Inspection on 17/06/05 for Clifden House

This inspection was carried out on 17th June 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.

Other inspections for this house

Clifden House 14/05/08

Clifden House 23/05/07

Clifden House 08/11/06

Clifden House 08/05/06

Clifden House 25/11/05

Clifden House 03/12/04

Clifden House 11/06/04

Clifden House 19/05/03

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Clifden House 82-88 Claremont Road Seaford East Sussex BN25 2QD Lead Inspector Gwyneth Bryant Unannounced 17 June 2005 07.50 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. Clifden House H59-H10 s21423 Clifden v218928 160605 stage4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Clifden House Address 82-88 Claremont Road Seaford East Sussex BN25 2QD 01323 896460 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) Histogrange Sheila Collins Care Home 36 Category(ies) of Dementia- over sixty-five (65) years of age registration, with number (DE(E) 36 of places Clifden House H59-H10 s21423 Clifden v218928 160605 stage4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users to be accommodated is thirty-six (36). 2. Service users must be aged sixty-five (65) years or over on admission. 3.Service users with a dementia type illness only to be accommodated. Date of last inspection 3 December 2004 Brief Description of the Service: Clifden House is a large detached house on two floors and provides two passenger lifts to access the first floor accommodation. The home is registered to care for 36 older people with Dementia. It is situated in a residential area of Seaford, with the seafront and town centre within short walking distance. The home is a member of the Alzheimer’s Disease Society. The home provides a light and airy dining room and four lounge areas. There is a large wellmaintained rear garden. The home provides 26 single bedrooms, 24 of which have toilet en-suite facilities and 5 double bedrooms with toilet en-suite facilities. Plans are in place to fit en-suite facilities to the remaining two single rooms. There are four bathrooms with assisted bath seats and six communal toilet facilities. Toilet riser seats, hand and grab rails are fitted as required. Clifden House H59-H10 s21423 Clifden v218928 160605 stage4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over six and a half hours. There were thirty-four service users in residence on the day of which three were spoken with. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect additional standards. Sixteen key standards and four of the remaining standards were inspected. Discussion took place with the Registered Manager, deputy manager and two members of care staff. A tour of the premises was undertaken and a range of documentation viewed including care plans, personnel and medication records. 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Clifden House H59-H10 s21423 Clifden v218928 160605 stage4.doc Version 1.20 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 Clifden House H59-H10 s21423 Clifden v218928 160605 stage4.doc Version 1.20 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) 3 and 4 Satisfactory pre-admission assessments are carried out prior to residents moving into the home which ensure that service users needs can be met. EVIDENCE: Pre-admission sheets were viewed and it was found that all care needs were identified enabling the home to demonstrate it can meet service users needs at the time of admission. Clifden House H59-H10 s21423 Clifden v218928 160605 stage4.doc Version 1.20 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 and 10 The systems for administering and recording medication are inadequate and potentially place service users at risk. Care planning systems need to ensure staff are guided in all aspects of service users care. Service users privacy and dignity are respected. EVIDENCE: A sample of care plans were viewed and generally they were detailed and identified care needs and ensured care was planned for. Risk assessments had been carried out but need to be reviewed more regularly. Risk assessments need to be undertaken for those service users who present challenging behaviour and include the management of the risk and any ‘triggers’. Discussion with staff and the deputy manager found that staff were knowledgeable about service users who presented certain behaviours and how to deal with them. However, this approach relies on staff memory and good communication. Service users are at risk if these informal systems break down. A chiropodist visits the home regularly, as does a hairdresser. All service users need to be weighed monthly and action taken based on weight lost or gained. Clifden House H59-H10 s21423 Clifden v218928 160605 stage4.doc Version 1.20 Page 9 Not all medication administered had been recorded and when medication was not administered staff did not use the prescribed ‘code’ letter on the medication record sheet. Not all staff have received accredited training in the safe handling of medication. Each of these issues need to be rectified. Care plans included service users personal preferences and staff were observed to treat service users with consideration, care and respect while providing care and assistance with meals. Clifden House H59-H10 s21423 Clifden v218928 160605 stage4.doc Version 1.20 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, 13 and 15 Social activities and meals are both well managed, creative and provide daily variation for people living in the home. Visitors are welcome to the home at all reasonable times to ensure service users maintain links with family and friends. EVIDENCE: The two service users spoken with said that the food was good. Menus were viewed and they were varied and well balanced. Choices are offered at each mealtime and service users care plans included their food likes and dislikes. The homes Statement of Purpose include arrangements for visiting and the daily log include entries of when friends and family visit or when service users go out on visits. The home has a weekly programme of suitable activities, including a magician, cards, board games, music and exercise with a beach ball. Clifden House H59-H10 s21423 Clifden v218928 160605 stage4.doc Version 1.20 Page 11 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 The home has a satisfactory complaints procedure with evidence that complaints are recorded and actions taken to resolve any issues. EVIDENCE: The complaints book was inspected and it was seen that all complaints are recorded and include actions taken and outcomes. No complaints had been received since the last inspection. A complaint was received by the CSCI in respect of the pronouncing of death and whether or not service users should be resuscitated. The complaint was upheld in part, in that staff believed they were acting in the service users best interest and the homes procedure was followed. However, guidance from the Nursing and Midwifery Council is that trained nurses may pronounce an expected death and that in all other cases staff should attempt resuscitation. The home has since revised its policies and procedures in this matter to ensure that staff attempt to resuscitate service users until the emergency services arrive. Clifden House H59-H10 s21423 Clifden v218928 160605 stage4.doc Version 1.20 Page 12 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, 24 and 25 Improvements are required in respect of the provision of adaptations and equipment to ensure service users are safe. The standard of décor is satisfactory, providing service users with a homely and attractive place in which to live. EVIDENCE: A tour of the premises was carried out and generally the home is clean, tidy and well maintained. A suitably qualified person needs to make an assessment of the premises and grounds to ensure the needs of all service users are met. Service users individual accommodation is furnished according to the required standard unless a risk assessment suggests otherwise. Service users bedrooms have recently been re-arranged and as a result calls bells are not accessible when service users are in bed and this needs to be rectified. In addition two call bells must be provided in all shared rooms. A number of door wedges were found in service users bedrooms and several doors were wedged open. This practice must cease and suitable self closing devices need to be fitted as required. Clifden House H59-H10 s21423 Clifden v218928 160605 stage4.doc Version 1.20 Page 13 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 and 30 The number of staff and the skill mix is such that residents’ needs can be met and consistent care provided, however sufficient staff should be on duty at all times to meet service users needs. The recruitment practice is not robust and does not provide sufficient safeguards for the protection of residents. Induction training is provided to ensure staff are aware of the home’s philosophy of care and enable them to provide good levels of care to service users. EVIDENCE: Staff rotas were viewed and there are at least five carers on duty each morning and at least four during the afternoon and evening shifts. Three night waking staff are employed. The Inspector was concerned to note that three carers were taking a break at the same time leaving one carer to look after the thirty-three service users. Given the number, care needs of service users and the layout of the home this is not acceptable and must be addressed. Recruitment records were viewed and it was found that recently employed staff had not provided two written references and POVA/Criminal Records Bureau checks had not been carried out prior to appointment. The staff application form needs to be expanded to include a full employment history to ensure any gaps in employment can be identified. The home has a staff induction training programme that meets the Care Skills sector specifications. A similar foundation training programme needs to be developed and implemented. Clifden House H59-H10 s21423 Clifden v218928 160605 stage4.doc Version 1.20 Page 14 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) 33, 35, 36 and 38 The home has satisfactory quality monitoring and quality assurance systems in place enabling the provider to ensure the home continues to provide a quality service. Systems are in place to ensure service users finances are safeguarded. Staff are appropriately supported. Satisfactory arrangements need to be put in place to ensure the welfare and safety of service users and staff. EVIDENCE: The home uses the Investors in People programme as a quality monitoring tool. Staff supervision records were examined and from these it is clear that these sessions identify training needs and good practice issues. An annual appraisal is also carried out for all care staff. Staff spoken with said that mostly they found supervision sessions to be of use. This is in addition to regular surveys for service users families and friends. Service users representatives are invited to care plan reviews to enable them to contribute to the care planning process. Clifden House H59-H10 s21423 Clifden v218928 160605 stage4.doc Version 1.20 Page 15 Service users families or representatives organize their finances. When the home buys items for service users the cost is included in the monthly invoice and receipts provided. Records were available to demonstrate that fire alarms and emergency lighting systems are regularly tested and fire drills undertaken. Testing of portable electrical appliances is carried out annually. A risk assessment of the grounds and premises in respect of all safe working practices has been undertaken. Door wedges were still in use in some parts of the home and this practice must cease. Training in food hygiene and infection control needs to be provided for all staff. Documents relating to Health and Safety were available and found to be satisfactory as were accident records. Clifden House H59-H10 s21423 Clifden v218928 160605 stage4.doc Version 1.20 Page 16 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION x x x 1 x 3 3 x STAFFING Standard No Score 27 2 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 3 x 3 3 x 2 Clifden House H59-H10 s21423 Clifden v218928 160605 stage4.doc Version 1.20 Page 17 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 7 Regulation 13 (4) (b) (c) Requirement Timescale for action 17.09.05 2. 3. 7 8 4. 9 5. 9 Detailed risk assessments need to be undertaken for those service users who present challenging behaviour and include the management of the risk.(timescale of 11.09.04 not met) 13 (4) (b) Risk assessments need to be (c) and 15 reviewed more regularly. (2) (b) 14 (1) (2) All service users need to be (a&b) and weighed monthly. Regulation 17 (1) (a) schedule 3 (o) Reg.17 All staff who administer (1) (a) medication need to receive Schedule accredited training. 3 (k) and 18 (1) (a) 13 (2) All medication that is and administered must be recorded Reg.17 on the MAR chart.(timescale of (1) (a) 11.07.04 not met) Schedule 3 (k) 17.09.05 17.07.05 17.09.05 17.06.05 Clifden House H59-H10 s21423 Clifden v218928 160605 stage4.doc Version 1.20 Page 18 6. 22 7. 22 8. 9. 27 29 10. 30 11. 38 12. 38 16 (1) (2) An assessment of the premises (c) and 23 by a suitably qualified person is (2) (n) undertaken in respect of specialist equipment and adaptations. (timescale of 07.03.05 not met) 16 That call bells in service users Regulation bedrooms be accessible to them. 4(3) (1) (2) (c) 18 (1) (a) That staff be deployed to ensure service users needs are met at all times. Regulation All staff need to provide the 19 (4) (c) required documentation listed in (5) and Schedule 2 of the Regulations prior to appointment. The Schedule application form needs to be 2 of the Regulation expanded to include an s and employment history and that staff records are available in Schedule accordance with Schedule 4. 4 of the Regulation s 12 (1) Foundation staff training (a&b) and programmes that meet the Care 18 (1) (a) Skills Sector specifications need (c) (i) (ii) to be created and implemented. 13 (3) (4) That all staff be trained in (5) and infection control and food 16 (2) (J) hygeine. and 23 (4) (a-e) (5) 23 (4) (a) That the use of door wedges (c) (i) (v) ceases. 17.09.05 17.09.05 17.06.05 17.07.05 17.09.05 17.09.05 17.06.05 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. Clifden House H59-H10 s21423 Clifden v218928 160605 stage4.doc Version 1.20 Page 19 Refer to Standard Good Practice Recommendations Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Clifden House H59-H10 s21423 Clifden v218928 160605 stage4.doc Version 1.20 Page 20 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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