Inspection on 20/08/07 for Clifford House

This inspection was carried out on 20th August 2007.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Clifford House 16/12/08

Clifford House 19/09/06

Clifford House 07/10/05

Clifford House 17/06/05

Clifford House 25/01/05

Clifford House 26/07/04

Clifford House 09/03/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Blenheim House

Prince Bishop Court

Park View (15)

Craigmore House

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

CARE HOME ADULTS 18-65 Clifford House Lucy Street Blaydon Gateshead Tyne & Wear NE21 5PU Lead Inspector Mr Clifford Renwick Key Unannounced Inspection 20 & 31st August & 28 September 2007 09:30 th th Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 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 Clifford House DS0000007373.V340164.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 Adults 18-65. 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. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clifford House Address Lucy Street Blaydon Gateshead Tyne & Wear NE21 5PU 0191 414 8178 0191 414 8959 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) Clifford House Homes Limited Mrs Patricia Sowerby Care Home 10 Category(ies) of Learning disability (10), Physical disability over registration, with number 65 years of age (6), Sensory impairment (1) of places Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th September 2006 Brief Description of the Service: . Clifford House is a large two storey building converted into two large flats. Five people live in each flat. The home provides care for people who have learning and / or physical disability, some of whom are over 65 but cannot provide for people who need nursing care. It is situated in the Blaydon area of Gateshead and is close to a variety of local shops and other facilities and is near to transport routes, which give good access to Newcastle and Gateshead. The home also has its own transport, which can be used by service users. Each flat has separate facilities including kitchen, dining and sitting areas. All service users share other parts of the building such as the laundry, gardens and patio areas. The design, layout and facilities provided in the downstairs flat are suitable for those people who have a physical disability. All necessary facilities are provided including an emergency call system and a lift that takes people to and from the first floor. It costs from £711.80 to £866.36 each week to live at this home. Additional charges are made for toiletries, newspapers / magazines, and hairdressing. Items, which are included in the cost, are listed in the homes terms and conditions. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the visit: We looked at: • Information we have received since the last visit in January 2007. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on the 20th & 31st August. An announced visit was made on 28th September 2007. During the visit we: • Talked with people who use the service, staff and the manager. • Observed life in the home. • Looked at information about the people who use the service & how well their needs are met. • Looked at other records, which must be kept. • Checked that staff had the knowledge, skills & training to meet the needs of the people they care for. • Looked around parts of the building to make sure it was clean, safe & comfortable. • Checked what improvements had been made since the last visit. • Looked at reports compiled by the owner of his monthly visits to the home. We told the manager what we had found. What the service does well: The staff and manager work well together to make sure that the assessed needs of service users can be met. These are written in care plans that show how staff will meet service users needs. Staff have welcomed the newest person to the home, have helped them to settle in and know what staff have to do to support them. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 6 Staff continue to support people to have interesting lives, they help make sure that people can take part in activities they like and they help them to find and try new ones. Holidays and trips out continue to be arranged for service users and in discussion the service users said they enjoyed these holidays. Two of the service users said they were looking forward to going on holiday to Blackpool as they enjoyed the entertainment in the hotel. The staff get on well together, and this contributed to the positive atmosphere, talking about their day and giving their views. There is a good rapport between service users and staff. Three people said, “I like it here the staff are good and they take me on holiday”. Though not everybody communicates using speech observations made of body language indicated that service users respond to staff and are comfortable in how they communicate. The house is comfortable and is decorated and cleaned to make it a pleasant place to live in. Service users rooms are private; they can have their own keys and make rooms their own with furniture and possessions if they want to. All bedrooms are personalised and reflect the individual choices of service users. The house has been changed so that it is easier for people to get around or use the facilities. The home has gardens which people use when the weather is good. There is a choice of meals offered, chosen by service users and the food is fresh and of a good quality. And people living at the home said that they like the food. What has improved since the last inspection? The owner is now carrying out monthly visits to the home and speaking to service users and staff to seek their views about the service. The owner prepares a report on these visits and these are available in the home to read. The manager has achieved NVQ Level 4 training and all but one staff member has achieved NVQ Level 2 training. Refurbishment and decoration has taken place in different areas of the building. The kitchens have been fitted with new flooring, new shower units have been fitted on both floors. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 7 Some bedrooms have been supplied with new carpets/floor coverings, furniture and blinds. A new television has been provided in the ground floor lounge. The rear garden has been landscaped and provides a pleasant area to sit in. What they could do better: The individual written plans of care must be updated to show what staff are doing to help meet service user’s assessed needs. The risk assessments that are in place and which are used to support the care plans must signed and updated when individual needs change. Medication must be stored in a secure cupboard and all staff must receive training by a health professional to administer those special medicines, which have to be used in an emergency. Staff must receive formal supervision from the manager at least 6 times a year and records should be kept that are dated and signed. The forms used for applying for a job in the home need to be revised to include a record of all previous employment. The manager must ensure that no one unsuitable is employed in the home and must therefore explore any gaps in employment. For those staff who are currently employed the manager should update their staff files to include a full employment history. All staff must have regular fire instruction training and take part in fire drills with a record being kept in the fire logbook. The owner must show that the business is profitable and properly managed so that service users and their families know that their interests are protected. The owner must ensure that in his absence a person is appointed/nominated to carry out a monthly visit to the home to check that the service is being run correctly and service users needs are being met. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 8 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. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each service user’s needs are assessed before they move to the home. This helps to make sure that their needs are met by the home and inappropriate admissions are avoided. EVIDENCE: The manager prefers people to visit the home before they decide to move in, for example by offering visits and overnight stays. However as in the case of the most recent admission, this was carried out under emergency admission procedures due to the illness of the main carer. The manager ensured that the service user’s needs were assessed by a social work as well as by staff in the home. This ensured that despite the admission being an emergency the manager wanted to make sure that this home was the right place to meet the needs of people who are going to live there. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 11 Appropriate support from social workers, staff and the manager make sure that the admission was successful. Part of the assessment process involves finding out about he cultural and lifestyle needs of people who wish to move to the home to make sure that these can be met. This person has now settled in the home and the assessment process is continuing to be updated by staff. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments are not always up to date, do not always reflect the actions that are taken by staff to help people and therefore it cannot be guaranteed that their needs will be met and their independence promoted. Service users are helped and advised to make choices and decisions about their lives and take calculated risks so that they can live as independently as they can. However risk assessments are not always dated or updated to reflect changes in service users lives.) EVIDENCE: Everyone who lives at the home has a care plan. These have lots of details in them which tells staff how to support the physical, emotional and lifestyle Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 13 needs of service users. Care plans are reviewed by staff every month, but not necessarily updated. A number of the service users have made positive improvements in their lives but this is not always reflected in the care plan. Observations made and discussions held with staff confirmed how they were supporting service users, but these actions were not recorded in the care plan. Where possible service users are involved in making and keeping care plans and staff help service users to make choices about how they live their lives. Typical choices that people have made are about what they do in the daytime, the interests that they have, such as holidays and what kind of food they like to eat. Service users are treated with respect by staff at the home though at times dignity can be compromised by staff practices. For example one service user who has a severe disability had a helium balloon attached to their wheelchair with a caption “Get Well” and on another visit a balloon with the caption “Birthday Boy”. However in discussion with staff they confirmed that they had not been unwell and neither was it their birthday. The manager stated that this person receives stimulation from the balloon and staff use these to engage in general activity, which the service user enjoys. The manager also stated that that advice had been sought from a physiotherapist who had advised that the use of balloons as an aid to engaging with this person and was an acceptable method of working. The care plan does not include any information about this activity and neither does it include information about how the service user is taken to shop by staff to purchase the balloon. Discussions were held with the manager about how this important information could be recorded in detail in the care plan. And also how a more appropriate type of balloon could be used to support the activity. The manager was advised that the use of balloons with inappropriate slogans/captions is not acceptable. Observations confirmed that relationships between service users and staff are relaxed, friendly and informal which helps people to feel comfortable. Discussion with staff confirmed that they have a good knowledge base of individual service users needs and this helps them to deliver care in a positive way. The care plans and assessment information confirmed that other professionals when required are involved in the care process. The home makes use of a multi disciplinary service provided jointly by health and social services to provide support for one service user who has behaviours that challenge. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 14 This ensures that additional support is available to carry out assessments and observations that will assist staff with being able to respond positively to challenging behaviour. The multi disciplinary team also offer a crisis intervention service that operates out of hours ensuring that staff has 24 hour support. Staff and the manager at the home help service users to take measured risks, for example to do something on their own or with less help from staff. Staff have agreed the actions that they take to make sure that people are safe and these are written in care plans so that everyone can follow them. However these have not been updated to reflect what is happening in practice now. People living at this home give staff and the manager their views about the service and they are respected by staff. For example by following their wishes when they go into bedrooms or private areas. Staff also listen to service users views and are courteous and respectful. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users lead full and enjoyable lives , their choices and preferences are listened to and respected. And they are assisted by staff to have active and interesting lives by accessing activities in the local and wider community. This helps them to lead a full and enjoyable life. People who live at the home are respected, and routines are flexible. This can help to promote service users’ choices and preferences. Service users are supported to keep in contact with their relatives and friends and are able to spend time together outside of the home. The food is of good quality and sufficient to meet the needs of service users. This helps them to enjoy meals and stay healthy. EVIDENCE: Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 16 As noted in previous inspection reports some service users have active lifestyles and their own routines and activities, many of which take place outside of the home with the support of staff, friends or other agencies. The needs of some service users have changed due to becoming older and this has placed limitations on the types of things they can do. Staff have responded positively to this to ensure that they are still able to take part in activities that interest them. A number of holidays have been organised and these have been specifically organised around having good disabled access and facilities that are suitable for someone who is a wheelchair user. Plans have been made for some service users to go to Blackpool in October and in discussion with them they said that they were looking forward to this holiday. Staff accompanies service users on the holidays and these are planned in advance with the service user. Some service users have the opportunity to attend a local day centre and this ensures that they have the opportunity to develop and acquire new skills. One person also goes out twice weekly to a community men’s group where they are able to meet up with friends and also play games such as dominoes. Activities care plans are kept in service users care files and these identify individual interests and how staff will support service users to take part in these activities. As previously stated in this report for some service users who are profoundly disabled, the activities may be limited (use of balloons as a tactile stimulus) and staff have responded to this. However this information is not recorded in detail in the activities plan. The home has a vehicle, which helps service users to get out and about, and the home is next to the main bus routes, which gives good access to Gateshead and Newcastle. In addition to this staff will make use of taxis that have been especially designed for disabled access. Assessments are carried out by staff to see if service users can manage their own finances and benefits. For those who can manage, staff support them to go to the post office to receive their weekly benefit payments. Service users have their own post office accounts for individual savings. Staff help service users to keep in touch with friends and relatives by making phone calls writing cards or letters or by encouraging people to meet and spend time together. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 17 Several choices of meals are offered at all times and service users help to plan their meals. Attempts to offer a balanced diet whilst still responding to service user choices were noted. Lunch was taken with service users and from observations made during lunch and the evening meal everyone enjoyed the food. In discussions with service users they said that they like the food in the home. And on some evenings they also have take away meals from restaurants in the local area. Some people need to eat food which helps them to stay healthy, for example if they have a medical condition. For these service users special diets and food supplements are made available and staff offer support by helping them to check their weight. Staff join service users at mealtimes to offer support and assistance where needed. Mealtimes are pleasant sociable events at the home where people talk and enjoy each other’s company. In discussion with staff it was confirmed that they and some service users go shopping together for the weekly foodstuffs for the house. Staff stated that service users like to take part in this activity so it continues to be supported. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have access to the health care services and treatment they need. This ensures that their health care needs are identified and arrangements are made so that they are promoted and met. Furthermore staff support service users in relation to their medication and to get the treatment which has been prescribed and therefore mistakes are avoided. EVIDENCE: Records of service users healthcare needs are included in care plans, which show that they supported by staff that look out for any deterioration in health and respond appropriately. If a service user’s health needs change, the appropriate health professional is contacted to provide treatment and this continues to be monitored by staff. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 19 All service users have a General Practitioner who can also refer to other health care professionals when this is required. The manager takes action to make sure that service users can get the healthcare treatment which they need and make sure that service users can make informed choices about how their health needs are addressed. One service user requires the support of staff to administer food through a specialised way, this is known as PEG (Percutaneous Endoscopic Gastostomy). Discussion with the manager confirmed that all staff that work with this person have received appropriate training from a health professional. Records are available to confirm this training has taken place. The manager stated that there are only 2 staff who work in a nightshift role who have not received this training as the process of PEG feeding does not take place during the night, therefore training is not required. There are advantages in all staff having the appropriate training as in times of sickness, holidays or unexpected absences all members of staff would be sufficiently skilled and able to maintain a service to the service user. Another service user receives an invasive treatment for epilepsy. There is a care plan in place detailing the treatment and responsibilities of the staff involved in the care process. However not all staff have received the appropriate training from a health professional to administer this medicine. This was discussed with the manager who was advised to organise training for all staff that work with this service user. The manager confirmed that this particular medication had not been used for three years so therefore was being managed well. However the inspector advised that as medication was still being prescribed then all staff would be required to undergo appropriate training in the administration of this medicine. One service user has been supplied with a specialised bed with integral bed rails following an assessment by the occupational therapist. However the risk assessment requires some updating and revision to show why this particular bed is in use. A copy of the occupational therapist assessment also needs to be available with the care plan to confirm that the bed is appropriate. Steps were taken by staff to obtain this as the inspection progressed. Where service users are not able to use speech to communicate their needs, staff pay attention to body language and any changes in behaviour as part of the monitoring process that may indicate someone is unwell or dissatisfied with an aspect of the service. Staff are very good at this and are able to respond quickly to any change in needs. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 20 Personal and intimate care tasks are carried out in the privacy of the service users bedrooms or other appropriate areas such as the bathroom. Due to their levels of need, service users are not able to administer their own medicines, and designated staff therefore assists in this area. However a list of the senior staff authorised to administer medicines was not available in the administration file. There was no information about the medicines in use and their potential side effects to assist staff with the monitoring process and this was discussed with the senior staff member on duty. It was confirmed by staff on duty that they have received training about how to store record and give out medication. Medication is locked away and records are accurate which makes checking simpler and avoids mistakes. However the current arrangements for the storing of medication (in a filing cabinet) are not suitable and this was discussed with the manager who was advised of the kind of storage which needs to be provided. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their families can make a complaint if they are unhappy, have a grievance or dispute. They can also give feedback when they are happy with the service. This helps them to have control over their lives and shows that their views are valued. The home has measures in place which protect service users from being harmed which helps to promote their safety and security. EVIDENCE: There is a clear complaints procedure in place at the home, which tells people how to complain, and the length of time a response will take. On a day-to-day basis the manager and staff make sure that service users are asked for their views and they are supported to make choices and decisions. As some of the service users do not communicate using speech, staff have a range of strategies in place to assist with dealing with any concerns or complaints. This includes observing any changes in service users behaviour, use of body language and any other signs that may indicate a service user is unhappy. Discussion with staff confirmed that they have become very adept at noting any changes and are able to respond quickly. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 22 There have been no complaints received about the service and no concerns were expressed during the inspection. The home has an adult protection procedure, which is robust and complies with the Public Disclosure Act and the Department of Health Guidance. Information on the role of the local authority is available and included in the homes procedures. There is a staff guide, which gives clear instructions about the actions which they must take if abuse is disclosed or witnessed. Updated protection of vulnerable adults training has been arranged for all staff and this will be completed by November of this year. In discussion with the manager it was confirmed that training has been sourced from an external training agency. Training methods will include workshops in the home as well as the use of workbooks to ensure that staff are fully up to date with practices in this area. The manager is also undergoing the same training as staff. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean and well maintained which ensures that service users are provided with a homely and safe environment in which to live. Furthermore, aids and adaptations have been provided to promote service users’ independence and safety. EVIDENCE: Recent refurbishments have been carried out in the home and there is an ongoing maintenance plan for redecoration and renewal to bedrooms and other areas of the home. Work has also been carried out to bathrooms/shower areas, ground floor bedrooms and also to the kitchen, and quotations are currently being obtained for further decorating work. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 24 The carpet in one room is about to be changed and a different kind of flooring fitted to assist and support the changing needs of one service user. The home is kept clean by staff who take effective steps to make sure that the home does not have any unpleasant smells. Service users are encouraged to keep their own rooms clean and tidy and staff help them when this is needed. Staff carry out weekly premises checks and records are kept of any works that need to be addressed. This is then attended to by the maintenance person who is on call at anytime. Hot water temperatures were tested in bathrooms and this confirmed they meet the safe requirements for bathing. Bedrooms are furnished to suit individual tastes and service users have been involved in choosing new furniture and blinds. All service users have decorated their rooms with their items, photographs and keepsake’s and this has personalised each room. Individual items such as televisions, music systems and DVD players mean that service users can choose to spend time in their rooms listening to music or watching films. One service user has overhead tracking in their bedroom and also their own en suite bath. This ensures that their personal hygiene needs can be met by staff. Another service user is waiting tracking to be fitted to their room due to a change in their mobility needs. The home has two floors, each with a separate kitchen lounge and dining area. And is run as two separate units, each with their allocated staff team. All areas of the home have been adapted so that service users can have safe access to the house and gardens, without restricting the rights, freedoms or independence. And service users are able to lock their bedroom doors so that they can have privacy. All service users have areas where they can talk to other people or visitors in private. Good access is available to the external garden area and also the small terrace that is used for barbeques in the good weather. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Sufficient staff are available to meet the needs of people living at the home. However, the homes recruitment policy does not support or protect service users, as staff are being employed without full checks of previous employment history. This potentially places service users at risk. EVIDENCE: As noted in previous inspection reports few staff leave the home so they have longstanding relationships with service users and they are knowledgeable of their personal histories and needs. In discussion with staff they are able to describe the needs of service users, both in terms of their practice and the principles which underpin the service that they give. All but one person in the staff team has attained NVQ awards in care at level 2 and a number are taking level 3 courses. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 26 Additional training has been arranged for staff and this will cover moving and handling and safeguarding/ protection of vulnerable adults. This will ensure that staff are able to update their skills and knowledge so that best practice guidelines are always followed. In discussion with a senior staff member it was stated that all staff receive regular 3 monthly fire instructions and take part in fire drills. However examination of the fire logbook confirmed that 7 of the staff team had not received any fire instruction or taken part in a fire drill in the last 6 months. An immediate requirement was made by the inspector for 7 staff who had not received fire instruction training within the last 8 months. The manager addressed this before the inspection was completed and a new fire risk assessment plan is now in place. An external training agency have been engaged to carry out yearly updated fire training and each member of staff has also been issued with their own logbook to record all training and instruction they receive. Discussion with staff confirmed that the manager is now carrying out supervisions and appraisals. The manager confirmed that since the last inspection in January there have been two periods of supervision carried out with each member of staff. Staff stated that the manager tells them when supervision will take place. A set format form is in use that covers supervision and appraisal but for those sessions that have been completed they were neither dated nor signed. This makes it difficult to determine when supervision takes place and with what regularity. There is still some staff that needs to receive formal supervision Two staff had been appointed and the appropriate Criminal Records Bureau check had carried out prior to working with service users at the home. However the current application form for employment in the home does not ask for previous employment history. Therefore there is no record to show how any gaps in previous employment are explored to ensure the suitability of potential employees. This was discussed with the manager who was advised of the legal requirements in relation to employment of staff. For staff currently employed in the home there are insufficient records of previous employment history. Following discussion with the manager she has now implemented steps to amend this by seeking retrospective information from all staff, which will then be placed on their individual file. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 40 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager offers support and direction to the staff so that they can meet the needs of service users. The home has all of the policies and procedures required, which help staff and the manager run the home efficiently and for the benefit of service users. However the financial viability of the home has not been demonstrated which would give assurance to service users and their families that the home will remain open. EVIDENCE: Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 28 As noted in previous inspection reports the registered manger has considerable experience in a variety of care roles as well as a number of years’ management experience at this care home. From observations and discussions with staff they confirmed that they receive good support from the manager. The manager has completed additional training in order to update and expand her knowledge. She has completed National Vocational Qualification Level 4 in management and NVQ Level 4 in care. The home helps service users to manage their money. Detailed records are kept of service users finances and where staff have supported them to make purchases. A programme of refurbishment has been carried out in the home and evidence is available to confirm that future decoration is to take place. Future financial investment is taking place. However requirements made in previous inspection reports have requested, that the proprietor provide the Commission with details, which demonstrate that the home is financially viable. This has still not been addressed. The responsible individual (owner) visits the home every month to make sure that it is being run properly and writes a report, which gives his findings. Reports were available for examination and these confirmed that the responsible individual speaks to both staff and service users. However the responsible individual goes abroad frequently for periods longer than a month and in his absence he has appointed the manager to carry out these monthly visits on his behalf. This is not acceptable, as someone independent of the manager must carry out the visits. The home is generally safe, however staff have not received enough fire instruction training to make sure that they and service users are safeguarded in the event of a fire. As stated in the staffing section of this report an immediate requirement was made regarding fire training for staff and this had been achieved before the inspection was completed. Other requirements relating to fire safety are that emergency lights in the home are checked on a monthly basis. Staff keep a record that they do this in the homes maintenance book but no entry is made in the fire logbook. Hot water is tested every week from all hot water outlets and a record is kept. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 29 Bedrails are in use for some service users and assessment has been carried out by an occupational therapist, however as previously stated in this report the assessment was not available for examination. Records of all accidents are kept and these are linked to the staff communication book for shift changes, to ensure that staff receive all necessary information to assist them with their work. Though an account of the accident is recorded there is no written information about action taken or the outcome following an accident. The manager stated that there are measures in place where service users are asked their views about how they would like to be supported, and also how the service can be improved. The last inspection carried out in January confirmed that a review of the homes quality assurance process has taken place along with the other home in this group. This was a formal process of measuring by audit to assess the quality of services at the home. It was stated that the next stages of the programme due to take place would include feedback from service users. The quality assurance programme that is in place does not provide sufficient information to demonstrate how this has been achieved. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 2 X X X Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 31 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard YA2 YA6 Regulation 14 (2) a & b 15 Requirement Individual assessments of service uses needs must continue to be updated. Individual service users care plans must be updated to reflect the current actions being carried out by staff. Medicines must be stored in a secure cupboard. (Immediate) The registered manager must ensure that all staff has formal supervision at least every two months. Supervision records must also be dated and signed by staff. (Previous timescale 01/02/07) The registered manager must obtain a full employment history for any person seeking employment in the home. (Immediate) All staff must receive regular fire instruction training and take part in fire drills as advised within the fire logbook guidance. (Immediate) The responsible individual must make arrangements for the monthly visits to the service to DS0000007373.V340164.R01.S.doc Timescale for action 31/12/07 31/12/07 3. 4. YA20 YA36 13 (2) 18 (2) 30/09/07 31/12/07 5. YA34 7, 9, 19 & Schedule 2 23 (4) d & c 30/09/07 6. YA42 30/09/07 1. YA43 26 31/12/07 Clifford House Version 5.2 Page 32 be completed when he is out of the country. (Previous requirements from 1/4/ 2005 and 1/9/05 & 01/03/07)). 5. YA43 25 The owner person must submit a 31/12/07 copy of the annual business and financial plan to the Commission. (Previous requirements from 1/4/05 & 01/03/07) 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 YA19 Good Practice Recommendations When dealing with accidents a record of the action taken and also the outcome should be recorded. Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South Shields Area Office 4th Floor St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Clifford House DS0000007373.V340164.R01.S.doc Version 5.2 Page 34 - 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. 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