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Inspection on 16/08/06 for Cliff House Nursing Home

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

This inspection was carried out on 16th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

Residents and visitors spoken with were positive about Cliff House. Comments included "I`m well cared for", the staff "treat me with respect", "I`m very happy with the way the staff look after him", "I only have to press the buzzer and they will come to help me". There were examples of good practice, such as the recent introduction of a booklet for residents and / or their representatives to complete with details of their lives, interests, preferences and people important to them. Another example was the system of care reviews for residents who were self-funding and who did not have a care manager or social worker. There were good systems in place to ensure residents were consulted and informed about events in the home, including regular residents` meetings and quality assurance surveys.Most of the care staff had achieved or were working towards NVQ (National Vocational Qualification) in care. The home had 75% of care staff already with NVQ in care, well above the national minimum standard of 50%.

What has improved since the last inspection?

The requirement made at the last inspection had been met, resulting in an improvement to the medication system. The providers had invested in improvements to the home and new equipment. A staff room and a nurse`s office had been created out of existing storage space, improving facilities for staff and helping to ensure confidentiality. A shower room had been converted to provide an additional bath plus hairdressing facilities. New equipment provided included a lifting hoist, televisions, and a specialist rise and fall bed.

What the care home could do better:

Although the home was generally well maintained, there was a split in a carpet on a first floor corridor, which was a potential trip hazard. There could be more formal involvement of residents and / or their representatives in care planning and review. This would ensure residents needs and preferences were fully addressed. The programme of activities could be improved and expanded to include the needs of more of the residents.

CARE HOMES FOR OLDER PEOPLE Cliff House Nursing Home Cliff Hill Clowne Chesterfield Derbyshire S43 4LE Lead Inspector Rose Veale Unannounced Inspection 16th August 2006 10:00 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 Cliff House Nursing Home DS0000002051.V307962.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. Cliff House Nursing Home DS0000002051.V307962.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cliff House Nursing Home Address Cliff Hill Clowne Chesterfield Derbyshire S43 4LE 01246 810246 01246 570094 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) Springbank House Limited Vacancy Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Cliff House Nursing Home DS0000002051.V307962.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th February 2006 Brief Description of the Service: Cliff House is situated on the outskirts of the village of Clowne, reasonably near to shops, public transport and other local facilities. The home is registered to provide personal and nursing care for up to 40 older people. Cliff House comprises an older, converted building with a newer purpose built ground floor extension. There are good views over the surrounding countryside and an accessible garden. Fees at the home range from £308.20 to £338.20 per week for personal care, and from £384.90 to £490.15 per week for nursing care. This information is taken from the pre-inspection questionnaire completed by the home’s deputy manager and administrator on 10th July 2006. Cliff House Nursing Home DS0000002051.V307962.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and took place over 5½ hours. The inspection visit focused on assessing compliance to requirements made at the previous inspection and on assessing all the key standards. There were 32 residents accommodated in the home on the day of the inspection, including 13 residents assessed as needing nursing care. Residents, visitors and staff were spoken with during the visit. Some residents were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Records were examined, including care records, staff records, maintenance, and health and safety records. A tour of the building was carried out. A questionnaire and surveys had been completed and returned prior to the inspection and information from this has been included in the body of this report. Since the last inspection, the registered manager, Tracey Leech, had resigned to become the deputy manager. A new acting manager, Jane Richardson, was appointed in April 2006 and was about to apply for registration with CSCI. The acting manager was available during the inspection and was very helpful. What the service does well: Residents and visitors spoken with were positive about Cliff House. Comments included “I’m well cared for”, the staff “treat me with respect”, “I’m very happy with the way the staff look after him”, “I only have to press the buzzer and they will come to help me”. There were examples of good practice, such as the recent introduction of a booklet for residents and / or their representatives to complete with details of their lives, interests, preferences and people important to them. Another example was the system of care reviews for residents who were self-funding and who did not have a care manager or social worker. There were good systems in place to ensure residents were consulted and informed about events in the home, including regular residents’ meetings and quality assurance surveys. Cliff House Nursing Home DS0000002051.V307962.R01.S.doc Version 5.2 Page 6 Most of the care staff had achieved or were working towards NVQ (National Vocational Qualification) in care. The home had 75 of care staff already with NVQ in care, well above the national minimum standard of 50 . 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. Cliff House Nursing Home DS0000002051.V307962.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 Cliff House Nursing Home DS0000002051.V307962.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There was a good system in place to ensure residents’ needs were fully assessed and residents could be confident the home was able to meet their needs. EVIDENCE: The records of 4 residents were examined, including 2 residents assessed as needing nursing care. The assessment information was seen for a resident recently admitted to the home. This included the home’s own assessment carried out prior to admission and the hospital assessment of nursing care needs. The home had written to confirm to the resident that their needs could be met by the home. Care plans had been produced from the assessment information. Residents and relatives spoken with confirmed that assessment had taken place before a place at the home was offered. Residents said their needs were met at the home. Cliff House Nursing Home DS0000002051.V307962.R01.S.doc Version 5.2 Page 9 Standard 6 did not apply to this service. Cliff House Nursing Home DS0000002051.V307962.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The personal and health care needs of residents appeared well met with evidence of respecting their privacy and dignity. EVIDENCE: The care plans seen covered all the assessed needs of residents and clearly detailed the action needed by care staff to meet residents’ needs. All the care plans seen had been updated at least monthly. Residents spoken with said their needs were met at the home. Staff spoken with were knowledgeable about the care needs and preferences of residents. Records were seen of the input of health care professionals, such as GP, district nurse, optician and chiropodist. Residents spoken with confirmed that they were able to see their GP when needed and that they had regular visits from the chiropodist. There was evidence that residents’ health care needs were promptly and appropriately referred. For example, a resident had recently been visited by the speech and language therapist for advice and support regarding swallowing problems. Cliff House Nursing Home DS0000002051.V307962.R01.S.doc Version 5.2 Page 11 Residents’ personal preferences were noted in their care plans, such as preferred times and routines for getting up and going to bed. The home had recently introduced a booklet for residents and / or their families to complete which detailed the important events in their life to date, their personal likes and dislikes, social interests and people important to them. It was observed during the inspection visit that staff knocked on bedroom doors before entering and that they spoke to residents in an appropriate and respectful way. Residents and relatives spoken with confirmed that staff respected their privacy and dignity. There were positive comments from residents and their relatives, such as “I’m well cared for”, the staff “treat me with respect”, “I’m very happy with the way the staff look after him”. The care records included space for residents and / or their representatives to note any preferences or any ideas to assist staff to meet the resident’s needs. Records of care reviews were seen and showed that residents and their representatives were invited and usually attended. A system of care reviews had been established for residents who were self-funding and who were not allocated a social worker or care manager. There was no formal system in place for recording the regular involvement of residents and/or their representatives in care planning and review. Relatives spoken with said they were kept informed and involved by the home. The medication system was not assessed in detail as this was generally satisfactory at previous inspections. A requirement was made at the last inspection that medication prescribed for individual residents must not be shared with other residents. It was seen at this inspection that action had been taken to address this and the requirement had been met. The medication administration records were seen for 4 residents and these were completed correctly. Medication was stored securely and was administered by the qualified nurses at the home. Cliff House Nursing Home DS0000002051.V307962.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Generally, the lifestyle experienced in the home matched residents’ expectations and preferences. EVIDENCE: There was an activities organiser at the home and there was evidence of a programme of activities, including entertainers, trips out to shops and the theatre, a regular exercises to music session, games and a regular church service. One resident spoken with enjoyed playing games of Trivial Pursuit. Some residents preferred to stay in their own rooms and watch television or read the newspaper. One resident enjoyed knitting. One resident commented that there should be more activities offered as “the days are so long”. Visitors spoken with said they were able to visit at any reasonable time and that they were always made welcome. One resident confirmed that they were able to see visitors in private in their bedroom if they wished. Details of residents’ family and other significant people were included in the recently introduced booklet for residents / their relatives to complete. It was observed during the inspection visit that visitors were greeted warmly and offered refreshments. Cliff House Nursing Home DS0000002051.V307962.R01.S.doc Version 5.2 Page 13 Regular residents meetings were held so that residents could contribute any ideas or opinions about the home. Residents spoken with were pleased that they could have their own possessions around them in their bedrooms. The menus were displayed in the main dining area and appeared varied and well balanced. Residents said they were offered a choice of meals and were asked each day what they would like from the menu for lunch and tea. Residents said that the food was good. The main dining area had been improved since the last inspection by a rearrangement of furniture, and cloths and flowers on each table. Cliff House Nursing Home DS0000002051.V307962.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents were confident that their complaints would be listened to and appropriate action taken. Residents were protected from abuse by staff awareness and attitudes. EVIDENCE: No complaints had been received by CSCI about the home. No formal complaints had been made directly to the home. The home’s complaints policy and procedure was displayed in every bedroom. Residents and relatives spoken with were aware that they could complain and said they were happy to take any concerns to the manager or deputy manager. Examples were given of concerns raised in the past which had been appropriately dealt with by the previous manager. The home had a satisfactory policy/procedure in place for the protection of vulnerable adults. Staff spoken with said they had received training and were aware of the procedures to follow if abuse was suspected. Staff training records showed that staff had received training regarding the protection of vulnerable adults. Cliff House Nursing Home DS0000002051.V307962.R01.S.doc Version 5.2 Page 15 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): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents lived in a safe, clean, pleasant and comfortable environment. EVIDENCE: A tour of the building was carried out, including some of the bedrooms. Improvements had been made since the last inspection including: decorating in some bedrooms; change of use of two storage areas to make a staff room and a nurses office; purchase of new equipment, such as a lifting hoist and a rise and fall bed. The furniture in the large main lounge had been rearranged so that residents were able to sit in smaller groups. The lounges were comfortably furnished. The bedrooms seen were well personalised with residents own possessions and furniture. The home was generally well maintained. A carpet in the first floor corridor had split next to a joining strip and was a potential trip hazard. Cliff House Nursing Home DS0000002051.V307962.R01.S.doc Version 5.2 Page 16 The home was very clean and fresh smelling throughout. Residents and visitors spoken with said the home was always clean. The laundry was suitably equipped, clean and tidy. There was a mechanical sluice provided. Staff had received training in the control of infection. The acting manager had obtained a copy of the most recent Department of Health guidance for the control of infection in care homes. It was observed that staff used disposable gloves and aprons when assisting with residents’ personal care. Cliff House Nursing Home DS0000002051.V307962.R01.S.doc Version 5.2 Page 17 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, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents were supported by a competent and well motivated staff team in sufficient numbers to meet their needs. EVIDENCE: The staff rotas seen showed that there were usually 5 care assistants plus 1 qualified nurse on duty during the day and 4 care assistants plus 1 qualified nurse on duty at night. An additional assistant was on duty during the late afternoon to provide help around teatime. There were also kitchen, domestic and laundry staff every day. Residents spoken with said that staff were usually available when needed. One resident said “I only have to press the buzzer and they will come to help me”. Staff spoken with said that staffing levels were sufficient to meet residents’ needs. Staff said they tried to cover each others shifts for holidays and sickness and that agency cover was used as a last resort. The records of 3 members of staff were seen, including 2 recently recruited staff. The records had all the required information, including 2 written references, Criminal Records Bureau disclosure, photograph, and recent form of identification. There was evidence of good practice in recruitment procedures, such as keeping interview notes and following up written Cliff House Nursing Home DS0000002051.V307962.R01.S.doc Version 5.2 Page 18 references by speaking to the referees. The records seen were well organised and stored securely. Staff training records showed that staff had received induction training and that all the required training was up to date. Staff spoken with confirmed that they had received training such as fire safety, protection of vulnerable adults and moving and handling. Most of the care assistants had either achieved or were working towards NVQ (National Vocational Qualification) in care. The questionnaire returned before the inspection stated that 75 of care staff had already achieved NVQ in care. This was well above the national minimum standard of 50 of care staff. Cliff House Nursing Home DS0000002051.V307962.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents benefited from a well organised home which was run with their best interests in mind. EVIDENCE: The acting manager, Jane Richardson, had been in post since April 2006. She is a qualified nurse and had several years experience of managing another care home for older people. Residents, visitors and staff spoken with were positive about the acting manager and expressed confidence in her ability to manage the home. The acting manager had not applied for registration with CSCI and said she would send in an application as soon as possible. At the last inspection in February 2006 the annual quality assurance audit was seen and was satisfactory. The acting manager had carried out surveys of Cliff House Nursing Home DS0000002051.V307962.R01.S.doc Version 5.2 Page 20 residents and staff in April and July 2006. The responses had been analysed and action taken to address the issues raised. The responses from residents/ their representatives were generally positive. Responses from staff were more positive in the second survey as action had been taken to address some of their concerns. Personal money was held by the home for some residents who were unable to manage their own money and who had no relatives to do this for them. Since the last inspection, a regular audit of the records by the provider and the acting manager had been introduced. Health and safety records were sampled, including accident books, maintenance and servicing of the hoists, the shaft lift, and the fire safety equipment, and the gas safety certificate. All the records seen were up to date. Staff had received training in moving and handling, first aid, basic food hygiene, health and safety, and fire safety. Cliff House Nursing Home DS0000002051.V307962.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 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 2 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 3 X X 3 Cliff House Nursing Home DS0000002051.V307962.R01.S.doc Version 5.2 Page 22 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 OP19 Regulation 13(4)(a) Requirement The carpet identified in the first floor corridor must be made safe to eliminate the potential trip hazard. Timescale for action 31/08/06 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. Refer to Standard OP7 OP12 Good Practice Recommendations There should be formal evidence of the involvement of residents and their representatives in care planning and review. The programme of activities should be expanded to included activities offered to meet the needs of all residents. Cliff House Nursing Home DS0000002051.V307962.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Cliff House Nursing Home DS0000002051.V307962.R01.S.doc Version 5.2 Page 24 - 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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