’ finances. Supervision for staff now takes place regularly during the year culminating in an appraisal. Staff interviewed said supervision takes place regularly and when needed. Records inspected showed that issues relating to resident care, personal and professional development had been discussed and actions planned to address issues raised. Records inspected showed clear evidence of improved supervision for staff. A maintenance man is employed and he ensures that all aspects of the home are safe and well maintained for the protection of residents. Records inspected indicated regular safety and fire checks are carried out. Staff spoken with confirmed that regular fire instruction and drills had taken place. Information Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 25 submitted in the AQAA indicates regular maintenance to gas and water systems. Records seen showed regular servicing of all equipment for the safety of residents. A number of staff have received first aid training. All accidents and incidents are well recorded and audited by the manager monthly, for any trends to ensure residents are provided with good care. Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 26 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 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 3 18 3 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 3 2 Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 27 NO 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 OP38 Regulation 13.4 Requirement The registered person must ensure that all substances hazardous to health are securely stored, for the protection of residents. Timescale for action 21/08/09 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. Refer to Standard OP7 Good Practice Recommendations The registered person to assist staff to be more aware of the psychosocial needs of residents and how to meet them as part of holistic care. The registered person to ensure that a clear audit trail of all medicines entering and leaving the home is maintained for the safety of residents The registered person to continue to provide training to NVQ level 2 for staff to ensure a suitably qualified and competent staff team to meet residents’ needs. 2. OP9 3. OP28 Clarence Park Nursing Home DS0000040907.V375645.R01.S.doc Version 5.2 Page 28 Care Quality Commission CQC South West PO Box 1251 Newcastle Upon Tyne NE99 5AN National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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