Inspection on 25/11/05 for Clifden House

This inspection was carried out on 25th November 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 17/06/05

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 HistoGrange Ltd 82-88 Claremont Road Seaford East Sussex BN25 2QD Lead Inspector Gwyneth Bryant Unannounced Inspection 25 November 2005 08:30 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 Clifden House DS0000021423.V253708.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. Clifden House DS0000021423.V253708.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Clifden House Address HistoGrange Ltd 82-88 Claremont Road Seaford East Sussex BN25 2QD 01323 896460 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) office@clifdenhouse.co.uk Mr Nial Joyce Sheila Collins Care Home 36 Category(ies) of Dementia - over 65 years of age (36) registration, with number of places Clifden House DS0000021423.V253708.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users must not exceed thirty six (36). Service users accommodated must be aged sixty-five (65) years or over on admission. Service users with a diagnosis of an early onset of dementia only to be accommodated. 17th June 2005 Date of last inspection 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 well-maintained 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 DS0000021423.V253708.R01.S.doc Version 5.0 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-three service users in residence on the day of which five were spoken with. One service user was in hospital on the day. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect additional standards. Discussion took place with one relative, the 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: Both service users and the home’s legal rights would be better protected if contracts were signed and copies maintained. The care planning documents need to be regularly reviewed and systems put in place to provide clear direction to staff in the delivery of care to service users and ensure care needs are met. Detailed risk assessments need to be provided for those service users at risk of tissue breakdown and falls. The home needs to improve the recording and administration of medication to ensure service users are not put at risk. Arrangements need to be made to ensure service users’ privacy and dignity is protected at all times. Recruitment practices need to ensure that any gaps in employment history are explored and two references obtained prior to appointment to protect service users. Quality assurance and quality monitoring systems need to be devised and implemented to enable the provider to objectively evaluate the service. Clifden House DS0000021423.V253708.R01.S.doc Version 5.0 Page 6 The heating systems need to be regularly tested to ensure room temperatures remain constant. An assessment of the premises and facilities needs to be carried out by a suitably qualified person, including an Occupational Therapist to ensure the needs of all service users are met. The requirements made by East Sussex Fire Service must be met within the given timescales The use of door wedges must cease and adequate arrangements for the regular testing of call bells and emergency lighting must be put in place. 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. Clifden House DS0000021423.V253708.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 Clifden House DS0000021423.V253708.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): 2, 3 and 5 Standard 6 is not applicable Service users’ legal rights would be better protected if contracts were signed when their stay becomes permanent. Satisfactory pre-admission assessments are carried out prior to service users moving into the home which ensure that their needs can be met. EVIDENCE: A service user’s representative raised a concern regarding service users contracts. While it was not a formal complaint this was discussed during the inspection and the deputy said that some service users’ representatives do not sign and return contracts when requested. The deputy agreed to discuss with the provider a means to overcome this problem. 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. The relative spoken with said that they were able to visit the home prior to the service users’ admission. Clifden House DS0000021423.V253708.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, 10 and 11 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. Systems need to be devised to ensure service users privacy and dignity is respected. EVIDENCE: A sample of care plans were inspected and some shortfalls were found in respect of reviews and risk assessments. Basic risk assessments had been carried out but they did not clearly identify the hazards nor include sufficient detail for the management of risks, this is especially true for those who are at risk of falls or tissue breakdown. Neither care plans nor risk assessments were reviewed monthly and there was no evidence that service users representatives are involved in compiling and reviewing the plans. The one relative spoken with and a service users representative confirmed this. All service users are now weighed monthly and action taken if noted to lose weight. Not all medication administered had been signed for on the MAR chart, some signatures had been scribbled out and a carer was seen to be ‘potting up’ medication. Medication administration needs to be individualised. Each of these poses a potential risk to service users and therefore needs to be Clifden House DS0000021423.V253708.R01.S.doc Version 5.0 Page 10 addressed. Staff have yet to be trained in the safe handling of medication and this also needs to be rectified. During the inspection a service users’ bedroom door was wedged open and she was wearing just a nightdress, thus her dignity and privacy was compromised. This occurred even though this aspect of care is included in the homes staff induction procedure. Service users’ care plans include arrangements for their care when their condition deteriorates. Clifden House DS0000021423.V253708.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 and 15 Service users are encouraged to exercise choice over their daily lives. The meals in this home are good offering both choice and variety and cater for special dietary needs. EVIDENCE: Service users’ care plans include, where possible, information on their individual preferences. Throughout the inspection service users were seen to choose where to spend their day; some stayed in their rooms, some sat in the communal areas while others preferred to wander throughout the building. The two service users who were able to express an opinion said that they enjoyed their meals. 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. Clifden House DS0000021423.V253708.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): 18 Systems are in place to protect service users from abuse. Service users would be better protected if adult protection procedures were followed. EVIDENCE: All staff have been trained in adult protection and there are policies and procedures on all adult protection issues. The deputy manager said the manager would investigate any allegations of abuse. However, the daily notes showed that there was an allegation of theft from a service user and this had not been dealt with according to the prescribed procedure. Practice needs to change to ensure that both East Sussex Social Services and CSCI are informed of any allegations of abuse. Clifden House DS0000021423.V253708.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): 22, 25 and 26 Improvements are required in respect of the provision of adaptations and equipment to ensure service users are safe. Service users would be more comfortable and safe if room temperatures were constant and call bells were working. Service users and staff would be better protected if staff were trained in infection control. EVIDENCE: A tour of the premises was carried out and generally the home was clean and tidy, however, staff were noted to carry soiled laundry without wearing protective aprons. This poses a risk of cross infection therefore staff need to be trained in infection control. Some rooms were cold as the radiators were not working. This was discussed, via the telephone, with the provider who agreed to address the matter that day. Subsequently he informed the inspector that the work had been carried out satisfactorily and room temperatures were now constant. Call bells in some rooms were not working and others were not accessible to service users. This was discussed with the deputy manager who said that a Clifden House DS0000021423.V253708.R01.S.doc Version 5.0 Page 14 new system was due to be installed and a demonstration model for the system was available. A suitably qualified person needs to make an assessment of the premises and grounds to ensure the needs of all service users are met. Clifden House DS0000021423.V253708.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, 28 and 29 The deployment and number of staff at key times needs to be reviewed to ensure service users’ care needs are met. Staff receive satisfactory training to enable them to meet service users’ care needs. The recruitment practice is not robust and does not provide sufficient safeguards for the protection of 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. Domestic and laundry staff are also employed along with a gardener and cook. The deputy manager said that the home aimed to provide six morning care staff and five for the other day shifts. She confirmed that arrangements are now in place to ensure staff take their breaks on a rota system to ensure there is adequate staff deployment at all times. On the day, staff appeared rushed and service users were noted to be left unattended in the lounge areas. Total weekly care hours provided is 630, based on the number of staff on duty during the inspection. The Care Forum Staffing Tool recommends at least 836.36 care hours per week be provided. Therefore, taking into consideration the number, care needs of service users and the layout of the home, staffing levels need to be kept under review to ensure their needs are met. There is a staff training programme in place to ensure 50 of staff employed in the home have at least NVQ level 2 by April 2006. Clifden House DS0000021423.V253708.R01.S.doc Version 5.0 Page 16 Recruitment records were viewed and it was found that recently employed staff had not provided two written references. The staff application form needs to be expanded to include a full employment history to ensure any gaps in employment can be identified and explained. Clifden House DS0000021423.V253708.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, 32, 33 and 38 Service users would benefit if staff were appropriately supported and supervised at all times. The introduction of formal quality monitoring systems would enable the provider to critically evaluate the service and take action where required. Not all aspects of service users’ safety and welfare are protected. EVIDENCE: The registered manager was not available on the day of the inspection and in her absence lines of responsibility and accountability are not clearly established. While the ethos of the home is open, service users would benefit from having their representatives more fully consulted in how care is delivered and the services provided. There are staff meetings and a ‘hand over’ at the end of each shift, thus ensuring regular communication between staff. However, staff do not receive regular formal supervision therefore communication with and support by management is limited. The introduction of formal quality assurance and quality monitoring systems would enable the provider to objectively evaluate the service and ensure it is Clifden House DS0000021423.V253708.R01.S.doc Version 5.0 Page 18 run in service users’ best interests. The registered provider undertakes monthly visits as required under Regulation 26 and the results made available to the Commission. Door wedges are still in use and some doors were wedged open with cushions and furniture; this practice must cease and suitable self-closing devices fitted as required. A fire safety officer from East Sussex Fire Service undertook an inspection in October and a number of recommendations were made. These had not been rectified within the required timescales putting both staff and service users at risk in the event of fire. Fire and smoke alarms are tested regularly and this needs to be extended to include emergency lighting and call bell systems to further protect service users. All staff need to be trained in infection control to reduce the risk of cross infection. Evidence was available to demonstrate that electrical and gas systems and appliances have been serviced and are safe. Documents relating to safe working practices and Health and Safety were available and found to be satisfactory. The accident book was viewed and some service users had received serious injuries as the result of falls. The CSCI had not been informed of these incidents; systems need to be put in place to ensure the CSCI is informed of all matters listed under Regulation 37. Clifden House DS0000021423.V253708.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 2 3 x 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 x 18 2 X X X 1 X X 2 2 STAFFING Standard No Score 27 2 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 1 X X 2 X 2 Clifden House DS0000021423.V253708.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 2 Standard OP7 OP7 Regulation 13(4bc) 15(1) (2bc) 13(4bc) 15(2b) Requirement Risk assessment for those at risk of tissue breakdown or falls need to be more detailed. Care plans and risk assessments need to be reviewed more regularly. Service users or their representatives be involved in the reviews. (timescale of 17/09/05 not met) The practice of ‘potting up’ medication must cease and signatures on the MAR chart must not be deleted. All staff who administer medication need to receive accredited training as under Schedule 3 (k). (timescale of 17/09/05 not met) All medication that is administered must be recorded on the MAR chart. As under Schedule 3. (timescale of 11.07.04 not met) That systems are put in place to ensure service users privacy and dignity are respected. That proper procedures are followed in the event of an allegation of abuse or theft and DS0000021423.V253708.R01.S.doc Timescale for action 02/02/05 02/02/06 3 OP9 13(2) 02/12/05 4 OP9 18 (1) (a) 02/02/06 5 OP9 13(2) 02/12/05 6 7 OP10 OP18 12 (4) (a) 13(6) 37(1f) 02/12/05 02/02/06 Clifden House Version 5.0 Page 21 8 OP22 16(1)(2c) 23(2n) 9 OP22 16(1) reg 4(2c) 19(4c)(5) 10 OP29 11 12 13 14 15 16 OP26 OP32 OP33 OP36 OP38 OP38 13(3 (4) (5)16 (2j) 12 (1) (5ab) 24 (1ab) (2)(3) 18 (2) 23(4a)(c) (i)(v) 37 (1c) 17 OP38 23(4)(a-e) 18 OP38 23(4)(iii) 16(2c) the CSCI notified. An assessment of the premises by a suitably qualified person is undertaken in respect of specialist equipment and adaptations. (timescale of 07.03.05 not met) That call bells in service users bedrooms be accessible to them. (timescale of 17/09/05 not met) All staff need to provide the required documentation listed in Schedule 2 (as amended) of the Regulations prior to appointment. The application form needs to be expanded to include an employment history and that staff records are available in accordance with Schedule 4. (timescale of 17/07/05 not met) That all staff be trained in infection control. That systems be put in place to consult with service users and their representatives. That formal quality monitoring and quality assurance systems be created and implemented That all staff receive formal supervision at least six times a year. That the use of door wedges ceases. Arrangements need to be made to ensure the CSCI is informed of any serious injury to a service user. That the requirements made by the Fire Safety Officer be carried out within the given timescales. Regular testing of emergency lighting and call bells needs to be carried out. 02/02/06 02/02/06 02/12/05 02/02/06 02/02/06 02/03/06 02/02/06 02/12/05 02/12/05 02/12/05 01/12/05 Clifden House DS0000021423.V253708.R01.S.doc Version 5.0 Page 22 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 OP27 Good Practice Recommendations That staffing levels be regularly reviewed. Clifden House DS0000021423.V253708.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection East Sussex Area Office 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. 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