CARE HOMES FOR OLDER PEOPLE
Clanfield 3 Toll Bar Road Islip Kettering Northants NN14 3LH Lead Inspector
Mrs Kathy Jones Unannounced Inspection 24th November 2005 13:10 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 Clanfield DS0000012743.V264327.R01.S.doc Version 5.0 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. Clanfield DS0000012743.V264327.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Clanfield Address 3 Toll Bar Road Islip Kettering Northants NN14 3LH 01832 732398 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 Paulette Yvonne Crossley Mrs Paulette Yvonne Crossley Care Home 30 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (20), of places Physical disability (5) Clanfield DS0000012743.V264327.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No more than 5 service users may fall withing the category of Physical Disability (55 years and over). 25.05.05 Date of last inspection Brief Description of the Service: Clanfield is a care home providing personal care and accommodation for 30 service users who are over 65 years of age up to 5 whom also have dementiarelated care needs. Clanfield is privately owned by Mrs Paulette Crossley who is also the Registered Manager.The home is located in the village of Islip. The village of Islip, although quiet, is on the outskirts of the town of Thrapston. There are, therefore, numerous shops and other community facilities within a reasonably short distance, although realistically transport would be needed for this resident group to travel into the town. Clanfield is a two-storey house, with lift access to the upper floor, set in large and attractive gardens and providing a peaceful setting for the residents Clanfield DS0000012743.V264327.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over approximately four and a half hours on the afternoon of a weekday. Prior to the inspection the inspector spent one hour reading the last inspection report, the homes service history and planning the areas to be inspected. During the inspection a sample of resident’s records was reviewed to check how their care is planned and supported. Discussions with residents, a relative and staff and observations of the daily routines and interactions between staff and residents were made. Records relating to recruitment practices and staff induction and training were reviewed and a sample check of the medication system made. Communal areas of the home and a new residents bedroom were seen during the inspection. Progress in meeting requirements and improvements made were discussed with the registered manager and staff throughout the inspection. What the service does well:
The home provides a clean, comfortable and homely environment for Residents. The conservatory area used by some of the more independent Residents provides a very pleasant outlook onto the large gardens. The separate lounge areas allow for different activities. Residents in one lounge area were enjoying a quiz while in another area residents were having an afternoon nap or reading the paper. Observations during the inspection identified that there are good relationships between the management team, relatives, staff and residents. Staff confirmed that good relationships have been developed with health professionals such as the Community Psychiatric Nurse who are contacted for support and advice as necessary. Discussions with staff, residents and a relative confirm that staff are committed to providing a good standard of care for residents. Clanfield DS0000012743.V264327.R01.S.doc Version 5.0 Page 6 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. Clanfield DS0000012743.V264327.R01.S.doc Version 5.0 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 Clanfield DS0000012743.V264327.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, standard 6 is not applicable. The admissions process is becoming more thorough which provides prospective residents with better assurances that their needs can be met. EVIDENCE: The assessment process for a recently admitted resident was reviewed. Records confirmed that the deputy manager had visited the prospective resident in her previous home to discuss and assess her needs. On this occasion there had been difficulty in obtaining additional information from other sources such as relatives and health professionals. The manager and the deputy manger confirmed that they understand the importance of gathering as much information as possible about residents needs. Discussion about another admission identified that they are more insistent on gathering information from all relevant sources in order to ensure that the needs of people admitted to the home can be met. Clanfield DS0000012743.V264327.R01.S.doc Version 5.0 Page 9 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 the following standard(s): 7, 8, 9 The overall care provided is good with health care services being accessed as appropriate. EVIDENCE: Care plans for a recently admitted resident had been in place on the day of admission. The care plans were based on information gathered during the assessment process and were sufficiently detailed to provide staff with clear instructions as to how to meet her needs. Staff were observed to be carrying out a continuous assessment of the residents needs and were mindful that these may be different in a new environment. Records and discussion with staff and residents confirm appropriate involvement of health professionals such as the General Practitioner, District Nurse and Community Psychiatric Nurse. A small storage cupboard/room has been refurbished to provide better storage of medication. The medication system is well organised and individual residents medication can be quickly and easily identified.
Clanfield DS0000012743.V264327.R01.S.doc Version 5.0 Page 10 A sample check of the medication system confirmed that procedures are in place for the management of medication with records kept of all medication received into the home and medication administered. Records indicated that the lunch time medication for a new resident had not been administered on the day of their admission. The manager was going to check the reasons for this. Clanfield DS0000012743.V264327.R01.S.doc Version 5.0 Page 11 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 the following standard(s): 14 Residents are able to exercise choice and individual preferences and routines are respected. EVIDENCE: Resident’s records and discussion with staff confirmed that they are able to exercise choices in relation to their care and the level of support that they receive. Staff are mindful of the need to assist residents in maintaining their independence. A resident confirmed that staff are respectful of individual routines and preferences. Activities are offered however the decision not to join in is respected. Clanfield DS0000012743.V264327.R01.S.doc Version 5.0 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 the following standard(s): This section of the standards was not assessed during this inspection. This section of the standards was not assessed during this inspection. EVIDENCE: This section of the standards was not assessed during this inspection however no concerns were identified during the inspection. Clanfield DS0000012743.V264327.R01.S.doc Version 5.0 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 the following standard(s): 20, 23 The standard of the environment is good providing Residents with a clean, comfortable and homely place to live. EVIDENCE: The home is set within its own grounds and has large mature gardens to the rear. A conservatory/lounge looks directly onto the gardens. Communal areas of the home include three separate lounge/seating areas and were found to be clean, comfortably furnished and warm. The separate lounge areas allow for different activities. Residents in one lounge area were enjoying a quiz while in another area residents were having an afternoon nap or reading the paper. The bedroom of a new resident had been prepared for her arrival, the room was found to be clean and comfortable. Staff had assisted in making the
Clanfield DS0000012743.V264327.R01.S.doc Version 5.0 Page 14 environment as homely as possible in displaying the resident’s personal items, which included photographs and ornaments. Clanfield DS0000012743.V264327.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 Recruitment procedures are good however arrangements for staff training need to be improved to adequately meet Residents needs. EVIDENCE: A resident confirmed that she felt that there were enough staff on duty to meet her needs. Discussion with staff identified that since the last inspection some changes to the staff rota had been made and also to the organisation of staff duties. Staff advised that the changes have meant that the staff team are more able to meet resident’s needs and that staff are clearer about their individual responsibilities and duties. A sample check of two files for recently recruited staff confirmed that two references and a criminal record bureau clearance are obtained prior to staff working in the home. Prior to the last inspection a relative/visitor to the home had raised the difficulty of identifying relevant staff members. The registered manager advised that uniforms and badges had been provided however the use of badges by carers had been discontinued due to the risk of them catching a resident’s skin. However staff were much easier to identify due to the different coloured uniforms. Clanfield DS0000012743.V264327.R01.S.doc Version 5.0 Page 16 Records show that staff receive induction training however this does not currently meet the expectations of the Sector Skills Council. The Sector Skills Council have identified areas to be covered through induction and foundation training which provide carers with a basic knowledge of the expectations of their role and the provision of care. Previous requirements relating to induction and foundation training have not been met however a new timescale has been discussed and agreed. A sample check of staff training records identified that training is provided however the systems for highlighting when training requires updating need to be improved. Clanfield DS0000012743.V264327.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 The management and organisation of the home is improved providing better outcomes for residents. EVIDENCE: Clanfield DS0000012743.V264327.R01.S.doc Version 5.0 Page 18 The registered owner who is also the registered manager has a number of year’s experience of managing the home. The current National Minimum Standards specify that the registered manager should have qualifications in management and care equivalent to National Vocational Qualification level 4. The registered manager has no formal qualifications however the deputy manager has recently completed the registered managers award. The Registered Manager is working part time in the home with the day to day running of the home being carried out by the Deputy Manager and Senior Staff. Discussion with staff confirmed that the registered manager is always accessible for advice and that she is consulted in all aspects of the management of the home. The adequacy of the management arrangements has been the subject of discussion over the previous two inspections due to a number of shortfalls in meeting the National Minimum Standards being identified. This inspection highlighted that continued improvements have been made and the staff and the management team have a better understanding of their responsibilities and the expectations for the provision of care in care homes as set out in the legislation. The current management arrangements appear to be satisfactory however must be kept under review to ensure that the home is effectively managed and standards maintained. A programme of staff supervision is in place with each of the senior team responsible for supervising a group of staff. The home does not currently have a formal quality assurance programme in place however questionnaires are sent out to relatives and residents every six months to ascertain their views on the service provided. The deputy manager confirmed that action has always been taken to address any issues raised and that plans are in place to implement a quality assurance programme. A sample check of staff training records identified that staff receive training in safe working practices, which include first aid, movement and handling and first aid. Records identified that some staff had not received updated training in movement and handling. Clanfield DS0000012743.V264327.R01.S.doc Version 5.0 Page 19 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 X X 3 X X N/A 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 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X 3 X X 3 X X X STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 2 Clanfield DS0000012743.V264327.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP30 Regulation 12(1),18( 1)(c)(i) Requirement Staff must receive induction and foundation training, which complies with the sector skills council specifications. (Previous requirements with timescales of 15.03.05 and 30.08.05 have not been met) All staff carrying out movement and handling must have received up to date training. Timescale for action 28/02/06 2 OP38 13 (5) 15/12/05 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 OP33 Good Practice Recommendations Plans for a quality assurance system should be implemented. Clanfield DS0000012743.V264327.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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