CARE HOMES FOR OLDER PEOPLE
Canford Cliffs 2 Bessborough Road Canford Cliffs Poole Dorset BH13 7JS Lead Inspector
Martin Bayne Key Unannounced Inspection 11th June 2007 09:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Canford Cliffs DS0000004070.V343010.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Canford Cliffs DS0000004070.V343010.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Canford Cliffs Address 2 Bessborough Road Canford Cliffs Poole Dorset BH13 7JS 01202 700272 NO FAX Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Marie Rosemai Askurn Mr Vidyanandsing Askurn Care Home 14 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (14), Mental disorder, excluding learning of places disability or dementia (2), Mental Disorder, excluding learning disability or dementia - over 65 years of age (14) Canford Cliffs DS0000004070.V343010.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. One named person (as known to CSCI) under the age of 65 may be accommodated. This condition will not apply after the person’s 65th birthday. The Home may accommodate up to 2 service users under the age of 65 whose care needs are compatible with those older service users already living at the home. 27th June 2006 Date of last inspection Brief Description of the Service: Canford Cliffs is registered to accommodate and provide personal care for up to 14 people over 65 who suffer from dementia. The home has been granted a variation of the conditions of registration to accommodate one named person who is under the age of 65. The home is located in a quiet residential area of Canford Cliffs, within 150 yards of the local parade of shops and local amenities. The home is provided on two floors with access to the first floor by means of a stair lift. There are 10 bedrooms on the ground floor six of which have ensuite toilet facilities. The communal areas of a lounge leading to the garden, kitchen and dining area are also on the ground floor. On the first floor there are a further four bedrooms, one of which has an ensuite toilet. From the first floor there are stairs that lead to private accommodation and the bedroom for the sleep-in staff. Fees for the home range from £407 to £515 per week. Canford Cliffs DS0000004070.V343010.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection of the home that took place between 9:15am and 12:30pm. Mr Askurn, the Registered Manager and Provider of the home assisted throughout the inspection. The home was evaluated against the key standards for older people and the two recommendations made at the last inspection were followed up. During the inspection, one member of staff was spoken with and six residents. Time was spent in the lounge area observing the residents and how the staff interacted with them. A tour of the premises was made and various records were seen that provided evidence of how the home is managed and residents cared for. The information contained in the Dataset and questionnaire sent out to the Providers of the service was also used to triangulate evidence of the care provided at the home. What the service does well: What has improved since the last inspection?
The two recommendations made at the last inspection have been complied with. The first concerned a concern raised by a resident that had been discussed at the last inspection and it had been recommended that this be written up into the log of complaints. The second concerned meeting leisure and recreational activities of residents and it was recommended that more be recorded about activities that take place within the home. Canford Cliffs DS0000004070.V343010.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Canford Cliffs DS0000004070.V343010.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Canford Cliffs DS0000004070.V343010.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 136 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from their needs being assessed prior to their being offered a place at the home. EVIDENCE: The certificate and current conditions of registration of the home were discussed. It was agreed that the Statement of Purpose would be amended to inform that needs of two people with dementia under the age of sixty-five can be accommodated at the home. Since the time of the last inspection four residents have been admitted to the home. At the time of this visit there were fourteen residents accommodated with one of these being in hospital. The personal files for two of these residents were used to track the paperwork that
Canford Cliffs DS0000004070.V343010.R01.S.doc Version 5.2 Page 9 the home is required to keep up to date as evidence of the care provided in the home. In both cases admissions had been in line with best practice and the home’s admission procedures. In the case of one person, they had visited the home together with a member of their family in helping them choose a suitable placement and a pre-admission assessment was also carried out at this time. In the case of the other person, they were visited in hospital by Mr Askurn, who carried a pre-admission assessment. In both cases a record was on file for the pre-admission assessment and the form used covered all of the topics contained within the Standards for Older People. Mr Askurn informed that currently about 70 of residents were privately funded and 30 through care management funding. Where a person is referred through the local council, a copy of the care management assessment is obtained. In all cases a trial period is offered and a letter then sent out informing that their needs can be met at the home. The home does not provide an intermediate care service. Canford Cliffs DS0000004070.V343010.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are treated with respect, their health needs are assessed and met and their medication administered safely. EVIDENCE: The two residents tracked through the inspection had a care plan that had been developed from the assessment process. The plans informed of the expectations on staff as to how they were to meet the needs of these two residents. Photos were attached to the front of the care plans so that a new member of staff could identify to whom the plan concerned. There was evidence that reviews were taking place as required with these being recorded in the daily recording sheets. Risk assessments had also been undertaken
Canford Cliffs DS0000004070.V343010.R01.S.doc Version 5.2 Page 11 where risk had been identified and the steps that should be taken to reduce risks of harm to residents. From the records seen there was evidence that residents were registered with a GP and that their health needs were being met. In the case of one person who had hearing difficulties, a referral had been followed up with the audiologist and a new hearing aid obtained for this person. In the case of the other resident, appointments had been followed up and a Consultant appointment had been made for this person. On the day of inspection a district nurse was visiting to dress a wound and a GP visited another resident who had health problems. The home has good links with the community mental health team and the home will liaise with this service should there be a need for specialist input. The inspector spoke with residents who were sitting in the main lounge during the inspection. Due to their mental frailty they were no able to provide much insight as to life in the home, however the home has recently carried out a quality review survey involving both residents and relatives. The results of this were seen and there were very positive comments made by relatives on the standard of care provided in the home and the respect for dignity of residents. The medication records for all of the residents were seen and it was found that these were being completed fully with no gaps within the records. It was recommended that where staff have to hand write entries onto the records, a second member of staff should check and sign the record to ensure that no errors in transposing are made. All of the staff who administer medication have received training and have been deemed competent to carry out medication administration. Due to the mental frailty of the residents, none are able to manage their medication safely and have medications administered by the staff. The medication cabinet is in the quiet room leading off from the kitchen and is kept locked with the senior member of staff on duty holding the key. The home uses a unit dosage system and the pharmacist supplies blister packs with people’s medication to the home. The home has an arrangement with the pharmacist who gives advice and checks procedures within the home for medication. Canford Cliffs DS0000004070.V343010.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. Residents benefit from the home developing opportunities for their recreation and leisure interests and also from being able to maintain relationships with friends and families. They also benefit from a good standard of food. EVIDENCE: As part of the assessment process the social and recreational needs of residents are identified and recorded. At the last inspection a recommendation was made that more be recorded about activities carried out with residents. It was reported that since the last inspection the home has contracted an outside person to come into the home and provide gentle exercise classes with residents. There was also more recorded in the daily recording sheets about activities that residents had participated in. On the day of inspection the majority of the residents were in the lounge. Two residents were in their
Canford Cliffs DS0000004070.V343010.R01.S.doc Version 5.2 Page 13 bedrooms, one who was not well and waiting to be seen by the GP and the other who chose to rest in their room and come into the lounge later in the morning. Classical music was playing in the lounge to the obvious enjoyment of some of the residents. Two residents were reading newspapers that they have delivered each day, some were asleep and another was playing a board game. Staff were seen to be involved talking and making sure residents were settled and comfortable. Four residents went out for the morning to a coffee morning run by one of the local churches. Within the daily recording sheets there was evidence of relatives and friends being encouraged to visit and be made welcome at the home. There was also a good response from relatives through the surveys carried out by the home earlier in the year. All of the residents appeared well and were smartly dressed with attention paid to their personal grooming. The records of food provided were seen. These reflected a varied and balanced diet with a choice of meals provided. Mr Askurn informed that the current resident group did not require any special diets. It was agreed that more detail would be provided in the records in future, recording the names of residents who had which particular choice of meal. Mr Askurn informed that only those staff who had a basic food hygiene certificate could prepare food in the home. Canford Cliffs DS0000004070.V343010.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well-publicised complaints procedure and the staff being trained in adult protection. EVIDENCE: At the last inspection it was recommended that an issue raised by one of the residents and looked into by the manager should be recorded in the complaints log. It was found at this inspection that this had duly been done. There have been no other complaints raised with the home and none have been brought to the attention of CSCI. The complaints procedure is detailed within the Statement of Purpose, the terms and conditions of residence and is also displayed on the resident’s notice board. Relatives are therefore informed of how they can complain. A new round of training had recently been provided in Adult Protection and four staff had attended this course. All of the staff receive this as core training for working in the home. The home has copies of all relevant procedures and policies for the protection of vulnerable adults.
Canford Cliffs DS0000004070.V343010.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a safe, well maintained physical environment. EVIDENCE: The home provides a suitable environment to meet its aims and objectives. The exterior of the home has recently been redecorated and internally the décor was in reasonable condition. Adaptations have been made within the home following an assessment of the building by an occupational therapist. The home has an enclosed garden that is well-maintained and leads from the patio doors in the main lounge providing easy access for residents. The home has parking for visitors at the front of the home. The front door is kept locked,
Canford Cliffs DS0000004070.V343010.R01.S.doc Version 5.2 Page 16 as residents need to be protected from wandering from the home and getting lost. This is recorded in the Statement of Purpose so that people when choosing a home are informed of this. During the inspection a tour of the premises was made and the home was clean and in the main free from adverse odours. Call bells are positioned throughout the home and all of the radiators have been covered in order to protect residents from hot surfaces. It has been established at earlier inspections that residents are also protected from hot water as thermostatic mixer valves have been fitted to the hot water outlets of baths. There was evidence that residents are able to personalise their rooms and a record is kept of furniture that is brought into the home. Staff are provided with gloves and aprons in line with the infection control procedures of the home. The home does not have a sluice however, Mr Askurn has liaised with the infection control nurses and procedures put in place for the safe cleaning of commodes. Canford Cliffs DS0000004070.V343010.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from staff being deployed in sufficient numbers to meet their needs, through the staff being recruited in line with Regulations and by their being well-trained. EVIDENCE: The home continues to provide the same staffing levels as those reported at the last inspection. There are three staff on duty between 8am to midday, four staff between midday and 2pm, two staff from 2pm until 8pm and during the night time period there is one awake member of staff and one person who carries out a sleep in duty. Mr Askurn informed that the needs of the residents could be supported though this level of staff. A duty roster was seen that reflected the levels of staffing reported. Mr Askurn reported that since the last inspection a cleaner had been employed to assist the care staff and also one carer had been appointed. The recruitment records for these two members of staff were seen. It was found that all of the checks and records required under Schedule 2 had been carried
Canford Cliffs DS0000004070.V343010.R01.S.doc Version 5.2 Page 18 out, including: two references, one being from the person’s last place of employment with vulnerable adults), a criminal record bureau check and check against the register of people deemed unsuitable for working with vulnerable adults, proof of identity, a full employment history with reason given for leaving positions where working with vulnerable adults and a health declaration. The only thing missing form the records was a recent photograph. Mr Askurn agreed to obtain a copy of a photograph when taking up and collating the information for the criminal record bureau check. The home has a staff complement of 6 full time members of staff and 3 part time. Information on staff training was provided through the data sent to CSCI prior to the inspection. All of the staff have received training in core subjects such as health and safety, adult protection, fire safety, first aid and moving and handling. The staff who handle food have had basic food hygiene training and the staff who administer medication have had training in medication administration. Many of the staff have been provided in training in care of people with dementia and mental health. 90 of the staff team have been trained to NVQ level 2 or above. Canford Cliffs DS0000004070.V343010.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from the home being well managed, run in their interests and from their financial interests being protected. EVIDENCE: Mr Askurn has completed NVQ level 4 in management and care and has been a Registered Provider of the home for many years. He is also a qualified Registered Mental Nurse.
Canford Cliffs DS0000004070.V343010.R01.S.doc Version 5.2 Page 20 Since the last inspection a survey involving residents and relatives has been carried out by the home and the results were seen. In general there was very positive feedback and there was evidence that Mr Askurn had taken action concerning some suggestions put forward by relatives. Mr Askurn informed that the home does not safe keep monies on behalf of residents and should there be a need, relatives take on this responsibility. From the data sent to CSCI there was evidence that servicing of equipment and testing of the fire safety system was taking place to the specified timescales. There were no hazards identified during the inspection. Canford Cliffs DS0000004070.V343010.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Canford Cliffs DS0000004070.V343010.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations Where staff have to hand write entries onto the records, it is recommended that a second member of staff should check and sign the record to ensure that no errors in transposing are made Canford Cliffs DS0000004070.V343010.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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