Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Clarence House Nursing Home Clarence House, Albert Street, Brigg, DN20 8HS Tel: 01652650950 Date of Inspection: 07 August 2013 Date of Publication: September 2013 We inspected the following standards as part of a routine inspection. This is what we found: Care and welfare of people who use services Safeguarding people who use services from abuse Management of medicines Safety, availability and suitability of equipment Supporting workers Assessing and monitoring the quality of service provision Inspection Report Clarence House Nursing Home September 2013 www.cqc.org.uk 1
Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activities Dasa Care Homes Limited Mrs. Simone Shepheard Clarence House is a situated close to the centre of Brigg. It is registered to provide accommodation and nursing care for up to 33 people Care home service with nursing Accommodation for persons who require nursing or personal care Diagnostic and screening procedures Treatment of disease, disorder or injury Inspection Report Clarence House Nursing Home September 2013 www.cqc.org.uk 2
Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 5 Our judgements for each standard inspected: Care and welfare of people who use services 6 Safeguarding people who use services from abuse 8 Management of medicines 9 Safety, availability and suitability of equipment 10 Supporting workers 11 Assessing and monitoring the quality of service provision 12 About CQC Inspections 14 How we define our judgements 15 Glossary of terms we use in this report 17 Contact us 19 Inspection Report Clarence House Nursing Home September 2013 www.cqc.org.uk 3
Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 7 August 2013, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members, talked with staff, reviewed information sent to us by commissioners of services and talked with commissioners of services. What people told us and what we found There was a warm and relaxed atmosphere throughout the home and we observed that people looked clean, well cared for and that staff engaged with them in a friendly and compassionate manner. We saw that staff involved people in decisions to ensure their personal wishes and feelings were respected. People said staff were, "Caring and kind" and that they felt safe and were comfortable in the home. They said staff listened to them and we observed they were assisted in a helpful and sensitive way. Visiting relatives told us they were happy with the support that was provided. Staff said they had confidence any issues would be appropriately dealt with by the manager. We observed that staff demonstrated a calm and friendly approach. They told us they enjoyed their jobs and worked well as a team. We found a variety of internal audits were undertaken, together with analysis of these, to ensure risks concerning their health safety and welfare were minimised and effectively managed. We saw evidence of audits the manager had completed of staff record keeping, together with surveys of people's views, concerning the quality of the service that was delivered. The service was being run by a firm of management consultants at the time of our visit. We were told the service was to continue to operate as business as usual. You can see our judgements on the front page of this report. Inspection Report Clarence House Nursing Home September 2013 www.cqc.org.uk 4
More information about the provider Please see our website www.cqc.org.uk for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Clarence House Nursing Home September 2013 www.cqc.org.uk 5
Our judgements for each standard inspected Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. People experienced care, treatment and support that met their needs and protected their rights. Reasons for our judgement People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were arrangements in place to deal with foreseeable emergencies. There was a warm and relaxed atmosphere throughout the home on the day of our visit. We observed that people looked clean, well cared for and that staff engaged with them in a friendly and compassionate manner. We saw that staff involved people in decisions about their lives, to ensure their personal wishes and feelings were respected. People who used the service told us that staff were, "Caring and kind" and that they were comfortable in the home. People said that staff listened to them and we observed they were assisted in a helpful and sensitive way to ensure their support was delivered appropriately. Visiting relatives told us they were happy with the support that was provided. We found that social activities were provided to ensure people's wellbeing was promoted. We saw this included; quizzes, crafts and exercise sessions, as well opportunities for the promotion of their personal dignity. On the day of our visit, one person was having an appointment with a visiting hairdresser. We were told about individual time that was spent with staff for things like personal manicures, one to one time and that social events took place, which had recently included a summer fete. There was evidence in people's care files of action by staff to involve community health care professionals when this was required, to ensure people's medical needs were appropriately met. We were told by one person how staff had supported them to a GP appointment the previous day. We saw applications for assessments under the Mental Capacity Act 2005, which had been made to the local authority, to ensure the human rights of people were protected and that they were not deprived of their liberty. We found that assessments about people had been carried out prior to their admission to Inspection Report Clarence House Nursing Home September 2013 www.cqc.org.uk 6
the home, to ensure the service was able to meet their needs. We saw that individual care plans had been developed from people's assessments, to ensure staff knew how to support them effectively. We saw that details about medical needs of people were available to enable this to be provided for visits to hospital, or emergencies should these occur. Information about the management of risks to people were included within their care files, to ensure they were kept safe from harm. We saw this included assessments of known issues, such as falls, pressure sores, malnutrition and use of bed rails. There was evidence that information about people's needs was monitored and evaluated on a regular basis. We saw this included information concerning fluid and nutritional intake where this was required, together with assessments about the dependencies of people, to enable the manager to determine appropriate staffing levels for meeting people's needs. Inspection Report Clarence House Nursing Home September 2013 www.cqc.org.uk 7
Safeguarding people who use services from abuse People should be protected from abuse and staff should respect their human rights Our judgement The provider was meeting this standard. People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Reasons for our judgement People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The provider responded appropriately to any allegation of abuse. We saw that safeguarding policies and procedures were in place, to ensure staff were aware of their professional responsibilities to protect people who used the service from harm and knew how to report potential safeguarding concerns when needed. We also saw evidence that safeguarding training had been provided to staff, to ensure they knew how to recognise potential signs of abuse. People who used the service said that staff listened to them and that they felt safe in the home. Staff told us they had confidence any issues would be appropriately dealt with by the manager. We found evidence that since the last time we visited the home, the manager had appropriately notified ourselves of safeguarding issues. We also saw the manager had reported these to the local authority to enable them to be officially investigated, when required. We saw evidence the manager had taken appropriate action and implemented disciplinary action against staff where this was required. We saw this included a referral to the Disclosure and Barring Service (DBS), to enable a decision about the suitability of a member of staff working with vulnerable people in the future to be reached. Inspection Report Clarence House Nursing Home September 2013 www.cqc.org.uk 8
Management of medicines People should be given the medicines they need when they need them, and in a safe way Our judgement The provider was meeting this standard. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Reasons for our judgement Appropriate arrangements were in place in relation to obtaining medicine and medicines were kept safely We found the local authority had raised some concerns earlier in the year about some medication practices, following a performance review of the service they had completed. We saw that the manager had notified ourselves of this issue and developed an action plan to ensure this matter was appropriately addressed. We saw evidence of good progress with implementing the action plan, which had included the use of a new pharmacy supplier and system for administering medicines, together with additional training to ensure staff were competent in its use. People who used the service told us about the support they received with medicines. They said they received their medication on a regular basis. One person said they always received their medication when it was required. We looked at the storage of medicines and a selection of people's medication administration records (MARs) and care plans. We saw that overall, these were appropriately completed, with staff signing to indicate whether medication was given or had been refused. The provider may to find it useful to note we found some minor discrepancies in the amount of stock for some medications that were maintained. We noticed that new stock had not always been appropriately recorded on the MAR when it was received, which made it difficult to find a clear audit trail and determine the effectiveness of the control measures used. The manager told us they would address this issue as a matter of priority and had already requested further medication training, together with another audit of the medication system by the pharmacy supplier. We checked the controlled medication that was used in the home and saw these were appropriately stored. We found that recording of controlled medication was completed satisfactorily and that stock levels accorded with records that were maintained. We found that a specialist fridge for medication requiring storage at levels below room temperature was available and that this was monitored daily. Inspection Report Clarence House Nursing Home September 2013 www.cqc.org.uk 9
Safety, availability and suitability of equipment People should be safe from harm from unsafe or unsuitable equipment Our judgement The provider was meeting this standard. People were protected from unsafe or unsuitable equipment. Reasons for our judgement People were protected from unsafe or unsuitable equipment. We saw where people needed specific equipment to help their mobility, there was appropriate equipment available. Where staff used equipment to help people they did so in a safe and appropriate manner. We found that a part time handyman was employed to ensure the upkeep of building was appropriately maintained and that records were kept of regular checks and servicing of equipment, to ensure people's safety was promoted. Records showed that regular safety checks of water temperatures, fire alarms, extinguishers and bed rails were carried out. We found records were available that demonstrated electrical equipment had been tested in accordance with current legislation. We also saw manual handling equipment such as hoists, baths and lifts had been serviced in March 2013. The provider may find it useful to note that we found the five year certificate for the testing of the electrical supply had expired in July 2013 and that another test was therefore due. We found the kitchen facilities and food safety systems were assessed last year by the local authority environmental health officer and that the home had been awarded a 'five star' rating. We were told there had been some problems with the plumbing and water supply in recent months. We saw that a contractor was visiting the home on the day of our visit, to ensure this issue was appropriately addressed and followed up. We found that a fire risk assessment for the building was available and that training on fire safety had been delivered to staff. We found the home was clean, warm and tidy on the day of our visit. People who used the service told us they were happy with the facilities that were provided. People told us they liked their rooms. One said, "Staff always keep my room very tidy and clean." We saw that people's bedrooms reflected their interests and personalities and that they were able to bring personal belongings with them, such as items of furniture and photographs to help them feel relaxed and at home. Inspection Report Clarence House Nursing Home September 2013 www.cqc.org.uk 10
Supporting workers Staff should be properly trained and supervised, and have the chance to develop and improve their skills Our judgement The provider was meeting this standard. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Reasons for our judgement Staff were able, from time to time, to obtain further relevant qualifications. We observed that staff interacted with people in a positive and caring way and listened to them, giving reassurance and support where this was required. We saw that staff demonstrated a calm and friendly approach and worked closely together. Staff told us they enjoyed their jobs and worked well as a team. They told us they were provided with opportunities to help them develop their careers. We found this included regular professional supervision and appraisals of their skills to enable their work to be monitored. We found that an induction and mentoring process was in place to enable new staff to familiarise themselves with their roles and responsibilities and what was expected of them. We also found that a variety of courses were provided which the provider considered essential, to ensure staff had the right skills needed to carry out their work. We found the people's dependency levels were assessed to ensure there were sufficient staff available to meet people's needs. The provider may to find it useful to note that whilst people told us that staff treated them well and answered their call bells when this was required, we observed staff were kept very busy and that a number of people required two staff to move them, which meant they were not available elsewhere. We were subsequently told that the staffing levels had been increased to cover busy periods. We saw evidence that checks were carried out to ensure staff were safe to work with people who used the service. We found this included a formal recruitment process including checks with the DBS and references being obtained. Inspection Report Clarence House Nursing Home September 2013 www.cqc.org.uk 11
Assessing and monitoring the quality of service provision The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. Reasons for our judgement People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. There was evidence that learning from incidents / investigations took place and appropriate changes were implemented. We found the service was being run by a firm of management consultants, following the company that own the home having recently gone into administration. We were told that meetings had been held with people who used the service and their relatives, to assure them about arrangements and that the service would continue to operate as business as usual. An area manager from the consultancy firm was visiting the service on the day of our visit, who told us they would visit the service on a regular basis, to ensure the service was appropriately monitored. We found a variety of internal audits were undertaken and saw evidence of records maintained of incidents concerning people who used the service, together with analysis of these, to ensure risks concerning their health safety and welfare were minimised and effectively managed. We found evidence of audits the manager had completed of staff record keeping, together with surveys of people's views, concerning the quality of the service that was delivered. We saw this included action plans to ensure shortfalls were appropriately addressed. We found this included earlier starting times for meals, additional snacks and drinks, staff availability and social activities provided. People told us they were satisfied with the service and that their views were taken seriously. We found a complaints policy and procedure was available to ensure their concerns were addressed. People and their relatives we spoke with said they knew how to complain and were confident appropriate action was taken by the manager when this was required. One relative told us, "I am plain speaking, if I had any issues I would make sure something is done." We looked at the records of formal complaints about the service and saw that none had been received since the last time we visited the home. Minutes of staff meetings contained evidence of leadership and direction that was provided Inspection Report Clarence House Nursing Home September 2013 www.cqc.org.uk 12
to ensure staff were aware of their roles and responsibilities. Staff told us they enjoyed working in the home and that the manager listened and included them in decisions that were made. They told us the manager provided them with good support to ensure they could appropriately carry out their work. Inspection Report Clarence House Nursing Home September 2013 www.cqc.org.uk 13
About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Clarence House Nursing Home September 2013 www.cqc.org.uk 14
How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Clarence House Nursing Home September 2013 www.cqc.org.uk 15
How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Clarence House Nursing Home September 2013 www.cqc.org.uk 16
Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Clarence House Nursing Home September 2013 www.cqc.org.uk 17
Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Clarence House Nursing Home September 2013 www.cqc.org.uk 18
Contact us Phone: 03000 616161 Email: enquiries@cqc.org.uk Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: www.cqc.org.uk Copyright Copyright (2011) 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. Inspection Report Clarence House Nursing Home September 2013 www.cqc.org.uk 19