Inspection on 24/09/08 for Clevedon Court Residential Home

This inspection was carried out on 24th September 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Clevedon Court Residential Home 01/06/09

Clevedon Court Residential Home 26/09/07

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

St George`s

5 Seafield Road

Credence House

Poldhu

Queensmount

Extracts from inspection reports are licensed from CQC, this page was updated on 19/12/2008.

CARE HOMES FOR OLDER PEOPLE Clevedon Court Residential Home 1-3 Clevedon Road Weston Super Mare North Somerset BS23 1DA Lead Inspector John Clarke Unannounced Inspection 24th September 2008 09:30 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 Clevedon Court Residential Home DS0000070055.V369222.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. Clevedon Court Residential Home DS0000070055.V369222.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clevedon Court Residential Home Address 1-3 Clevedon Road Weston Super Mare North Somerset BS23 1DA 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) 01934 621981 01934 621981 ANJ & ASH Care Ltd Mrs Doreen Ann Harrop Care Home 22 Category(ies) of Learning disability (3), Old age, not falling registration, with number within any other category (22) of places Clevedon Court Residential Home DS0000070055.V369222.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) 2. Learning disability (Code LD) - maximum of 3 persons The maximum number of service users who can be accommodated is 22. 26th September 2007 Date of last inspection Brief Description of the Service: Clevedon Court provides personal care for up to 22 people elderly people. The home also cares for 3 elderly people with a learning disability. Clevedon Court is set just off the sea front, with level access to the town centre. All bedrooms have en-suite facilities, and two of the en-suites have bathing facilities. There are 21 bedrooms, one of which may be used as a double. At present, all are being used as singles. All bedrooms meet the new spatial standards and many exceed them. There is a passenger lift accessing both sides and both floors of the home, and a stair lift, which accesses three bedrooms on a mezzanine floor. The mezzanine level is also accessible via a ramp. The provider makes information available through a brochure and information pack. The information pack contains the Statement of Purpose and Service User guide and all relevant information about the home. The fees range between £356.37 and £400 a week with additional charges being made for hairdressing, chiropody, newspapers, and toiletries. This information was provided in September 2007. Clevedon Court Residential Home DS0000070055.V369222.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars, This means the people who use this service experience good quality outcomes. This was an unannounced visit to the home as part of an inspection. We looked at a number of documents including care plans, staffing records (recruitment and training) and those relating to health and safety practice in the home. We also looked at the arrangements for managing, storage and administer of medication. We also had the opportunity to talk with a number of individual who live and work in the home. A number of Have Your Say questionnaire were sent to the home before this inspection responses were received from 9 residents, 6 staff members and 3 health professionals. As part of this inspection the manager completed a Annual Quality Assurance Assessment (AQAA) which set out the areas of practice based around the National Minimum Standards summarising what the home does well, the evidence for this, what they could do better and how they have improved in the last 12 months. The information from the AQAA and questionnaires has been used to help make a judgement about the quality of care provided in the home. What the service does well: The home provides a warm and friendly environment with the strength of having a stable and committed staff group. Individuals we spoke with all described staff as “friendly” and “feel you are in a family”. One individual said they felt that the home “was just the place for us”. One individual commented in their questionnaire response “the residents are looked after with love and care from a dedicated staff in a clean and homely environment”. The home makes every effort to provide a person centred approach and promotes the independence and strengths of individuals who live in the home. Activities are area for improvement as recognised by the home however there was evidence that staff encourage individuals to take part in the life of the home and activities are provided which suit and have appeal to individuals. The home has continued to improve the environment in updating and decorating part of the home and this is to continue. Clevedon Court Residential Home DS0000070055.V369222.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Clevedon Court Residential Home DS0000070055.V369222.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 Clevedon Court Residential Home DS0000070055.V369222.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): 1,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s Statement of Purpose provides the required information about the home, the facilities, staffing arrangements, admission procedure and aims and objectives of the home so that individuals can make an informed choice about the suitability of the home. The home undertakes full and comprehensive assessment of prospective residents so that they are able to make an informed decision about the capacity of the home to meet health and social care needs. EVIDENCE: We looked at the home’s Statement of Purpose it provided good information about the service individuals can expect when living the home. Included is information about the management and staff with details as to qualification Clevedon Court Residential Home DS0000070055.V369222.R01.S.doc Version 5.2 Page 9 and experience. The admissions policy is set out as well as facilities and services available to those who choose to live in the home. A copy of the home pre-admission assessment was seen and provided good information about the health and social care needs of perspectives residents. Clevedon Court Residential Home DS0000070055.V369222.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. Care Planning and arrangements for meeting health care are generally good providing staff with the necessary information so that the health and social care needs of residents are met. However improvements must be made in relation to some elements of care plans so that the health and welfare of individuals is protected. Arrangements for managing resident’s medication make sure that resident’s health needs are protected. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. EVIDENCE: A number of care plans were looked and showed good information about the individual with Life Style Choices and Preferences, Physical Health and WellBeing. Regular reviews had been held. There were no moving and handling profiles or specific risk assessments e.g. for one individual who had epilepsy and another who had poor skin condition and noted to have “small sore”. It is Clevedon Court Residential Home DS0000070055.V369222.R01.S.doc Version 5.2 Page 11 noted that when speaking to staff they were aware of particular needs of individual and the specific care needs they had. There was also no evidence of involvement of the individual in completion of the care plan. Individuals who live in the home have full access to community health services such as chiropody, optician and records confirmed this. One individual told us that they found the staff very attentive and how they always responded positively when they wanted to see a doctor. A health professional in their questionnaire response said, “The manager and deputy have always worked well with our team and accessed the specialist services appropriately”. There was also record of contact with the local disability team. We looked at medication records and found that records had been completed as required with no gaps in the administering records. Storage arrangements are good though there is no controlled drug storage at present. This was discussed with the manager who is aware that if such medication is needed by individuals the required storage will need to be provided. We spoke with a number of individuals who live in the home about the approach of staff and generally whether they felt their privacy was respected. All spoke positively of staff “they are all very kind” “couldn’t wish for better staff”. One individual said they were able “to do as I want”. All those we spoke with said they felt their privacy was respected. Staff were observed during the visit and their approach particularly when assisting individual was supportive and sensitive to the feelings of those they were helping. Clevedon Court Residential Home DS0000070055.V369222.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for meeting the social and recreational needs of residents are good and there are opportunities for residents to maintain links with family, friends and the local community. The home’s practice and routines are flexible and enable residents to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home. EVIDENCE: We spoke to individuals about the activities in the home. There was a mixed response from “enough for me” to “could be more”. One individual said they enjoyed the sing-a-longs and that staff “do sit and have a chat which is nice”. Staff said they felt there was more one to one time rather then organised group activities. In response to the Have Your Say questionnaire 2 said there was “always” activities they could take part in, 1 “usually” and 5 sometimes. Clevedon Court Residential Home DS0000070055.V369222.R01.S.doc Version 5.2 Page 13 On the day of our visit staff were observed sitting and chatting with individuals. Individuals also spoke of going out with staff. A comment made by a visiting health professional said that what the home does well is “offer service users choices and support increasing daily activities i.e. working in the garden, film afternoons. Another said their client had “been given the opportunity and encouragement to try out new activities. The home’s AQAA said they were hoping to focus more on one to one activities and care plans included information about social pastimes individuals enjoyed. We spoke to a relative who regularly visits the home they said how staff were “very nice, always polite, always happy”. They felt that staff and manager were always available to talk to if they wished and felt that they “always tell about how my relative is getting on, have never had any concerns about the care here”. Individuals we spoke with said how they enjoyed the meals provided in the home. On the day of our visit the meal was well presented. Staff were available to give assistance where this was needed and did so in a sensitive and supportive manner. There is no daily choice for the main meal of the day however one individual said they were always offered something else “if there was something I didn’t like” and another individual said, “They always give me something I like”. Individual’s likes and dislikes are recorded. Respondents to the questionnaire said they “always” 4, “usually” 5 like the meals provided in the home. Menus showed a varied, balanced and nutritional diet is made available to individuals who live in the home. Clevedon Court Residential Home DS0000070055.V369222.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. The home has clear procedures in place and this enables individuals to make a complaint and voice their views about the service they receive and to know that they will be listened to and actions taken where necessary. The home makes sure that as far as possible residents are protected from harm by having policy and procedure about the Protection of Vulnerable Adults and providing training to all staff in this area. EVIDENCE: We spoke to individuals who live in the home about what they would do if they were unhappy about the care they received or wished to make a complaint. All of those we spoke with said they knew they could make a complaint if they wanted but would “always” speak to a member of staff or the manager. One individual said she felt she would be listened too and “something would always be done about it”, another said “you can always go to the manager she would do something”. The home has not received any complaints since the last inspection and has responded to care concerns in a positive and professional manner. Clevedon Court Residential Home DS0000070055.V369222.R01.S.doc Version 5.2 Page 15 Staff have received Safeguarding Adults training and records confirmed this however the manager and deputy need to undertake further training in this area. I discussed a Adult Protection scenario with the manager and deputy and they were able to give a response which illustrated their knowledge in this area. The home has an Adult Abuse policy giving clear guidance in how to respond to any allegation of abuse and includes contact details for North Somerset Social Services. There had been some concerns about an individual’s health and welfare and the manager had acted professionally in responding to those concerns. Clevedon Court Residential Home DS0000070055.V369222.R01.S.doc Version 5.2 Page 16 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. The home provides a safe and hygienic environment for the residents and staff. EVIDENCE: In walking around the home it was in good order and there have been some improvements in the facilities since the last inspection. These have included replacement of carpets and wardrobes in individual’s accommodation. The home is in the first year of new owners and there are plans to continue to improve and update the environment. On the day of our visit the home was clean and individuals we spoke with all said how the home is “always clean” “its always well kept”. Communal hand washing facilities are available supplied with dispenser soap and paper towels to help in reducing risk of infection. Records showed that domestic member of staff had not completed infection control training. Clevedon Court Residential Home DS0000070055.V369222.R01.S.doc Version 5.2 Page 17 Clevedon Court Residential Home DS0000070055.V369222.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing arrangements in the home are generally satisfactory so that the needs of residents can be met in an efficient way with care being provided by skilled and competent staff. The recruitment and selection of staff is undertaken to make sure that as far as possible the health and welfare of resident is protected. EVIDENCE: On the day of our visit there were 3 care staff on duty am with two pm and two waking night staff. The manager was on duty in addition to care staff. This is the normal level of staffing in the home. Individuals we spoke with said that staff were “always there if we want them” “I only have to ask and staff will help me when I need them”. Staffing recruitment and training records were looked at and showed the required checks had taken place. Criminal Record Bureau and POVA checks had been obtained. Two references had been received and application forms gave full employment history. Clevedon Court Residential Home DS0000070055.V369222.R01.S.doc Version 5.2 Page 19 Training records for 4 members of staff showed they had completed “mandatory” training; moving and handling, first aid, fire training, Adult Protection. Records also showed that staff regularly receive supervision and this was confirmed by two members of staff we spoke with who also said they have regular staff meetings. Clevedon Court Residential Home DS0000070055.V369222.R01.S.doc Version 5.2 Page 20 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): 31,33,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good opportunities for individuals who live in the home and others to express their views about the service they receive. The practices of the home help to make sure that the health, safety and welfare of residents and staff is protected. EVIDENCE: The manager of the home has extensive experience in managing a care service. Individuals we spoke with said she was “someone we can always speak to” “she there if we want her”. Staff also spoke of her as being “approachable”. Clevedon Court Residential Home DS0000070055.V369222.R01.S.doc Version 5.2 Page 21 We looked at records relating to health and safety practice in the home and found that fire system was serviced within the last year, weekly alarm test take place and a fire risk assessment has been completed. Fire drill records showed drills taking place the last being 16/07/08. There was no record of staff that were present for these drills. Lift service twice yearly last being 05/09/08. There is a quality assurance system in place through questionnaires though residents meetings are not held. Some of the comments received from relatives: “My relative is very happy that is because staff are very caring and considerate” “The home has a warm, homely and friendly atmosphere with a great deal of care and dedication from the staff” “You would have to go along way to get better staff”. Clevedon Court Residential Home DS0000070055.V369222.R01.S.doc Version 5.2 Page 22 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 2 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 X 3 X 3 Clevedon Court Residential Home DS0000070055.V369222.R01.S.doc Version 5.2 Page 23 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. 1 Standard OP7 Regulation 13 (5) Requirement Timescale for action 30/12/08 2 OP7 15 The manager to make sure that there is suitable arrangements to provide a safe system for moving and handling of individuals who live in the home. (This refers to undertaking moving and handling assessments for all individuals in the home.) Care Plans must be prepared in 30/12/08 consultation with the resident to show how the health and welfare needs are to be met. The manager to make sure that unnecessary risk to the health and safety of individuals are identified and so far as possible eliminated. (This refers to the need to undertake risk assessments relating to health and care needs of individuals.) Staff must be provided with the appropriate training for the work they are to perform. (This refers specifically to staff undertaking infection control training)l 30/12/08 3. OP7 13 (4) © 4. OP30 18.1 (c) 30/12/08 Clevedon Court Residential Home DS0000070055.V369222.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Clevedon Court Residential Home DS0000070055.V369222.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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