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Inspection on 07/09/05 for Cleveland House Nursing Home

Also see our care home review for Cleveland House Nursing Home for more information

This inspection was carried out on 7th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service is good at assessing service users` needs before they are admitted to the home. Service users reported that the staff meet their needs at the home. The makes considerable efforts to ensure that people can continue to do the things they enjoy doing when they come to live at the home. The activities coordinator`s role is fundamental to achieving this. Service users reported that the meals are of a good quality and choices are good. Relatives and friends are welcomed to the home. Complaints are taken seriously and acted upon. Staff are trained in protecting service users from abuse and are all vetted to ensure they have no history of abuse themselves. There is a good system of maintenance of the building, of equipment and redecoration. Induction and foundation training for staff is good. Staff say they are well supported by the manager.

What has improved since the last inspection?

Assessments for service users are now completed before admission to the home and around nutrition and tissue viability. Staffing levels at the home have improved since the last inspection. Fire safety issues have been dealt with. Monthly reports by the provider have been carried out.

What the care home could do better:

Staff should be better at reviewing service users` needs to make sure the care plans are up to date and accurate. The service must improve its arrangements for booking in medication when service users are admitted. Clinical waste disposal needs to be improved. The positioning of the breakfast hot trolley needs to be changed to prevent it being a hazard to service users.

CARE HOMES FOR OLDER PEOPLE Cleveland House 2 Cleveland Road Edgerton Huddersfield HD1 4PN Lead Inspector Cathy Howarth Unannounced 7 September 2005 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. Cleveland House 20050907 Cleveland House IR OP J51 v241681 s1112.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Cleveland House Address 2 Cleveland Road Edgerton Huddersfield HD1 4PN 01484 512323 01484 548043 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) BUPA Care Homes Ltd Ms Joan Walton Care Home with nursing 45 Category(ies) of Older People (over 65 years) - 45 places registration, with number Physical Disability - 5 places of places Terminally Ill - 5 Places Cleveland House 20050907 Cleveland House IR OP J51 v241681 s1112.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Conditions of this registration are listed on the registration certificate displayed at the service. Date of last inspection 6 January 2005 Brief Description of the Service: Cleveland House provides personal care and nursing for up to 45 elderly people. The home is a large stone built, converted residence with two new purpose built extensions. It is approximately half a mile from Marsh and 1 mile from Lindley with all their local amenities. Huddersfield centre is about 2 miles away with the bus stop at the end of the road. There are spacious gardens for service users to use and there is ample parking. Cleveland House 20050907 Cleveland House IR OP J51 v241681 s1112.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over a 7 hour period from 9.30 in the morning. Inspectors looked around the building accompanied by the manager, met with service users and staff, shared a meal with some service users in the dining room and looked at records relating to service users and in the areas identified in this report. Overall inspectors felt the home was functioning well and has made strides forward since the previous inspection, but some areas still need to be addressed to make further improvements. Inspectors would like to take this opportunity to thank service users and staff for their welcome on the day. What the service does well: The service is good at assessing service users’ needs before they are admitted to the home. Service users reported that the staff meet their needs at the home. The makes considerable efforts to ensure that people can continue to do the things they enjoy doing when they come to live at the home. The activities coordinator’s role is fundamental to achieving this. Service users reported that the meals are of a good quality and choices are good. Relatives and friends are welcomed to the home. Complaints are taken seriously and acted upon. Staff are trained in protecting service users from abuse and are all vetted to ensure they have no history of abuse themselves. There is a good system of maintenance of the building, of equipment and redecoration. Induction and foundation training for staff is good. Staff say they are well supported by the manager. Cleveland House 20050907 Cleveland House IR OP J51 v241681 s1112.doc Version 1.40 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. Cleveland House 20050907 Cleveland House IR OP J51 v241681 s1112.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Cleveland House 20050907 Cleveland House IR OP J51 v241681 s1112.doc Version 1.40 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 standard(s) 3 Service users needs are assessed prior to them moving into the home to ensure the home is able to meet those needs. EVIDENCE: Prior to a service user moving into the home a pre-admission assessment is completed by the home manager. The home also receives a community care assessment, which has been completed by the service users social worker. These assessments enable the home to decide if they are able to meet the needs of the service user. The information gathered is also used to formulate an initial plan of care. Evidence was seen in four service users files that the pre-admission assessment had taken place prior to the service users being admitted to the home. Cleveland House 20050907 Cleveland House IR OP J51 v241681 s1112.doc Version 1.40 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 standard(s) 7,8,9,10 Some care plans and risk assessments were not reviewed at regular intervals. Stock balances of medication for recently admitted service users were not recorded, this could place the service user at risk. Service users said the staff treat them with respect. EVIDENCE: A selection of service users care files were inspected, these have improved since the last inspection. Care plans had generally been put into place for problems identified on the pre-admission assessment, however these were not always updated to reflect the service users current state of health. There were risk assessments in place for such things as tissue viability, moving and handling and nutrition. These assessments must be reviewed at regular intervals and measures put into place to prevent the decline of the service user’s health. Daily entries in the care files were in the main good but did not always reflect the care that the staff had given. There was evidence that if specialist help, or advice is required then staff access this from other members of the multidisciplinary team. Cleveland House 20050907 Cleveland House IR OP J51 v241681 s1112.doc Version 1.40 Page 10 Through observation and evidence seen in the care files it was seen that the staff were addressing the service users’ health and welfare needs. Service users appeared appropriately dressed with their personal appearance attended to. An audit of a selection of medication was conducted. The stock balances on two medications checked could not be reconciled. The staff had failed to record the amount of medication, which had been brought into the home by the service user, or brought forward the balance from the previous month. This is the third occasion where inspectors have found problems with medication and this issue needs to be addressed urgently for the safety and welfare of service users. Cleveland House 20050907 Cleveland House IR OP J51 v241681 s1112.doc Version 1.40 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 standard(s) 12,13,14,15 The home makes considerable efforts to ensure that service users can continue to exercise control over their lives and have the lifestyle they choose as far as possible. Relatives and friends are encouraged to visit. Meals are of a good quality and choices are offered but the organisation of serving lunch may need review. EVIDENCE: Inspectors found that the home makes considerable efforts to ensure that service users can adopt and continue their preferred lifestyle at the home. Information about individual preferences for leisure activities and how they receive personal care and support was found in care. There is an activities organiser who spends time on one to one with service users helping them to pursue individual interests and who also organises and plans group activities, such as crafts or games. Service users who spoke with inspectors said that they find this a very important part of the service and something they enjoy. The organiser has information sheets about each service user outlining their particular interests and she plans to spend time with all residents over the course of a week. Cleveland House 20050907 Cleveland House IR OP J51 v241681 s1112.doc Version 1.40 Page 12 In the course of the inspection several visitors came and went. Both staff and service users reported that visiting is very flexible and the home tries hard to encourage relatives and friends to visit. One relative spoke with inspectors and confirmed that they find the home a friendly place and they can visit at all reasonable times. Inspectors noted that service users appeared to have plenty of choices regarding how and where they spend their time. For example meals can be taken in rooms or in lounge areas if people prefer. Inspectors were present for the service of lunch in the dining room. Tables were well presented. Service users make choices the day before about what they wish to eat for their main meal. Service users said that generally the food is good. The meal was well presented, although there was a long delay between the first and second course which some service users found frustrating. This appears to be because of only one staff member working in the dining room to serve meals. This arrangement should be reviewed. Breakfasts are available in bedrooms for those who prefer it, although some service users do choose to have breakfast in the dining room. Some service users need a lot of support to feed and this was given in a discreet manner with staff taking time over the task. Cleveland House 20050907 Cleveland House IR OP J51 v241681 s1112.doc Version 1.40 Page 13 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 Complaints are taken seriously and the outcomes acted upon. Service users are protected from abuse through staff training and awareness. EVIDENCE: The home has a complaints procedure in place and displayed for service users and relatives in the hallway and in each bedroom. Service users who spoke with inspectors were clear about how to use this procedure. From the complaints log it was clear that they system for dealing with complaints is robust. The manager deals with these promptly and takes each one seriously. There is a monthly analysis of complaints done also, which is sent to BUPA head office. This ensures that the organisation is also aware if there are consistent problems within the home. This is good practice. Staff receive training in Adult Protection issues and whistleblowing as part of their induction into the home. In addition the home is due to run a one-day training event in October around prevention of abuse. Cleveland House 20050907 Cleveland House IR OP J51 v241681 s1112.doc Version 1.40 Page 14 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, 22, 26 The environment at Cleveland House is clean, tidy and well maintained. Safety issues are taken seriously but there are some issues that require attention as a mater of priority. EVIDENCE: Inspectors found the environment at Cleveland House to be clean and tidy, free from offensive odours and generally well maintained. There is an ongoing programme of decoration. The quiet lounge had just been redecorated before this visit and the entrance hall and landing were due to be redecorated the following week. The grounds were well maintained and are obviously a great source of pleasure to many of the service users that inspectors spoke to. Specialist equipment such as hoists and walking aids are available as required by each service user. All such equipment is routinely checked for safety and good records are kept of these checks. One area of concern to inspectors was the availability of call bells in some of the lounge areas. The manager explained that staff are allocated to cover Cleveland House 20050907 Cleveland House IR OP J51 v241681 s1112.doc Version 1.40 Page 15 these areas in the afternoons, which is when they are mainly used. However inspectors observed significant periods of time where staff were engaged elsewhere and could not be observing whether individuals might need support. It is recommended that the system be extended to increase the availability of call bells so that service users can alert staff more easily. Laundry facilities in the home are good but inspectors did note that there were bags of tights found on some linen trolleys. Sharing communal tights is not good practice and this should cease. Inspectors also noted that the home does not have adequate facilities for clinical waste. Although small bags are used to put soiled items in these are then placed in a bin which is simply a bag hanging off a trolley. Clinical waste should be put in a bin with a lid to prevent any risk of cross infection. Cleveland House 20050907 Cleveland House IR OP J51 v241681 s1112.doc Version 1.40 Page 16 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, 30 Staffing issues have improved since the last inspection. Staff recruitment procedures help to protect service users. Basic training for staff is good. EVIDENCE: Staff rotas showed that the home is now providing staff at a level to meet the needs of service users and this is monitored weekly by BUPA headquarters. The home has had some staff vacancies for a while but these have now been largely filled, most notably the deputy post and that of the activities coordinator. Staff recruitment is standardised by BUPA policies and staff records showed that proper checks had been carried out on staff working at the home. BUPA have standard procedures for induction and foundation training for new staff. Staff have workbooks to go through that require them to learn the basics of care and these are signed off by managers once each new person has completed their induction. Staff who spoke with the inspectors confirmed that they had been through this procedure. These books cover such areas as principles of care, adult protection and safety issues. Cleveland House 20050907 Cleveland House IR OP J51 v241681 s1112.doc Version 1.40 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 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) 36, 38 Staff are well supported by the manager. Safety issues are addressed effectively in general but some safety and security arrangements need to be reviewed. EVIDENCE: Inspectors spoke with staff in the home. They reported that they feel well supported and supervised by the manager both formally through supervision sessions and informally by her being visible ‘on the shop floor’. Health and safety issues are generally well controlled within the home. There is a maintenance person who oversees all such areas and the records of checks made were found to be in good order. There were a couple of issues relating to safety that the inspectors highlighted, some of which have been noted in the environment section of this report. Cleveland House 20050907 Cleveland House IR OP J51 v241681 s1112.doc Version 1.40 Page 18 Other areas to be addressed were in relation to the use of a hot trolley in one corridor, which inspectors felt was a hazard and a risk to service users. The manager had already considered this and is taking steps to address position the trolley where it can be used safely. The weather on this visit was warm and inspectors found that all exit doors had been left open. This constitutes a security risk and given the layout of the building it was felt that it would be relatively easy for an intruder to go about service users’ bedrooms undetected for some time. Security arrangements should be reviewed by the manager, to identify ways of managing this risk while still ensuring that service users can access the grounds independently Cleveland House 20050907 Cleveland House IR OP J51 v241681 s1112.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 x x 2 x x x 1 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x 3 x 1 Cleveland House 20050907 Cleveland House IR OP J51 v241681 s1112.doc Version 1.40 Page 20 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. 2. 3. 4. Standard OP 7 OP 9 OP26 OP 38 Regulation 15 13(2) 13(3) 13(4) Requirement Service users plans must be reviewed regularly. Accurate records of all medication held at the home must be kept. Lidded bins must be purchased for the disposal of clinical waste. The hot trolley used at breakfast needs to be resited to prevent risks to service users. Timescale for action 30 Septmeber 2005 30 September 2005. 30 September 2005 31 October 2005. 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. 2. 3. Refer to Standard OP 15 OP22 Good Practice Recommendations The arrangements in the dining room should be reviewed to minimise delays in serving food. The number of call bells avaialble in lounge areas shoulld be increased. - Cleveland House 20050907 Cleveland House IR OP J51 v241681 s1112.doc Version 1.40 Page 21 Commission for Social Care Inspection Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Cleveland House 20050907 Cleveland House IR OP J51 v241681 s1112.doc Version 1.40 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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