Inspection on 16/12/09 for Clifton House

This is the latest available inspection report for this service, carried out on 16th December 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

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Extracts from inspection reports are licensed from CQC, this page was updated on 14/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Clifton House Clifton House Clifton Court Ayres Road Old Trafford Manchester M16 7NX     The quality rating for this care home is:   one star adequate 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: Val Bell     Date: 1 8 1 2 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 Adults (18-65 years) Page 2 of 30 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 Adults (18-65 years) 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 Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Clifton House Clifton House Clifton Court Ayres Road Old Trafford Manchester M16 7NX 01612267698 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): cliftonrch@mailauth.co.uk Deepdene Care Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of people who can be accommodated is: 32. The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the service are within the following category: Mental Disorder, excluding disability or dementia - Code MD. Date of last inspection Brief description of the care home Clifton House is registered to provide care and accommodation to 32 young adults with enduring mental ill health. The home is owned by Deepdene Care Ltd. The property is arranged on three floors and is situated in a residential area of Old Trafford, approximately two miles from Manchester city centre. Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 32 Brief description of the care home Accommodation is provided in single bedrooms. A landscaped garen area with seating is available for use by the people using this service and a large car park is available at the rear of the building. The fees for this service are dependent on the specific assessed needs of each individual. Care Homes for Adults (18-65 years) Page 5 of 30 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was the first key inspection of Clifton House, which is a newly registered service. We paid two visits to the home. The visits were unannounced, which means that the manager was not told beforehand that we were coming to inspect. During the visit we spent time talking to people living in the home, support staff, an administrator, the chef and the manager. An Annual Quality Assurance Assessment (AQAA), which is a self-assessment document had been completed and returned to us by the manager prior to our visits. We examined a variety of documents including care plans, policies and procedures and we undertook a tour of the home to assess cleanliness, hygiene and health and safety. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The majority of requirements and recommendations made dueing this inspection related to the standard of care planning in the home. We were concerned at the lack of detail in care plans and in some cases no care plans had been developed for needs identified during the assessment process. Of particular concern was the absence of risk assessments and management plans for people who had been identified as at risk of malnutrition. The AQAA informed us that support staff had not been trained in this area and that nutritional risk assessments were not used in the home. This places the health and welfare of people at risk of harm as there is no system in place for monitoring and reviewing food and fluid intake or potential weight loss. Of similar concern is the lack of a system in the home for assessing and managing the risk of behavioural incidents. Improvements also need to be made by ensuring that people have structured social care plans to identify an individuals preferred activities and chosen lifestyle. Care plans must be reviewed regularly and updated when a persons needs change and evidence provided to demonstrate the involvement that individuals have had in developing their Care Homes for Adults (18-65 years) Page 7 of 30 care plans. Further concerns were identified from records that detailed two incidents occuring some months before our visits. Both incidents had been investigated internally, when they should have been referred to the local authority for investigation under their safeguarding procedures. Neither incident had been reported to us as required by Regulation 37 of the Care Homes Regulations. This prevents us from monitoring the conduct of the home and the welfare of people using the service. Shortfalls in fire safety had been identified in the homes risk assessment in May 2009, although no action had been taken to remedy the situation. This placed the health and safety of people living and working in the home at risk of harm in the event of a fire. The current manager was appointed in March 2009. Managers of care homes are required to submit an application for registration with the Care Quality Commission. The registration process determines if they are fit to be in charge of a care home. The manager of Clifton House is required to submit her application for registration by 12th March 2010. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 30 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Peoples needs are assessed before they move into Clifton House to ensure that their care and support needs can be met. Evidence: We asked the manager for copies of the homes current Statement of Purpose and Service User Guide. These documents contain important information about what services are provided by the home. We wanted to examine both documents to see if the information provided to users of the service was accurate and up to date. The Statement of Purpose and Service User Guide that we were given did not relate to Clifton House, but another care home owned by the provider. We have asked the provider to send us the correct copies of both documents. We looked at the care records belonging to two people to see if their needs had been appropriately assessed before they moved into the home. One person had been living in Clifton House for some time, while the second person moved in eight months before our visit. Both people had their needs assessed before a decision was taken on whether the service would be able to meet their needs. Risks involved in the safe Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: delivery of care and support had been identified and written down. There was some evidence that the individuals had participated in their assessments, which gave them the opportunity to make a decision on whether the home would be a good place to live. Care Homes for Adults (18-65 years) Page 11 of 30 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system in Clifton House does not empower people using the service to take responsible risks, maintain their independence or make informed choices about the support they receive. Evidence: We looked at the care plans belonging to two people living in the home. We were concerned to find that these plans contained insufficient information to show how each persons assessed needs would be met. One person was subject to a Care Programme Approach (CPA) under the Mental Health Act. This ensures that a framework for good practice is in place to deliver the support that the person needs and that their needs are formally reviewed on a regular basis. Records showed that this persons last CPA review was held during October 2008. Records also showed that the person had recently been involved in incidents which placed himself and members of staff at risk of harm. There was no evidence to show that the persons care co-ordinator had been contacted to request a review of his needs. Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: Neither care plan identified the goals that each person wanted to achieve and there was insufficient evidence to demonstrate that people were receiving support to participate in the development of their care plans. A lack of written information meant that we were unable to assess the support people receive to make decisions that are important to them. Both persons assessments of need identified risks to the safe delivery of care and support. Insufficient care had been taken to assess these risks and to provide staff with enough information to ensure that people were safe from harm. For example, both people had been assessed as at risk of weight loss, due to not eating when they were unwell. Nutritional risk assessments had not been undertaken and the selfassessment told us that none of the care staff had received training in malnutrition care. The chef had been trained in this area, although he had not been consulted about the nutritional support needed by the two individuals. The manager acknowledged that the standard of care planning needed to improve, although there was no evidence of an action plan to achieve this. The self-assessment completed by the manager stated, All care plans that have been discussed with residents have been signed by the resident to demonstrate that they have been involved in the process. Additionally, residents progression through their care plans are reviewed and documented by the responsible keyworker. The manager agreed that the information provided in the self-assessment did not accurately reflect the standard of care planning in place. By the time of our second visit to the home the manager had developed a strategy for reviewing each persons care plan to ensure that they accurately reflected the care and support that would be provided to safely meet each persons needs. We will assess progress on this when we next visit the home. Care Homes for Adults (18-65 years) Page 13 of 30 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. People using the service are provided with activities and a variety of nutritious meals, which they enjoy. Evidence: We asked two members of staff if people were empowered to engage in activities of their choice. Both staff said that people were involved in planning activities and were consulted on a regular basis. We saw written evidence of this in the minutes of house meetings. Plans for celebrating the festive season were underway. People living in the home were going out for a Christmas meal at the expense of the company. A member of staff told us that relatives and friends had been invited to join people living in the home for a meal. One of the people accommodated said, We went on a trip to Blackpool in the summer and had a really good time. Staff encourage people to be as independent as possible and we observed several Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: people making arrangements to go out shopping and visiting family and friends. The people accommodated in Clifton House were seen to have access to all parts of the home and routines appeared to be flexible to meet individuals preferences. One person told us that he receives visitors and that they are always made welcome by staff. We asked him what it was like living in the home. He responded, Its alright. We sometimes get on each others nerves and have arguments, usually over cigarettes, but its good really. I like the food here. We have been asked about what we like to eat. I usually choose the healthy option on the menu because I like salads. Menus provided evidence of varied and nutritious meals that are cooked fresh at each mealtime. Fresh fruit and vegetables are always available and people have access to a small kitchen where they can make themselves drinks and snacks at any time. We asked the kitchen staff about the nutrition needs of people living in the home. We were surprised to find that kitchen staff rely on important information being passed to them in relation to individuals special dietary needs, such as diabetes and people at risk of weight loss. The chef was trained and had good knowledge in this area. People using the service would benefit from his involvement in assessments of their nutritional needs. This could be achieved by involving him in staff and house meetings and ensuring that he has regular opportunities to discuss diets with individuals living in the home. The three care plans we examined lacked detail in providing evidence of structured activities. None of the care plans we examined contained social care plans, which made it difficult to assess whether each persons aspirations and life choices were being met. The manager agreed that this was an area for development. Care Homes for Adults (18-65 years) Page 15 of 30 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Clifton House are potentially at risk if their personal and health care needs are not recorded in a clear manner. This means that staff do not have clear written instructions on how to look after them properly. Evidence: The three care plans we examined contained insufficient information about the support people were to receive in meeting their personal and health care needs. Each need identified during the assessment process should have a respective care plan. We were concerned that two of the three people had been assessed as at risk of malnutrition. Nutritional risk assessments had not been undertaken and no instructions had been written down to guide staff in what they must do to ensure people are not at risk of weight loss. There was also insufficient attention to weighing people regularly. Although one person had lived in the home for five months, only one weight had been recorded. Consequently, it was not possible to determine if this person had lost or maintained his weight during this time. The self-assessment completed by the manager told us that none of the staff had been trained in malnutrition care or assistance with eating. This places the health and welfare of people at risk. Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: We found similar concerns relating to the risk assessment of aggressive behaviours. Care records informed us of an incident where a person living in the home had assaulted a member of staff. There was no evidence that the persons care plan or risk assessment had been reviewed or updated to inform staff of what they must do to keep themselves and others safe from further harm. This placed people living and working in the home at risk. We examined the system in place for administering medication to people living in the home. Good practice was in evidence in this area and we were satisfied that people were receiving their medication as prescribed by their doctors. Care Homes for Adults (18-65 years) Page 17 of 30 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Failure to follow the correct procedures in relation to identified safeguarding issues, potentially places the welfare and safety of people using this service at risk. Evidence: We looked at the homes policy and procedure for dealing with complaints. This contained clear guidance on how complaints must be managed and it detailed the timescales for investigating and resolving such issues. We were told that copies of the complaints procedure were issued to people during their admission to the home. We recommend that the complaints procedure is also posted on noticeboards so that visitors to the home know who to contact if they have any concerns about the service. The self-assessment completed by the manager informed us that there had been two complaints and that these had been resolved within 28 days. The staff we spoke to confirmed that they had recently been trained in what action they must take if there were allegations or suspicions that people using the service were at risk of harm. There was written evidence that care staff had passed concerns to the manager in relation to a medication error and a sum of money that had gone missing from the safe. The manager had failed to identify these incidents as safeguarding issues and both incidents had been dealt with internally. This had resulted in a senior member of staff being dismissed for gross misconduct. We made a retrospective safeguarding referral to the local authority following our first visit to the home. Furthermore, a referral should also have been made when the member of staff Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: was dismissed for consideration of inclusion on the Protection of Vulnerable Adults list. The manager gave us an assurance that she would make the required referral to the Independent Safeguarding Authority who, from October 2009, are responsible for vetting the suitability of people to work with vulnerable adults. The AQAA told us that five referrals had been made to the local authority safeguarding team and that four of these had been investigated. Care Homes for Adults (18-65 years) Page 19 of 30 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clifton House provides clean and hygienic accommodation for people using the service. The use of wedges or furniture to hold fire doors open potentially places the health and safety of people at risk from smoke inhalation in the event of a fire. Evidence: We looked around the home and found communal and private areas to be wellmaintained, clean and hygienic. Records provided evidence that equipment used in the home had been maintained and serviced on a regular basis. The small lounges had been tastefully decorated in preparation for the Christmas festivities and people were observed to be relaxing in the lounges while listening to music or watching TV. The laundry was situated away from food preparation areas and was found to be neat and tidy. It was evident that staff were following good practice in infection control and the self-assessment completed by the manager told us that 14 staff had received training in the prevention and control of infection. We found one of the lounge doors propped open with a chair and evidence of the use of a door wedge in a downstairs lounge. The fire risk assessment conducted by Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: Quantum Consultancy in May 2009 had identified that these were fire doors and that the use of wedges to hold them open placed people living and working in the home at risk. Staff and people living in the home must be reminded of this risk and that fire doors must be kept closed at all times. Care Homes for Adults (18-65 years) Page 21 of 30 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Robust recruitment procedures ensure that people living in the home can be confident that staff will act in their best interests. Evidence: We looked at the personnel files belonging to two staff recruited since this home was registered. Both files contained a full set of documents that had been obtained prior to their appointment. This provided evidence of a robust system of recruitment that ensured staff selected for employment were suitable to work with vulnerable adults. The self-assessment completed by the manager told us that more than half of the 17 staff employed had achieved a National Vocational Qualification in care at level 2 or above. Written evidence of this qualification was held in the staff files. We also saw evidence that newly employed staff had completed induction programmes that met the specifications of Skills for Care Common Induction Standards. Further training had been provided in such areas as Health and Safety and Safeguarding Adults from Abuse. Care Homes for Adults (18-65 years) Page 22 of 30 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current management systems do not ensure the efficient running of the home and the ongoing improvement of the service. Evidence: The current manager was appointed in March 2009. She is a qualified general nurse and has a management qualification and two years relevant experience of running a care home for people with enduring mental ill-health. Managers of care homes are required to apply for registration with the Care Quality Commission and we expect the manager of Clifton House to submit her application soon. The manager appeared to have developed good relationships with staff and people living in the home. Staff told us that she was approachable, a good listener and fair. During our first visit to the home we found serious issues in the manner in which safeguarding and health and safety issues had been managed. A sum of money deposited for safekeeping on behalf of a person living in the home could not be traced two months later. This should have been referred to Trafford Local Authority for Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: investigation under their safeguarding adult procedures. The incident was investigated internally and resulted in a member of staff being dismissed for gross misconduct. The manager had a legal obligation under Regulation 37 of the Care Homes Regulations to notify us about such incidents, but this was not done. During our visits to the home we found evidence of other incidents that had not been reported to us, such as a medication error and an incident where a member of staff was assaulted by a person using the service. The self-assessment completed by the manager told us that Deepdene Care have appointed an external risk management consultancy that works with us to ensure that all health and safety issues within the home are managed. Any issues raised are addressed promptly. This statement was inaccurate. We looked at the fire risk assessment undertaken by the consultancy on 1st May 2009. Their report identified serious concerns, such as unsafe storage of combustible materials and the risk of using wedges to hold fire doors open. No action had been taken to address these risks in the six months following the report. This potentially placed the welfare and safety of people living and working in the home at serious risk in the event of a fire. During our first days visit we observed the manager spending a large proportion of her time engaged in hands-on support with people living in the home. In discussion with the manager we expressed our concern that this was compromising her ability to focus and prioritise on essential management tasks. We found evidence that people living in the home were being consulted about matters that were important to them. House meetings had been held in July and November and peoples suggestions for additional activities had been incorporated into the plan for 2010. Care Homes for Adults (18-65 years) Page 24 of 30 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 Adults (18-65 years) Page 25 of 30 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 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 6 15 Care plans must accurately 16/02/2010 record the support that each person will receive according to their assessment of needs. Care plans must be kept under regular review and updated as peoples needs change. To provide evidence that people are receiving the support that they need and that this is delivered in a safe way. 2 9 13 Risks must be thoroughly 16/02/2010 assessed and clear guidance provided to staff on what they must do to keep people safe from harm. People using the service have the right to take responsible risks and to receive appropriate support to keep them safe from harm. Care Homes for Adults (18-65 years) Page 26 of 30 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 3 19 13 Nutritional risk assessments and care plans must be undertaken when people have been assessed as at risk of malnutrition. To monitor and keep under review the health and welfare of people at risk of weight loss. 29/01/2010 4 23 37 Allegations or suspicions 18/01/2010 that people using the service are at risk of abuse must be referred, without delay, to Trafford Safeguarding Team and the Care Quality Commission. To ensure that vulnerable adults welfare is protected according to local authority safeguarding procedures. 5 24 13 Fire doors must be kept closed at all times. To prevent harm to people from the inhalation of smoke in the event of a fire. 18/01/2010 6 37 37 Incidents affecting the welfare and safety of people living in the home must be notified to the Commission without delay. 18/01/2010 Care Homes for Adults (18-65 years) Page 27 of 30 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 To provide evidence that people living in the home are being supported in a safe manner. 7 37 8 The current manager must submit an application for registration with the Care Quality Commission. To assess if the manager has the required knowledge, skills and experience to safely manage Clifton House. 8 42 13 Action must be taken to address the risks identified in the homes fire risk assessment. To ensure that the health and welfare of people living and working in the home is safeguarded from home. 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 12/03/2010 01/02/2010 1 1 The Commission should be provided with a current Statement of purpose and service User Guide to provided evidence that people using the service are provided with accurate and up to date information. People using the service should be supported to fully participate in developing their care plans and to express their aspirations and lifestyle preferences. 2 7 Care Homes for Adults (18-65 years) Page 28 of 30 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 3 13 Care plans should detail the social care needs of individuals and what support they will receive to meet each persons aspirations and lifestyle preferences. This will ensure that support is provided in a person-centred way. Kitchen staff trained in nutrition should be involved in assessment and care planning in relation to the dietary needs of people using the service. This will ensure that good practice guidelines in nutrition are followed. Evidence should be provided that staff have the skills and knowledge to safely support people at risk of malnutrition. The manager should ensure, by training or other means, that she has the knowledge and skills needed to correctly follow local authority safeguarding procedures. 4 17 5 6 19 23 Care Homes for Adults (18-65 years) Page 29 of 30 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). 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