CARE HOMES FOR OLDER PEOPLE
Canford Cliffs 2 Bessborough Road Canford Cliffs Poole BH13 7JS Lead Inspector
Martin Bayne Unannounced 14 September 2005 08:45 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 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 D55 S4070 Canford Cliffs V248272 140905 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Canford Cliffs Address 2 Bessborough Road, Canford Cliffs, Poole, Dorset, BH13 7JS Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01202 700272 Mrs Marie Rosemai Askurn Mr Vidyanandsing Askurn Care Home 14 Category(ies) of DE(E) - 14 registration, with number MD(E) - 14 of places Canford Cliffs D55 S4070 Canford Cliffs V248272 140905 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 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. Date of last inspection 14 January 2005 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. Canford Cliffs D55 S4070 Canford Cliffs V248272 140905 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place between 8:45am and 12:45pm. When the inspector arrived there were two staff on duty and the majority of residents were already up and sitting in the lounge. The three requirements from the last inspection were followed up and also the seven recommendations. One requirement, concerning the recruitment records of the staff remains in force while all the other issues were complied with. During the inspection it was also agreed that a record would be maintained of furniture brought into the home by a resident, and that the registered manager Mr Askurn, would liaise with the infection control nurses about the procedure that should be adopted for the cleaning of commodes. It was further agreed that all the radiators would be covered by Sept 06. It was difficult to gain much feedback from the residents due to their mental frailty, however the residents looked clean and well looked after. What the service does well: What has improved since the last inspection? 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.
Canford Cliffs D55 S4070 Canford Cliffs V248272 140905 Stage 4.doc Version 1.30 Page 6 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 Standards Statutory Requirements Identified During the Inspection Canford Cliffs D55 S4070 Canford Cliffs V248272 140905 Stage 4.doc Version 1.30 Page 7 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 To ensure that the home can meet the needs of residents admitted to the home, a full assessment is carried out and a four-week trial is offered. EVIDENCE: The personal care files for two of the residents most recently admitted to the home were used to track required paperwork through the inspection. It was found that a full record had been maintained of all communication and actions that had been taken after a referral had been made to the home. The two residents had been admitted from hospital and Mr Askurn had been to see them and carried out an assessment to ensure that their needs could be met at the home. A four-week trial is offered to all new people admitted to the home. The assessments provided details of the mental and physical health needs of residents. Canford Cliffs D55 S4070 Canford Cliffs V248272 140905 Stage 4.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 Residents care needs are assessed and documented in the care plans. Health needs of residents are met at the home and medication safely administered. EVIDENCE: For the two residents tracked through the inspection there was a care plan on file that had been developed from the assessment. The care plans contained a section on risk assessments with actions that should be taken by the staff to reduce hazards. Within the file was also a shortened précis of the care plan, which would enable a new member of staff to gain a quick familiarisation of a persons care needs. A requirement was made at the last inspection concerning one resident and how a care plan should be in place should a dressing be damaged or removed. This care plan was found to be in place at this inspection. Through discussions and from details recorded in the two files viewed, there was evidence that health needs of residents are met at the home. Each resident is registered with a local GP and other health needs such as dentistry, chiropody and eye care are attended to as and when required. It was also evident from discussing with Mr Askurn one resident who was having difficult
Canford Cliffs D55 S4070 Canford Cliffs V248272 140905 Stage 4.doc Version 1.30 Page 9 settling into the home that their are good links between the home and the community mental health team. The home has an agreement with a local pharmacy and medicines are delivered to the home packaged in a unit dosage system. These are then stored in the medication cabinet sited in the quiet area leading from the dining area. Mr Askurn informed that there was one set of keys to the medication cabinet and that the senior person on each shift had responsibility for the key. The medication administration records for each resident were viewed and it was found that these had been completed in full with no gaps within the records. A medication return book records all medication not used and returned to the pharmacist. Mr Askurn said that the staff who administered medication had internal training, but were to be booked for external training. Canford Cliffs D55 S4070 Canford Cliffs V248272 140905 Stage 4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 & 15 Resident’s preferences and wishes are taken into account in providing for their care. Residents are provided with a balanced diet and assistance offered as required. EVIDENCE: At the last inspection a recommendation was made that the clocks and calendars sited around the home to orientate the residents, record the correct times and dates. It was found at this inspection that this had been complied with. On the morning of inspection the majority of the residents were sitting in the lounge area. There was one group of residents who were sitting and talking to each other, others were reading or looking at the papers and magazines that had been provided and some were sleeping. Mr Askurn said that it was difficult to provide activities but staff would spend individual time with residents. The occasional outing is also arranged to take people out of the home. It was also reported that one resident is taken out to church each week. In respect of times for getting up and going to bed, Mr Askurn said that staff tried to work around residents individual preferences in terms of their sleep patterns. All of the residents were well groomed, in clean clothes and care taken in respect to their physical appearance.
Canford Cliffs D55 S4070 Canford Cliffs V248272 140905 Stage 4.doc Version 1.30 Page 11 The inspector was able to observe the staff assembling residents for their lunch. Four of the residents require a soft diet and assistance from the staff with eating. The meal looked wholesome and adequate in portions. The records were seen for the food and meals provided to residents. It was reported that there were no residents accommodated who required a specialist diet. Canford Cliffs D55 S4070 Canford Cliffs V248272 140905 Stage 4.doc Version 1.30 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Residents are safe guarded through their relatives being informed of the home’s complaints procedure and staff being trained in adult protection. EVIDENCE: Due to the mental frailty of the residents there are inherent difficulties in ensuring that they are aware of their right to complain through the homes procedure documented in the Service User Guide and Contract with the home. It was reported that all of the residents have relatives who are in contact with them and the relatives are all made aware of the home’s complaints procedure. Since the last inspection there have been no complaints made to the manger and none have been brought to the attention of CSCI. Within the two staff recruitment records sampled during the inspection there were certificates seen for attendance on elder abuse training. Mr Askurn reported that all of the staff are put forward for this training. Canford Cliffs D55 S4070 Canford Cliffs V248272 140905 Stage 4.doc Version 1.30 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 Residents will be better protected once the radiators are covered and an infection control procedure is developed for the cleaning of commodes. EVIDENCE: A tour of the building was made as part of the inspection when five individual bedrooms were seen. The home was found to be in reasonable decorative order throughout. A recommendation was made at the last inspection that residents should be consulted as to the furnishings supplied within their rooms, where this is provided for them. It was reported that this takes place and rooms were reasonably furnished with the required furniture. It had also been recommended that washbasin plugs be available in all sinks and this was the case in the rooms seen. A further recommendation was also complied with, with keys available to residents to a lockable area within their room. Canford Cliffs D55 S4070 Canford Cliffs V248272 140905 Stage 4.doc Version 1.30 Page 14 Since the last inspection an occupational therapy assessment has been carried out of the building as had been recommended and a certificate was seen for this. It was agreed that a record would be maintained of all furniture that residents bring into the home, as no record of this was available for the last person admitted to the home. The building was found to be suitable to meet its aims and objectives, being homely and having an enclosed garden to which residents have access. A new shed has been provided at the bottom of the garden that is kept locked so that residents cannot gain access to hazards of equipment kept in the shed. The three exits from the building have been alarmed to ensure that staff are made aware should a resident leave the building as all of them are at risk of getting lost should they wander from the home. It was noted that a process of risk assessment had been carried out for identifying the radiators that posed a risk to residents burning themselves and these had been covered. It was agreed that all the remaining radiators would be covered by September 2006. This will be followed up at future inspections. Residents are protected from the risk of scalding from hot water as the hot water outlets are controlled thermostatically to a safe temperature. The home has policies and procedures for infection control measures. Gloves, aprons and protective clothing are available to the staff. The home has a contact for dealing with clinical waste. The laundry room is fitted with commercial machines and is situated in an outhouse outside of the main house. The laundry room has suitable washable walls and floor surfaces. It was reported that some of the residents use commodes, however the home does not have a sluicing facility. It was agreed that the Mr Askurn would liaise with the infection control nurses as to a procedure for maintaining the most suitable infection control measures. Canford Cliffs D55 S4070 Canford Cliffs V248272 140905 Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) . 27 & 29 The home provides staffing levels that meet the needs of residents but this is compromised through the required recruitment checks not be undertaken in all cases. EVIDENCE: The staffing levels remain the same as at previous inspections with three staff on duty between 7:00am – 2:00pm and then 2 staff for the remainder of the day. During the night time period there is one awake member of staff on duty and one who does a “sleep-in” duty. A bedroom for this member of staff is available on the second floor. The staff spoken with said that they thought the levels were adequate to meet the needs of the residents. Mr Askurn said that should there be an emergency he is readily available as he lives next door to the home. Mr Askurn reported that currently the home was in the process of recruiting a vacant cleaner post and the care staff were having to carry out these duties until such time as the appointment is made. The staff recruitment records for a sample of two staff were viewed as there was a requirement from the last inspection in relation to these. In the case of two workers whose first job it was since coming from overseas, there was no CRB check. A record was on file of a check that had been undertaken in their home country. Mr Askurn reported that he was unaware that in this situation a CRB was necessary. It shall remain a requirement that all staff have a CRB before being employed within the home. It was also found that in the case of one worker, their work permit was not specific to their employment at the home. In other respects full records were found to be in place.
Canford Cliffs D55 S4070 Canford Cliffs V248272 140905 Stage 4.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) . 31 The residents now benefit by the partnership being registered with a person responsible for the management of the home. EVIDENCE: Since the last inspection Mr Askurn has been registered as the manager of the home and he has recently obtained an NVQ Level 4 in management and care. Staff reported that they enjoyed working in the home and that Mr Askurn was always available for advice or support. Canford Cliffs D55 S4070 Canford Cliffs V248272 140905 Stage 4.doc Version 1.30 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3
COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x x x x Canford Cliffs D55 S4070 Canford Cliffs V248272 140905 Stage 4.doc Version 1.30 Page 18 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 29 Regulation 19 Requirement You must ensure that relevant documentation is obtained on staff beofre they are allowed to work in the home, specifically work permits and criminal record bureau disclosures. Timescale for action 3-10-05 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 Good Practice Recommendations Canford Cliffs D55 S4070 Canford Cliffs V248272 140905 Stage 4.doc Version 1.30 Page 19 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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