CARE HOMES FOR OLDER PEOPLE
Cliffe Vale 228 Bradford Road Shipley West Yorkshire BD18 3AN Lead Inspector
Liz Cuddington Key Unannounced Inspection 14th December 2007 10:25 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 Cliffe Vale DS0000048525.V358448.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. Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Cliffe Vale Address 228 Bradford Road Shipley West Yorkshire BD18 3AN 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) 01274 583380 Cliffe Vale Registered Care Home Ltd Mrs Rita Christine Williams Care Home 27 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (23), of places Physical disability (1), Physical disability over 65 years of age (3) Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th January 2007 Brief Description of the Service: Cliffe Vale is located on a main bus route that goes from Shipley to Bradford. It is close to local shops. This detached property provides accommodation on ground, first and second floors. Access between floors is by stair lifts. There are three separate communal areas, including two lounge/dining rooms. Patio areas are available for people outside. Parking is available. The majority of people living at the home are over 65 years, a number may have physical and mental health needs. The current weekly charge at the home is £377. This charge does not include chiropody, hairdressing, private dental, optical or medical fees, newspapers, meals out or telephone calls. Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The purpose of the inspection was to assess the quality of the care and support received by the people who live at Cliffe Vale. No visits have been made since the last inspection in January 2007. The inspection process included looking at the information we have received about the home since the last key inspection as well as a visit to the home, which was carried out over one day and lasted approximately 8 hours. The methods used to gather information included conversations with people living at the home, their relatives and the staff, as well as looking at care plans and examining other records. We sent questionnaires to people who live at the home, their relatives, staff and health and social care professionals. We received two questionnaires back from people who live at the home, 8 from relatives, 14 from staff and 1 from a health care professional. We also received the home’s self-assessment questionnaire. These questionnaires provide a lot of valuable information to help form a judgement about the quality of the care and support offered to the people who live at Cliffe Vale. We would like to thank the people who live at the home, their relatives and the staff, for their welcome and hospitality and for taking the time to talk and share their views during the visit. What the service does well:
People who live at the home said that they were happy and well looked after. One relative wrote in their questionnaire that they chose the home because the ‘…staff were nice and welcoming and the premises were well lit and smelt nice’. Another wrote ‘We chose the home on the basis that we could live there ourselves’ and another relative commented ‘…I think the care home is excellent and the staff are wonderful’. People said that the staff listen and act on what they say and they know who they should speak to if they are not happy about anything. Relatives said that the home always responded appropriately to any concerns. Communication between staff and people who live at the home is good. Relatives commented that the staff ‘…seem very patient…’ and one wrote that the home deals with communication issues in the way agreed with the family. Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 6 Our visit confirmed one person’s comment that Cliffe Vale is ‘Friendly, welcoming, helpful and the home is always clean and warm’. Relatives said that the home always or usually meets people’s diverse needs. A member of staff wrote in their questionnaire that the staff make sure the ‘clients always come first, make their own choices, give them independence’. Staff training and support is good and covers the areas staff need to help them do their jobs well. Thirteen staff who commented said their training was relevant, helped them understand their role and kept them up to date. One member of staff wrote ‘my manager is very helpful, and gives great guidance on how to fulfil my role as a carer successfully’. One member of staff wrote that they felt staff ‘…work as a team to provide the best care possible’. Twelve staff said that communication between staff and the manager always works well and two said it usually does. One health and social care professional wrote in their questionnaire that the home has a ‘pleasant atmosphere’, staff are ‘usually well informed and care about the residents’. What has improved since the last inspection? What they could do better:
Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 7 People’s care plans and risk assessments need more detail. The plans should clearly reflect people’s care and support needs and show how they are to be met. To make sure people are fully protected, the medication administration systems need to be reviewed and all records must be accurately maintained. This is to show that the home can account for all medicines they receive, administer and have in stock. To protect people’s privacy, all confidential documents need to be stored in a locked cupboard or room. When a significant incident occurs at the home, CSCI must be notified. This is to give us information about how the home manages events such as accidents, deaths and other serious occurrences and to confirm that they are being handled correctly, in order to safeguard and promote the wellbeing of the people who live at the home. 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. The summary of this inspection report can be made available in other formats on request. Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 8 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 Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard 6 does not apply People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed before they are admitted to the home to make sure their needs can be met. EVIDENCE: Both people who replied to our questionnaires said that they were given enough information about the home before deciding to move in, and they had also received a contract. Most of the care plans had pre-admission assessments completed either by the home or Social Services. The acting manager said that they prefer to speak with everyone involved, in order to gather information to allow them to decide whether or not they can meet the person’s needs.
Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 10 The home invites people to come and spend time at the home, share a meal and maybe take part in the day’s activities. This means that the home can get a full picture of the person’s needs and the individual has the information they need to make a decision. Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s personal and healthcare needs are met. People are not fully protected by the medication systems. Staff treat people with respect, care and consideration at all times. EVIDENCE: Three care plans were looked at, to make sure that people’s health and personal care needs are being met in the way the person prefers. The plans cover each area of the individual’s health and care needs but some information was very brief. For example, if someone is to be assisted to the toilet regularly in order to promote their health and dignity, then the care plans need to detail
Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 12 the times and regularity of this support. The plan that was looked at gave some detail but did not give staff this information. From observation and discussions with staff and people living at the home, it was clear that the staff are fully aware of each person’s needs and preferences. The staff make sure they provide the help people need in the way they prefer. One relative wrote in their questionnaire that the home ‘looks after the needs and wellbeing of the service users at all times’. People who need assistance with their mobility have a moving and handling plan. One instance of poor moving and handling practice was seen and discussed with the acting manager. One person said the home is doing all it can to support their efforts to get a mobility scooter. The home was in the process of applying for planning permission to build a secure storage shed or garage to keep the vehicle. People said that they always receive the medical support they need. Details of visits by GPs and other healthcare professionals are kept. The home has ‘sit on’ scales and care plans showed that most people are being weighed regularly, although one person, whose weight gains and/or losses are particularly significant, was not being weighed regularly. During the visit, all the staff were seen to treat people with respect and maintain their dignity. The people who commented said that they receive the care they need and are supported to maintain their independence for as long as they are able. The medicines are kept safe and secure and the Medicines Administration Record (MAR) charts are securely stored. The MAR charts, which must show clearly the quantities of medicines received and in stock for each person, were examined. The records and the quantities in stock of some medicines did not always agree. For example, each person has a separate record for paracetamol and other ‘as required’ medicines. None of the three records that were looked at showed the same number of tablets in stock as there were in the packages. Staff must sign the MAR charts each time they administer a dose of medicine. This was not always being done. If someone does not take his or her medication, this must also be recorded accurately. One person’s record stated that, on one day, they had refused all medication, yet the teatime tablets were missing. Medications received in bottles and packets are no longer being transferred to the monitored dosage boxes by the home’s staff. All medicines are now being administered directly from the packaging, as supplied by the pharmacist. This is safer and reduces the possibility of mistakes being made.
Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to take part in a range of activities. People are offered a good choice of meals to make sure their dietary needs and preferences are met. EVIDENCE: The atmosphere at the home is warm and friendly and families and friends are always welcome to visit. People are treated as individuals, and their choices and wishes are respected. People are supported to continue with their preferred activities, such as listening to music, knitting and crocheting. People’s social and leisure preferences need to be recorded in their care plan, so that staff know what people prefer to do and, where needed, can offer people support to follow their chosen activities.
Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 14 On the afternoon of the inspection, there was a quiz in one lounge and everyone seemed to enjoy taking part. There is also a ‘games’ cupboard containing a wide variety of games, which people said they like to play. These provide mental stimulation and help maintain hand/eye co-ordination, as well as being fun and sociable. Staff are available to support people to go out independently. Since employing additional domiciliary and maintenance staff, the care staff have more time available for activities during the afternoon. People said they enjoy their meals, and the main course and desserts did look appetising. Staff ask people what they would like to choose before each meal. Alternatives to the day’s menus are available if people wish. There is a good variety of dishes on the menu and special diets are catered for. The staff are aware of people’s needs and preferences. Assistance is offered to people who are not able to manage to eat independently. Mealtimes are relaxed and sociable occasions and each person takes all the time they need to eat. The tables are properly laid before each meal and look attractive. Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are aware of how to raise a concern or make a complaint if they are dissatisfied with the service. Most staff have received suitable training and understand the adult protection policies and procedures which makes sure that people at the home are safe. EVIDENCE: Any complaints or concerns are recorded in a complaints book. The actions taken and the outcomes are recorded. All the staff said they know what to do if anyone has concerns. Six relatives said the home always responded appropriately to any concerns. One wrote that ‘All issues raised by us have been appropriately dealt with’. People who live at the home said they know what to do if they have a concern or complaint. Newly employed staff are made aware of the home’s ‘whistle blowing’ policies and procedures, to be used if they suspect abuse or see examples of poor practice. All the senior staff, and most other staff, have had adult protection training. Further training is planned. All the appropriate policies and procedures are in place to guide staff.
Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 25 & 26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe, comfortable and generally well maintained environment. EVIDENCE: The home is generally well maintained and there is an ongoing maintenance programme. A new member of staff has recently been employed to look after the maintenance of the house and gardens. Additional domestic staff have also been employed recently. The home is clean and attractive. The bedrooms have been personalised to reflect the individual’s taste. The rooms are well decorated and the person’s choice of floor covering is provided when they move in.
Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 17 One relative commented that ‘the care home is clean and seems very well run.’ People who live at the home said that the home is always fresh & clean. One person wrote that Cliffe Vale is ‘Very clean and comfortable. I think it’s lovely’. Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff are employed to meet people’s needs. People are protected by thorough recruitment procedures which ensure that staff are suitable to work with people who live at the home. Suitable training is provided to make sure staff have the skills and knowledge they require to meet people’s needs. EVIDENCE: The staff rotas confirmed our observations that there are enough staff on duty to meet people’s care, social and leisure needs. Staff confirmed that staffing levels are adjusted to meet people’s needs. All staff complete an application form and provide two written references. Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) register checks are obtained and no new staff begin work until these checks have been completed satisfactorily. Staff have a copy of the terms and conditions of their employment. All fourteen staff who completed our
Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 19 questionnaires confirmed that CRB checks and references were completed before they started work. Staff confirmed that they have plenty of training opportunities to support them in their roles. Thirteen staff who responded said their training was relevant, helped them understand their role and kept them up to date. Half of the care staff have completed a suitable National Vocational Qualification (NVQ) in care at level 2 or above. All new staff undertake induction and foundation training which meets the Skills for Care criteria; this training is provided by Age Concern. All new staff have their own induction booklet to complete and sign. Twelve of the 14 staff who commented said their induction covered all they needed to know very well, two said it mostly did. Senior staff have either completed, or are currently taking, a medication administration distance learning course. Other training that staff have recently taken includes Dementia Care, Food Hygiene, Infection Control and Moving and Handling. One member of staff confirmed this in their questionnaire. Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is safe and well managed. EVIDENCE: At the time of the inspection the registered manager/owner had been unavoidably away from work for an extended period of time. The acting manager has worked hard to maintain and improve standards during this period, including following up on the requirements and recommendations of the last inspection. Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 21 The manager’s office has been moved and is more secure than it was; the door is kept locked when the room is not occupied. At the time of the inspection, people’s care plans were being kept in an unlocked cupboard in the main part of the house. People’s personal information must be securely stored at all times. The home’s policies and procedures are kept up to date; to make sure they provide relevant information to guide staff on how to act in every situation. All the regular health and safety checks for the home are carried out in a timely manner. These measures make sure that the health, safety and welfare of the people at the home is promoted and safeguarded. The home’s kitchen has recently had an Environmental Health Officer’s inspection. The kitchen was awarded three stars and, when we looked, the kitchen was clean and hygienic. When a significant incident occurs, such as an admission to hospital or to the accident and emergency department, or the death or of someone who lives at the home, CSCI must be notified. This is to give us information about how the home manages such events and to confirm that they are being handled correctly, in order to safeguard and promote the wellbeing of the people who live at the home. This is not being done at present. Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 22 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 2 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 3 3 X X X X 3 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 2 3 Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 23 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. Standard OP7 Regulation 15 Requirement To fully reflect the needs of each individual, the care plans must be more detailed. They must clearly set out each person’s needs and provide detailed information about the action staff need to take to make sure that identified needs are met. This is brought forward from the last inspection: dated 31/03/07 Accurate records must be maintained of the administration and stock levels of all prescribed medication. This will make sure that people receive their medication as prescribed and sufficient stock levels are maintained. People’s social and recreational needs must be recorded so that suitable activities can be provided to meet individual preferences. Arrangements must be in place to notify us about any incidents that affect the wellbeing of people living at the home. This
DS0000048525.V358448.R01.S.doc Timescale for action 31/03/08 2. OP9 13 29/02/08 3. OP12 16 31/03/08 4. OP38 37 29/02/08 Cliffe Vale Version 5.2 Page 24 is so that we can monitor the welfare of people living at the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Cliffe Vale DS0000048525.V358448.R01.S.doc Version 5.2 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
