Care Home: Clarendon Nursing Home

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What the care home does well What has improved since the last inspection? No requirements arose in the previous inspection in 2007 indicating that this care home has in place effective self auditing systems and is monitoring the quality of care and services provided for residents. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Clarendon Nursing Home Clarendon Nursing Home 7a Zion Place Thornton Heath Surrey CR7 8RR Lead Inspector Michael Williams Key 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 Clarendon Nursing Home DS0000019024.V365746.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. Clarendon Nursing Home DS0000019024.V365746.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clarendon Nursing Home Address Clarendon Nursing Home 7a Zion Place Thornton Heath Surrey CR7 8RR 020 8689 1004 020 8689 1019 ccarecentre@schealthcare.co.uk www.schealthcare.co.uk Southern Cross (LSC) Ltd 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) Acting Manager, Krystyna Bosko-De-Santamaria Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51) of places Clarendon Nursing Home DS0000019024.V365746.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 (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is:51 21st June 2007 Date of last inspection Brief Description of the Service: Clarendon nursing home is registered to provide a service to 51 older people. The house itself is purpose-built and located in the centre of Thornton Heath. It is therefore well placed for access to public transport, community based services and shopping facilities. However, the site is extremely compact, it has no garden, just a very small, enclosed courtyard for service users. There is little on-site parking plus fee-paying parking bays in the local streets. Within the building there is ample communal areas, several lounges and dining rooms; however, all the communal areas are located on the ground floor so there are no visitors’ rooms or communal lounges on the first and second floors. All bedrooms are a minimum of twelve square metres, and all bedrooms have ensuite facilities including a toilet. Clarendon has the usual facilities associated with a nursing home, including offices and nurse stations, kitchen, laundry, staff training room, staff changing rooms and so forth. The home provides information about its services in a Service User Guide, which is made available to current and potential Service Users. Additional information can be found in the home’s Statement of Purpose. The current weekly fees, at the time of writing this report, are from £560 to £700. Clarendon Nursing Home DS0000019024.V365746.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. To monitor all aspects of care we ‘tracked’ the care provided to a number of people who use this service, (referred to in Clarendon as ‘residents’) and we cross-checked the information by examining the documentation supporting care, by observing the meals provided, and by checking the arrangements for medication, handling money and other records. Staff providing care were interviewed, we also met with several relatives as well as meeting the residents themselves. Questionnaires were distributed and feedback from thirteen replies were noted. The manager was away at the time of our inspection so the Deputy assisted us and the Commission appreciates her input. What the service does well: What has improved since the last inspection? What they could do better: A number of matters will need attention and they include repair of door furniture, locks and catches, that are broken and some doors are not closing fully; a smoke detector was also damaged near an exit. There is, perhaps inevitably, damage to the décor, often caused by wheelchairs scuffing walls. Call bells (Nurse-call) are not always accessible for residents and nor are some of the over-bed night-lights. Some of the linen is very poor indeed, some towels were not very white and had holes. We are recommending that senior staff familiarise themselves with the new Mental Capacity Act where relevant to this care home. Clarendon Nursing Home DS0000019024.V365746.R01.S.doc Version 5.2 Page 6 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. Clarendon Nursing Home DS0000019024.V365746.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 Clarendon Nursing Home DS0000019024.V365746.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): NMS 3: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. New service users are being admitted only on the basis of a full assessment undertaken by people trained to do so and this involves the resident or, in some cases, their representative so residents know that they will be provided with sufficient information and that their needs have been fully assessed and can be met in this home. EVIDENCE: The owners of Clarendon Nursing Home, Southern Cross, understand the importance of having sufficient information when choosing a Care Home. It has developed clear information to help them understand what specialist services the home can provide, this includes an information pack that includes a detailed resident guide. The home provides a Statement of Purpose that is specific to Clarendon and the resident group they care for. It clearly sets out the objectives and philosophy of the service supported by the resident Guide. These documents detail what the prospective individual can expect and gives a clear account of the specialist services provided – in particular that the home is physically well Clarendon Nursing Home DS0000019024.V365746.R01.S.doc Version 5.2 Page 9 adapted for older people with physical disabilities – it also outlines the type of accommodation, qualifications and experience of staff, how to make a complaint, recent Commission inspection findings. All residents are given a copy of the Guide - located in the information folder in each bedroom. When requested the service could also provide a copy of the Statement of Purpose and guide in a format which will meet the varying needs of residents, for example those with visual impairment. Both documents are kept updated by the owners. Admissions are not made to the home until a full needs assessment has been undertaken. We are advised that the home makes sure it receives a copy of the care manager’ or hospital assessment before deciding upon admission. But for people whom are self funding and without a Care Management Assessment the assessment is always undertaken by a skilled and experienced member of Clarendon’s staff team. The assessment is conducted professionally and sensitively and involves the individual, and their family or representative, where appropriate. Where the assessment has been undertaken through care management arrangements the service insists on receiving a summary of the assessment and a copy of the care plan. Admissions to the home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. This point was discussed at some length during the inspection because the Commission is revising all registration certificates and is asking care home to update their statement of purpose to make clearer the criteria for admission. In Clarendon this will mean their statement of purpose emphasises its strengths, particularly their ability to provide for the needs of older people with physical disabilities and who use a wheelchair. Prospective residents are given the opportunity to spend time in the home. An individual member of staff, referred to as a ‘key worker’, is allocated to give them information and to help them understand how the home is organised and run and the facilities and services available. The allocated staff member will give them special attention, help them to feel comfortable in their surroundings, and enable them to ask any questions about life in the home. So residents know who this person is their details are added to a notice on each bedroom door. New residents are provided with a Statement of Terms and Conditions or Contract, this sets out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the individual. This is clear, jargon free, easy to understand and gives a very clear understanding of what residents can expect. Areas of strength include the very detailed statement of purpose and guide. No requirements are made. This section, about choice of home, is assessed as good. Clarendon Nursing Home DS0000019024.V365746.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): NMS 7 to 11: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for care planning, the provision of health care and the procedures for dealing with medication, and with the care of the dying, are all satisfactory so as to ensure the social, and health care of residents can be met. EVIDENCE: Clarendon is one a number of homes in the Croydon area operated by Southern Cross and the company uses a very detailed care plan format with multiple assessment and care plan forms. This means that personal healthcare needs including specialist health, nursing and dietary requirements are all clearly recorded in each resident’s plan and gives a comprehensive overview of their health, social and spiritual needs and provides an indicator of change in requirements. This information is initially taken from the assessment provided by care managers at the time of admission. The statement of purpose details the specialist treatments the home can deliver with a commitment to personcentred planning, and it refers to the skills and ability of the staff group. As this is a nursing home the statement makes clear what nursing staff are available in the home. Clarendon Nursing Home DS0000019024.V365746.R01.S.doc Version 5.2 Page 11 To evaluate the care provided in Clarendon a sample of residents’ case files were read and other records were checked; residents and relatives were interviewed; staff and visiting professionals were also given questionnaires. The deputy manager explained how they aim to met the social and health care needs of all residents. The administration in this home is very good and the case files were in good order despite the home being in transition from old to new formats these vital documents need to be well managed and they are. Personal support is responsive to the varied and individual needs and preferences of the residents. The delivery of personal care is individual and is flexible, consistent, reliable, and person-centred. Staff respect privacy and dignity and are sensitive to changing needs. The service listens and responds to individuals’ choices and decisions about who delivers their personal care. Residents are supported and helped to be independent and can take responsibility for their personal care needs in so far as that is possible given that many residents are quite dependent because of the frailty and mobility problems. Staff appeared to be listening to residents and taking account of what is important to them and this was observed during the meal time when staff asked about choice and preferences. The care plans also provide evidence that staff consult residents about their individual needs including we noted any ‘Living Wills’ residents might have drafted. Here we noted when this part of the form indicated that Will had been drafted but staff were not at all clear where it was and what the resident’s wishes were. With the forthcoming introduction of the Mental Capacity Act in October (2007) this information will need to be much clearer. In the example we saw staff agreed to check the details directly with the resident concerned. The home may also note that the London Ambulance Service have devised a form to assist all parties if an emergency arises. Residents have access to healthcare and remedial services and staff make sure that those residents who are fit and well enough are encouraged to be independent, have regular appointments and visit local health care services. However, as most residents are too frail to attend appointments the home arranges visits from local health care services including General Practitioners, Specialist nurses such as Palliative Care Nurses, Opticians, Dentists and so forth. Residents have the aids and equipment they need and these are well maintained to support both residents and staff in daily living. We observed maintenance staff replacing or adjusting raisable beds to ensure they are suitable for particular residents. We also note that a range of pressure relieving mattresses are available for preventing pressure sores. This care home was purpose built and whilst its location is very problematic, sited as it is between terraced house and lacking adequate parking and garden space it is otherwise well suited to older people with mobility problems. It has wide corridors and door openings, large bedrooms that are ensuite, adapted baths, handrails and other adaptations. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. We checked to confirm that medication records are fully completed, that they contain the required Clarendon Nursing Home DS0000019024.V365746.R01.S.doc Version 5.2 Page 12 entries, and are signed by appropriate staff. Regular management checks are recorded to monitor compliance using their various and numerous audit systems. Residents are given the support they need to manage their medication. If individuals prefer or where they lack capacity, care staff can manage medication and this is usually the case in Clarendon. The home has a good record of compliance with the receipt, administration, safekeeping, and disposal of Controlled Drugs. Nurses administer medication and they confirm that they have completed and passed an appropriate medication course. They advised us that they have also undertaken other specialist training courses for example, phlebotomy (blood-taking). Staff have access to training in health care matters and are encouraged and given time to attend seminars on specialist areas of work – for example staff advised us the they are being supported by a local Hospice in providing ‘palliative care’, (care of the dying), to ensure staff are able to provide care to support the dying in a caring and sensitive manner taking account of known wishes and cultural beliefs. This is in line with Clarendon’s aims and objectives to reinforce the importance of treating individuals with respect and dignity. During the dying process there are arrangements in place, which enable family and friends to stay and help with the care with the agreement of the resident. Staff support both the family and the homes’ other residents during the bereavement process. Areas of strength are the comprehensive care planning documentation that is being introduced and the specialist care for older people with mobility problems and the use of palliative, end of life, care to support the terminally ill. No requirements are made. This section, about health care, is assessed as good. Clarendon Nursing Home DS0000019024.V365746.R01.S.doc Version 5.2 Page 13 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): NMS 12 to 15: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily routines in this home are reasonably flexible, within the constraints of a large service. Residents are being supported and encouraged so they can maintain links with family, friends and to exercise choice and control over their lives in so far as they wish and are able to do so. Residents can be assured they will get a wholesome, appealing and well balanced diet in a congenial setting. EVIDENCE: As most residents are older people and already quite dependent when they arrive few have any ambition to learn new skills for independent living; they have been independent are now retired and often quite frail. But, whenever possible staff encourage residents to maintain such independence as they can manage and this usually means in areas such as personal hygiene and selfcare; use of self-propelled wheelchairs – one resident said how “Happy he was to have this (electric wheelchair), I can move around when I want to on my own”. Staff also help residents maintain contact with friends and family independently and again this was confirmed when we met visitors who said how “welcoming” staff are in this home. The practice of staff is promoting individual rights and choice, but also considers protection of individuals, supporting people to make informed choices so the home will take account of Clarendon Nursing Home DS0000019024.V365746.R01.S.doc Version 5.2 Page 14 close personal relationships whilst being mindful of the need to protect vulnerable adults from abusive relationships. Help with communication skills is given by the staff team, both within the service and when accessing the community to enable residents to fully participate in daily living activities. In practice this means use of aids such as hearing aids when residents have sensory impairment or support in language translation when English is their second language as it is in several cases at Clarendon. This home is a little unusual in that it is providing care for a larger than average proportion residents from a wide range of backgrounds, African, Caribbean, Asian and so forth, there are also a large proportion of male residents in this home compared to similar nursing homes. The staff team reflects a similarly wide range of backgrounds and is therefore well equipped to meet the needs of residents not just from the local English community but those from minority ethnic groups. An activity coordinator has been appointed and she is assisted by staff from each floor during the day. As activities were again mentioned in one of the feedback forms we received, this person will need to ensure each resident is consulted and an acceptable programme of engagement is developed. We discussed the implications of electronic tagging and advise senior staff to familiarise themselves with the new Mental Capacity Act in case it has implication for residents’ rights. This service is committed to the principles of inclusion and promotes, and fosters good relationships with neighbours and other members of the community and to this end the new managers intends to make use it encourages visitors and community representatives such church leaders. The menu is varied with a number of choices including a healthy option. It includes a variety of dishes that encourage individuals to try new and sometimes unfamiliar food. The meals are balanced and nutritional and cater for the varying cultural and dietary needs of the individuals using the service. For example Caribbean residents advised us that as they are routinely offered meals familiar to them and their own culture. We observed the midday meal being served and saw that care staff are sensitive to the needs of those residents who find it difficult to eat and give assistance with feeding in thoughtful and kindly manner. Staff are clearly aware of the importance of feeding at the pace of the resident, making them feel comfortable and unhurried. We checked the menus and noted that the evening meals seem rather ‘heavy’ - much as might be expected for the main midday meal. The cook advised us that residents often prefer a lighter cooker meal. We therefore recommend review the evening meals Areas of strength include the care planning which identifies individual needs, wishes and preferences and the support that is provided by a large and well managed staff team. The new activity coordinator must be doing a good job since few people asked for more activities during this visit. Recommend review of evening meals especially as summer approaches. We assess this section, about daily living, good. Clarendon Nursing Home DS0000019024.V365746.R01.S.doc Version 5.2 Page 15 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): NMS 16 to 18: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. The home procedures for dealing with complaints so residents cane be confident their concerns will be dealt with promptly and effectively. The home ensures vulnerable residents are safeguarded from abuse. EVIDENCE: The new manager has developed an open culture that allows staff and residents to express their views and concerns in a safe and understanding environment. Residents and others involved with the service say that they are happy with the service, they feel safe and well supported by an organisation that has their protection and safety as a priority. The questionnaire we gave residents, and others, provided an opportunity raise with us any concerns they may have but no complaints arose during this inspection (except about the laundry service, see the next section for comments about this point) - suggesting a resident group feeling confident with the management team. We interviewed staff, residents a number of visitors as well as noting written feedback to confirm this is the case. The deputy manager, whom we also interviewed, said Clarendon has a complaints procedure that is clearly written and easy to understand and could be made available on request in a number of formats including other languages and large print to help anyone living at, or involved with, the service to complain or make suggestions for improvement. The record of complaints held by the home indicates the procedure is working and that concerns are being dealt with in a timely manner. The complaints procedure is supplied to everyone living at the home and is displayed in a Clarendon Nursing Home DS0000019024.V365746.R01.S.doc Version 5.2 Page 16 number of areas within the service. Most residents and others involved with the home understand how to make a complaint and are clear about what will happen if a complaint is made but we did receive some feedback to suggest the information is not made widely enough known and that sometimes the manner in which has been handled has not sensitive enough nor followed through as might be expected according to the feedback we received. As indicated in earlier sections we discussed the implications of electronic tagging of residents and the use of digital locks intended to protect resident but inevitably restricting their movements in and out of the care home and so we advise senior staff to familiarise themselves with the new Mental Capacity Act in case it has implication for residents’ rights especially the ‘deprivation of liberty safeguards’ that will be overseen by the local authority. The home’s policies and procedures for Safeguarding Adults are available and give clear specific guidance to those using them. We interviewed staff to confirm that they know when incidents need external input from local care managers and who to refer the incidents to, which includes the Commission. The home understands the local authority’s procedures for Safeguarding Adults and has been attending strategy meetings when requested. There are a low number of referrals - made as a result of lack of incidents, rather than a lack of understanding about when incidents should be reported. Training of staff in the area of protection is regularly arranged by the Home. Other training around dealing with physical and verbal aggression and restraint is also made available to staff as needed. Areas of strength include the new manager’s positive approach to resolving complaints and concerns in an effective and thoughtful manner and the staff’s awareness of safeguarding adults procedures. We recommend further staff training in respect of the Mental Capacity Act. This section, about complaints, rights and protection is assessed as good. Clarendon Nursing Home DS0000019024.V365746.R01.S.doc Version 5.2 Page 17 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): NMS 19, 22 and 26: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that the home is generally well adapted so that it can meet the needs of older people who need a variety of aids and adaptations and that the premises are being kept clean, hygienic and free from offensive odours and systems are in place to control the spread of infection. EVIDENCE: The home provides a physical environment that is appropriate to the specific needs of the people who live there, that is, older people with nursing needs and who may have substantial mobility problems. To meet those needs the home has a variety of specialist aids and equipment including for example several types of hoists and assisted baths. Internally the home is a very pleasant, safe place to live in, the bedrooms and communal rooms meet the modern standards and bedrooms have en-suite facilities. The lay out and design of the home does not allow allow for small clusters of people to live together in a non-institutional environment, and regrettably there aren’t even any lounges on the first and second floor. This means everyone stays in their Clarendon Nursing Home DS0000019024.V365746.R01.S.doc Version 5.2 Page 18 own room or descends to the ground floor to join the larger groups – not the best design for new care home. There are several lounges and dining areas including a conservatory that is designated for smokers (and which does not contain any equipment or activity that would compel non-smokers to use the room and so it is in compliance with the new non-smoking laws that came into force July 2007). This problem of ‘communal space’ inside is compounded by a lack of garden space outside the premises (as intended by standard 20.3 and regulation 23(2)o). There is little realistic opportunity for providing suitable grounds now the home is up and running – it therefore remains an unresolvable shortcoming in the service. Residents are encouraged to personalise their bedrooms. All the homes fixtures and fittings meet the needs of the individuals and can be changed if their needs change - a point we noted when visiting as residents beds were being modified to meet the specific needs of several residents. The shared areas (lounges for example) provide a choice of communal areas but there is little opportunity for residents to meet relatives and friends in private away from their bedroom – privacy can be provided for meetings but a private visitors’ room is not readily available. We noted that not all call bells were within reach of residents, for example those residents isolated in their bedrooms and not all lights over their beds were accessible to switch on and of from the bed. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of the residents, and are in sufficient numbers and of good quality and well maintained. Residents say that there is plenty of hot water and the temperature in the home generally or in individual rooms can be changed, on request. We conformed that water supplies are checked to ensure they are maintained at safe temperature for cold storage and hot water supply is at a safe level at hot taps, that is, 43oC. The home is well lit, clean and tidy and smells fresh. The management has a good infection control policy; they seek advice from external specialists, e.g. infection control, and encourage their own staff to work to the homes’ policy to reduce the risk of infection. Staff confirmed that they have been on training courses about infection control. Areas of strength are the general layout of the building and its adaptation for wheelchair users and matters requiring improvement are limited to only minor damage was noted, as we did in 2007, often the corners of walls are damaged, perhaps by wheelchairs. Some walls are in need of repair, particularly where wallpaper has been removed and plastered over leaving an unsightly patch. Calls bells and light switches need to within reach. Door flocks and handles need to fixed. Despite some shortcomings, overall this section, about the environment, is assessed as good. Clarendon Nursing Home DS0000019024.V365746.R01.S.doc Version 5.2 Page 19 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): NMS 27 to 30: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that staffing arrangements in this home will meet their needs. EVIDENCE: The inspections for this and last year, 2007 indicate that residents of Clarendon can have confidence in the new manager and the staff team she is building to take care of them. Rotas is well organised with particular attention given to busy times of the day and changing needs of the residents. This includes varying the number of nurses and social care staff available on each floor as residents’ dependency levels changes. When we visited there were 3 nurses, one for each floor and 12 care staff plus the deputy manager, who is herself a qualified nurse. In addition there were activity person, catering, laundry, housekeeping and maintenance staff. There is little need for a gardener in this care home. Staff members undertake external qualifications beyond the basic requirements and certificates are in place to confirm this. Managers encourage and enable this training and development and recognise the benefits of a skilled, trained workforce. Job descriptions and specifications clearly define the roles and responsibilities of staff and again staff we interviewed confirmed this to be the case. Residents report that staff working with them are very skilled in their role, and are consistently able to meet their needs; for example one person giving feedback states, “The care my mother receives has always been excellent”. Clarendon Nursing Home DS0000019024.V365746.R01.S.doc Version 5.2 Page 20 The deputy manager advises us that there are always enough staff available to meet the health care needs of the residents, with more staff being available at peak times of activity if required. The home uses detailed assessment and dependency charts to gauge quite accurately the overall dependency levels of residents and so the staffing structure can be based around delivering outcomes for the residents, and not be led by staff requirements. The service now has a satisfactory recruitment procedure that clearly defines the process to be followed as demonstrated in the detailed index to each staff file, this allows the managers to monitor all stages of recruitment. Staff recruited confirm that the service was clear about what was involved at all stages and was robust in the following of its procedure and that these the correct procedures had been followed in their case, for example police checks, references, work history, work permits and so forth. Staff meetings take place regularly and supervision sessions are now set up to held with each member of staff six times each year. Notes are taken of meetings and sessions and were available for inspection. Areas of strength include the recruitment processes, the induction, training and support systems and the professional attitude of staff shown during our inspection visit. We recommend that in addition to the activity coordinator, who will lead activity programmes, all staff are given guidance in supporting residents’ social aspirations and to this each a care worker from each floor take turns to work with the activity coordinator. This section, about staffing, is assessed as good. Clarendon Nursing Home DS0000019024.V365746.R01.S.doc Version 5.2 Page 21 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): NMS 31, 33, 35, 37 and 38: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. This is a well managed care home so residents can be confident it is being run in their best interests. EVIDENCE: The Manager appears, from the evidence deduced during this and previous inspections, to be someone with the required qualifications, experience skills to run Clarendon. Supported by are large national organisation (Southern Cross) the manager has shown herself to be competent in delivering effective financial planning and budgetary control within the budgets that she is responsible for and she appears to have every confidence this is the case. The deputy manager assures us that the manager will continue to work assiduously towards continuously improving services, to improve the quality of life for residents and that she has a strong focus on equality and diversity issues as demonstrated by a diverse resident group and an equally diverse Clarendon Nursing Home DS0000019024.V365746.R01.S.doc Version 5.2 Page 22 staff team. The policy of diversity is thoughtful and practical guide for all staff and residents. There already appears to be a strong ethos of being open and transparent in all areas of running of the home. The acting manager is aware that strong clear and dynamic leadership is needed if this home is attain the high standards she is aiming for in Clarendon. The service has sound policies and procedures, which the manager with the support of the owners effectively reviews and updates, in line with current practice and changes in law. The manager ensures staff follow the policies and procedures of the home, and in the case of the corporate provider, Southern Cross, those of the parent organisation. The staff team are positive in their approach to translate policy into practice. Efficient systems are in place to monitor staff adherence to policies and procedures during their practice. Management processes ensure that staff receive feedback on their work. This is achieved by multiplicity of internal auditing and cross-checking methodologies, not least of which are the monthly visits by senior managers of the organisation. These visits are also used to supervise and support the manager of the home appropriately in the running of the service. The home has access to professional business and financial advice and has all the necessary insurance cover in place to enable it to fulfil any loss or legal liabilities. We checked a wide range of written records including visitors’ book, residents’ case files, food records, catering records, fire, complaint and accident records and the monthly owners’ visits. Records are of a good standard and are routinely completed. Residents are aware of safety arrangements and have confidence in the safe working practices of staff. The manager ensures risk assessments are completed and taken into account in planning the care and routines of the home and this includes both local risk associated with individual residents and risks of a wider nature affecting the whole home such as infection control and fire safety. Areas of strength include the development of a robust management team intending to lead by example and improve the quality of care for all residents. And as no matters requiring improvement arise, other than the prompt application to register the manager, this section, about management and administration, is assessed as good. Clarendon Nursing Home DS0000019024.V365746.R01.S.doc Version 5.2 Page 23 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: Good Standard No Score 1 2 3 4 5 6 ENVIRONMENT: Good Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE: Good Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES: Good Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION: Good Standard No Score 16 3 17 3 18 3 2 X X 2 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 X 3 3 Clarendon Nursing Home DS0000019024.V365746.R01.S.doc Version 5.2 Page 24 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 OP19 OP22 Regulation 16(2)c 23(2)b Requirement Environment, doors: All doors must be maintained in good working order including, catches, handles and door closing devices so residents safety and comfort is maintained at all times. Environmental aids: call-bells and bedside lighting must be accessible to the residents so that residents can summon assistance safely. Timescale for action 30/08/08 2 OP19 OP22 16(2)c 23(2)b 30/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP17 Good Practice Recommendations Residents’ Rights: It is recommended that staff receive further instruction in the implications of the Mental Capacity Act so residents will know their rights in respect of potential restraint, or deprivation of liberty situations, are adhered to. DS0000019024.V365746.R01.S.doc Version 5.2 Page 25 Clarendon Nursing Home 2 OP15 Meals: It is recommended that the evening meal menus be reviewed to ensure residents are receiving the sort of meal they want. Clarendon Nursing Home DS0000019024.V365746.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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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