Inspection on 09/04/09 for Clifton Gardens, 59

This is the latest available inspection report for this service, carried out on 9th April 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Clifton Gardens, 59 28/06/06

Clifton Gardens, 59 25/01/06

Clifton Gardens, 59 25/07/05

Clifton Gardens, 59 03/12/04

Clifton Gardens, 59 30/06/04

Clifton Gardens, 59 15/02/04

Clifton Gardens, 59 09/10/03

Clifton Gardens, 59 09/12/02

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Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for older people Name: Address: Clifton Gardens, 59 Clifton Gardens, 59 Chiswick W4 5TZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jean Bovell     Date: 1 4 0 4 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 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. 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 Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Clifton Gardens, 59 Clifton Gardens, 59 Chiswick W4 5TZ 02089951955 02087427322 lorretta.keating@hounslow.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: London Borough of Hounslow care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 43 The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home 59 Clifton Gardens is a purpose built home for older people. It is situated close to Chiswick High Road where there are shops, cafes, places of worship and a library. Chiswick Park and Turnham Green underground stations, and a number of bus routes are within walking distance. There is a health centre near to the home. The home is owned and managed by the London Borough of Hounslow. Accommodation is situated over two floors and is divided into five units. They are: Elmswood, Belmont, Savoy Lavender and Hoggarth. Belmont, Elmswood and Hoggarth units are dedicated for dementia care. The home also offers two intermediate and two respite care beds. Each unit has a lounge, kitchen and dining area. There is a designated room for Care Homes for Older People Page 4 of 27 43 0 Over 65 0 43 Brief description of the care home smoking. Overall, there are thirty-three single bedrooms and one double bedroom at the home. All of the bedrooms are suitably fitted and furnished with en-suite toilet facilities in each bedroom within the dementia units. There are also four communal assisted bathrooms, one shower room and nine toilets. The offices and laundry are located on the ground floor. Pleasant grounds surround the building. There is a courtyard and a roof garden. The staff team consists of a Registered Manager, Assistant Manager, four senior Support Workers, a team of day and night Support Workers and a part-time Admin Assistant. There is a separate team of domestic and catering staff, a Business Support Manager and a Handy Person. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection was carried out between 11:00 and 5:30 on 9th April and 11:45 and 2:15 on 14th April 2008. The Registered Manager, a Duty Manager and a total of nine care workers and 40 residents were at the home. During the course of the inspection, documents, records, policies and procedures in relation to key Standards were viewed. Observations were made and a tour of the building was undertaken. Seven residents, two visitors, two Duty Managers, five care staff and an Administrator were spoken with. Thirteen completed service users surveys, three staff surveys and an Annual Quality Assurance Assessment (AQAA) submitted by the home, were considered. Care Homes for Older People Page 6 of 27 Requirements made at the last inspection and all key Standards were examined. The Registered Manager was co-operative and provided appropriate assistance throughout the inspection. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 27 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. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 care needs of propspective residents are being fully assessed prior to admission . Evidence: The files of six residents were viewed at random. Each file contained a written assessment submitted by the placing authority at the point of referral. It was evidenced also that full needs led assessment were being carried out by the home in relation to prospective residents prior to admission. Two beds are being allocated to people who require intermediate care. People who replied to CQC surveys indicated receiving sufficient information about the home before they moved in. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Initial care plans are being appropriately carried out but care plan reviews are not being fully undertaken. Although, the overall healthcare needs of residents are being met, individuals do not at all times receive prompt medical attention or are fully informed of their medical condition. The administration of medication is satisfactory. Poeple who use the service are treated with respect and their right to privacy is being upheld. Evidence: The personal, social, dietary and healthcare needs of residents had been appropriately assessed within initial care plans viewed and risk assessments on Moving and Handling were in place. Care Homes for Older People Page 12 of 27 Evidence: Eight care plans were viewed and all were being reviewed on a monthly basis. However, no change was the recorded outcome on each reviewed care plan. Changes relating to separately recorded incidents and/or accidents such as falls, peoples behaviours and increased personal care needs and/or developments in healthcare requirements, were not seen to have been reassessed. Related risk assessments had also not been undertaken. Of thirteen people who replied to CQC surveys, it was indicated that two always and eleven usually received the care and support they needed. One person reported that care workers did not cut his/her toenails. Individual healthcare needs were identified within initial care plans and indicated that peoples mental and physical healthcare needs were being met satisfactorily. It was, nonetheless, indicated on CQC surveys that only two people felt that they always received the medical support they needed. Others indicated usually or sometimes. Comments included: feedback regarding GP visits are often incomplete. Takes days to arrange urine tests. Difficult to get information to my family for example if I have a course of antibiotics. It was commented on a staff survey that Xrays can be delayed being done because of lack of transport. Medicines at the home were safely and appropriately stored and medication administration sheets were accurately documented and signed. There was documented evidence that medication audits were being carried out by Boots Chemist twice annually and most recently on 25th March 2009. We were informed by a Duty Manager who holds overall responsibilty for the administration of medication, that none of the residents were self-administered their medication. Records were reflective of up-to-date training on medication being delivered to all care staff. The homes policy and procedures were in place. Care staff were observed being respectful and polite when responding to the needs of residents. Each file viewed contained a written/signed statement relating to gender appropriate carers. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Daily activities are being provided and regular outings within the community are arranged. Contact with relatives and/or friends are encouraged and facilitated. People who use the service are able to exercise choice in relation to their daily living routines. Wholesome and appealing cooked lunches are being provided. Evidence: The Registered Manager confirmed that the home received monthly visits from a Church of England Vicar and that a small number of residents were taken to Sunday Church Services by relatives. The home employs two part-time Activities Co-ordinators and activities include daily exercise sessions, art therapy, music to movement, quizzes, coffee mornings and monthly outings within the community. People with capacity are able to be independent within the local community. Care Homes for Older People Page 14 of 27 Evidence: We observed a lively atmosphere on the ground floor at the time of the inspection. Residents enjoyed listening and dancing with care staff to familiar taped songs. They were also observed reading, chatting with others in separate lounges and having their hair done by a hairdresser who called on a weekly basis. Various food items such as cakes and Easter eggs were seen in an office and we were informed by the Registered Manager that preparation was ongoing for a planned Easter party. Although music was being heard from a radio in the lounge of a unit on the first floor, the general atmosphere was dull. People were in individual bedrooms or sat in dining areas drinking tea. One resident was having cereal and a cold drink. A care worker explained that he/she had already received breakfast but had requested a second bowl of cereal. Two relatives reported that there was always alot going on at the home but only for those who are able to take part. It was indicated on the majority of service users surveys that residents were usually able to participate in activities arranged by the home but we were informed by four residents in frail elderly units that they were physically unable to participate in ground floor activities. At the time of the inspection, care workers confirmed that of a total of eleven residents in two frail elderly units, six were participating in activities on the ground floor. An open visiting policy is in place and contact with relatives and/or friends are encouraged and facilitated. Several visitors were seen at the home during the course of the inspection. The Registered Manager confirmed that people were able to make decisions regarding their daily living routines such as what they wore each day, activities and meals. People were seen with different hairstyles, clothing and accessories. Individual choices and interests were also reflected in separate bedrooms. The home employs a trained cook and a part-time kitchen assistant. The menus indicated that main meals were served at lunch and included varied and wholesome choices. A choice of sandwiches and one other option such as sausage rolls and beans, jacket potato, chunky vegetable casserole and soup were listed for supper. Breakfast included cereal, porridge and/or toast. Care Homes for Older People Page 15 of 27 Evidence: Four residents in frail elderly units were spoken with and reported being offered only sandwiches for supper. We were informed by two visitors that their relative, also placed in a frail elderly unit, received nothing but sandwiches at supper and that he/she would welcome a hot option. Comments on service users surveys included: Would b nice to have a hot option in the evenings instead of sandwiches. In relation to breakfast: Bacon sandwich in the mornings. You have to order in advance. I dont remember and no one asks if you would like say a bacon sandwich the day before. and Porridge not properly cooked. A large variety of fresh, frozen and dried foods, and liquids, were being appropriately stored. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 complaints procedure is appropriately detailed and accessible. People who use the service are being protected from abuse but notifications are not in each where appropriate, forwarded to CQC Evidence: The complaints procedure was in place and accessible to residents and visitors. It was indicated on service users surveys that people who used the service were aware of how they should make a complaint. The complaints book was viewed and indicated that three complaints had been made to the home following the last inspection and were fully investigated and satisfactorily resolved. Although records of accidents and incidents were being maintained, notifications were not in each case forwarded to CQC, where appropriate. Individual financial records relating to personal financial allowances were viewed at random and were satisfactory. The records confirmed that up-to-date training on Safeguarding Adults had been Care Homes for Older People Page 17 of 27 Evidence: delivered to all care staff. Policies and procedures on Safeguarding Adults including Whistle Blowing, were in place. Care staff spoken with indicated knowledge of Whistle Blowing. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 home is generally well maintained and the environment is safe and homely. Evidence: The home is bright, airy and spacious and suitable for shared and/or individual activity. A programme of maintenance and renewal was in place and decorative works were ongoing. Specifically, the kitchen had been fully refurbished. The Garden was well maintained. No issues were identified in relation to the laundry. Overall, the home was clean, hygienic and well maintained. The environment was lively on the ground floor and safe and homely throughout. Residents who replied to CQC surveys indicated that the home was always fresh and clean. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 home is adequately staffed but floaters are not being effectively deployed to ensure that additional assistance is available in all unitis during peak periods. The homes recruitment procedures are satisfactory. Care staff are qualified and receive approriate training for meeting the needs of the people who use the service. Evidence: It was reflected on staff rotas that two care workers covered duty on dementia units and one care worker covered duty on each unit for frail elderly during waking hours. There were also two floaters who were appointed to provide additional assistance to care staff during peak periods. However, care staff on frail elderly units reported that they did not receive additional assistance particularly in relation to people whose personal care needs had increased, despite repeated requests. This was discussed with the Registered Manager and we assured that these issues would receive appropriate attention. Three care staff covered waking duty throughout all units at night. We were informed by the Registered Manager that of twenty permanent care staff, Care Homes for Older People Page 20 of 27 Evidence: sixteen achieved NQVQ 2 or above and four were receiving training. Five staff files were inspected and each file contained all required recruitment documents. A training programme was in place and reflected that suitable training and refreshers for meeting the needs of residents were being delivered to care staff. Individual training certificates were with recruitment files viewed. Care staff who replied to CQC surveys and those spoken with confirmed that they received induction and subsequent training and refreshers relevant to their role. Care staff were observed being competent and attentive in meeting the needs of residents. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 Registered Manager is appropriately qualified and experienced. Annual quality assurance has been undertaken effectively. The personal allowances of ressidents are being satisfactorily safeguarded. The health, safety and welfare of residents are being fully safeguarded. Evidence: The Registered Manager is suitably experienced and qualified. Care staff spoken reported that the Registered Manager was open, approchable and supportive. The annual quality assurance assessment (AQAA) was satisfactorily undertaken and returned to CQC at the required time. We were informed by the Registered Manager that relatives or placing authorities held Care Homes for Older People Page 22 of 27 Evidence: overall responsibility for the finanacial affairs of residents but personal allowances were held in safekeeping at the home. Separate financial records relating to personal allowance expenditure were inspected and no decrepancy was identified. Health and safety records were examined and all were satisfactory. Environmental risk assessments were in place. Fire drills were being undertaken on a regular basis and clearly and appropriately recorded. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 27 18 The Registered Person must 30/05/2009 make sure that floating care staff are effectively deployed. To ensure that peoples needs are being met in all units. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The Registered Person must make sure that care plans are accurately flective of changes that occurs in residents care needs. To ensure that the needs of people who use the service are fully met. 30/06/2009 2 18 37 The Registered Person must make sure that Regulation 37 notifications are submitted to CQC where appropriate. To ensure that the the health and welfare of residents are being fully protected. 30/06/2009 Care Homes for Older People Page 25 of 27 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: 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. 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. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!