CARE HOMES FOR OLDER PEOPLE
Cliff House Nursing Home Cliff Hill Clowne Chesterfield Derbyshire S43 4LE Lead Inspector
Rose Veale Unannounced Inspection 6th February 2006 10:15 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.V282602.R01.S.doc Version 5.1 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.V282602.R01.S.doc Version 5.1 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 Tracey Jane Leech 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.V282602.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22nd September 2005 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. Cliff House Nursing Home DS0000002051.V282602.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced. There were 34 residents accommodated in the home on the day of the inspection, including 11 residents assessed as requiring nursing care and 1 resident for respite care. Residents, staff and visitors were spoken with during the inspection. Care records were examined, plus records relating to the staffing and management of the home, and the safe handling of medication. The manager and administrator were available and very helpful throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better:
Although medication in the home was generally dealt with correctly and safely, it was found that medication prescribed for one resident was being used for other residents. This is an illegal and potentially unsafe practice. The records of personal money held by the home for residents were clear and well kept. However, it would be good practice for the records to be audited regularly by the provider to fully ensure residents’ money was safe and also to provide support to the member of staff responsible for dealing with the money. Cliff House Nursing Home DS0000002051.V282602.R01.S.doc Version 5.1 Page 6 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.V282602.R01.S.doc Version 5.1 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.V282602.R01.S.doc Version 5.1 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 The home’s thorough assessment process ensured that residents were confident the home was able to meet their needs. EVIDENCE: The care records of two residents recently admitted to the home were examined. Both records included detailed and comprehensive assessment information and an individual care plan produced to meet the assessed needs. Both records included a copy of the letter to the resident confirming that the home was able to meet their assessed needs. The manager confirmed that it was now standard practice to inform residents in writing that the home was able to meet their needs. Cliff House Nursing Home DS0000002051.V282602.R01.S.doc Version 5.1 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, 9 and 10 The care needs of residents appeared to be well met with evidence that residents’ privacy and dignity were promoted and upheld. Generally, the robust systems in place ensured that medication was handled safely in the home. However, there was one illegal and potentially unsafe practice noted. EVIDENCE: The care plans were seen for two recently admitted residents. Both care plans were clear and detailed and covered all the assessed needs. The home had introduced six monthly care reviews for residents who were completely selffunding, (i.e. without the support of a care manager or Primary Care Trust nurse). Residents spoken with said the home was meeting their needs. Three residents spoken with said that staff ensured their privacy and dignity were protected, for example, by knocking on bedroom doors before entering. Other evidence that privacy and dignity were respected included screens used in shared bedrooms, and the preferred name of residents noted in their records and used by staff. Staff spoken with were knowledgeable about the care needs of residents.
Cliff House Nursing Home DS0000002051.V282602.R01.S.doc Version 5.1 Page 10 The systems in the home for the safe handling of medication were examined. Medication was securely stored. Medication Administration Records, (MARs), seen were correctly completed. Records were seen of the ordering, receipt and disposal of medication and these were all satisfactory. The medication policy and procedure was seen and this included all the required information. It was found that medication prescribed for one resident was being ‘shared’ with other residents prescribed the same medication. This was to help with storage problems and it was noted that it would be difficult to fit all the medication in the drug trolley if each resident had their own container of the medication. However, it is a legal requirement that medication prescribed for an individual must not be used for another person as this is a potentially unsafe practice. Cliff House Nursing Home DS0000002051.V282602.R01.S.doc Version 5.1 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 It appeared that residents were helped to exercise choice and control over their lives. Residents were offered a varied and appealing choice of meals. EVIDENCE: The care records seen included information about residents’ preferences regarding their daily routines. Residents spoken with said they were able to exercise some choice and control over their lives, such as having personal possessions in their rooms, choices of food, and contributing to residents meetings. One resident said that although it was sometimes preferable to get up earlier in the morning, this was not always possible because of the limitations of living in a care home. Information about local advocacy services was displayed in the main entrance hall. The menus for the home were seen and appeared varied and well balanced. Residents spoken with said the food was good and that they always had a choice of meals. The meal served at lunchtime on the day of the inspection included home-made dishes and looked appetising. Residents were encouraged to comment on the food at the monthly residents meetings and changes were made to the menus according to their suggestions. Residents ate
Cliff House Nursing Home DS0000002051.V282602.R01.S.doc Version 5.1 Page 12 in the main dining area, a smaller dining area, in the main lounge or in their bedrooms. The dining areas were clean and pleasant. Cliff House Nursing Home DS0000002051.V282602.R01.S.doc Version 5.1 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 the following standard(s): EVIDENCE: These standards were not assessed at this inspection. The key standards, 16 and 18, were assessed and met at the last inspection. Cliff House Nursing Home DS0000002051.V282602.R01.S.doc Version 5.1 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 the following standard(s): EVIDENCE: These standards were not assessed at this inspection. The key standards, 19 and 26, were assessed and met at the last inspection. Cliff House Nursing Home DS0000002051.V282602.R01.S.doc Version 5.1 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): 29 Residents were protected by the robust recruitment systems in place in the home. EVIDENCE: The files of two recently employed members of staff were examined. Both files were well organised and included all the required information, such as two references, recent identification and a photograph. Cliff House Nursing Home DS0000002051.V282602.R01.S.doc Version 5.1 Page 16 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 and 35 There was a good quality assurance system in place to ensure that the views of residents and their representatives were heard and acted upon. EVIDENCE: The manager of the home was due to leave her post in March 2006 and said that a new manager had been appointed. Residents, visitors and staff spoken with were all aware of the change. Two residents spoken with were naturally apprehensive about a change of manager. The quality assurance system in the home included monthly residents’ meetings, annual surveys about different aspects of life in the home, and annual audits of the environment and facilities in the home. Surveys had been carried out in the previous twelve months regarding activities and meals in the home. The responses received had been analysed and reported on. Minutes were kept of the residents’ meetings and showed that residents were kept
Cliff House Nursing Home DS0000002051.V282602.R01.S.doc Version 5.1 Page 17 informed of events and changes in the home, such as social activities, the change of manager and the ongoing work to re-surface the car park. The home held personal money for some residents who were unable to manage their own finances and had no relatives to do this for them. The records seen were well kept and up to date. Although it was said that the provider checked the records periodically, there was no evidence of this. It was discussed as a matter of good practice that the records should be audited and signed by the provider at least annually. This would also provide support to the staff member responsible for the records. There was a requirement at the last inspection that records must be kept of all fire alarms and fire practices, and a recommendation that there should be unannounced fire practices for staff every 6 months. Records seen showed that the requirement and the recommendation had both been met. Cliff House Nursing Home DS0000002051.V282602.R01.S.doc Version 5.1 Page 18 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 X 9 3 10 3 11 X 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 X X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X X Cliff House Nursing Home DS0000002051.V282602.R01.S.doc Version 5.1 Page 19 NO 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 OP9 Regulation 13(2) Requirement Medication prescribed for one individual must not be used for another person. Timescale for action 31/03/06 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. Refer to Standard OP35 Good Practice Recommendations The provider should carry out audits, at least annually, of residents personal money held by the home. Cliff House Nursing Home DS0000002051.V282602.R01.S.doc Version 5.1 Page 20 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
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