Inspection on 21/09/06 for Clifford House

This inspection was carried out on 21st September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Clifford House 18/02/09

Clifford House 12/12/05

Clifford House 31/05/05

Clifford House 15/09/04

Clifford House 28/04/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Clifford House Westlinton Carlisle Cumbria CA6 6AG Lead Inspector Liz Kelley Unannounced Inspection 21st September 2006 13:00 Clifford House DS0000056548.V304201.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 DS0000056548.V304201.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 DS0000056548.V304201.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clifford House Address Westlinton Carlisle Cumbria CA6 6AG 07958390002 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) Mrs Oriel Graham Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Clifford House DS0000056548.V304201.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 5 service users to include: up to 5 service users in the category of LD ( Adults with Learning disabilities) 12th December 2005 Date of last inspection Brief Description of the Service: Clifford House is a modern six bedroomed detached property, approximately 3 miles north of Carlisle. It is based in the village of West Linton, which has a pub and café and is served by a regular bus service to Carlisle and Longtown. Service users access day services by either taxi, or minibus provided by that service. Mrs Graham arranges taxis or uses her own car to transport service users to town or to visit relatives. Service users bedrooms were all above the National Minimum Standard size and all had hand wash basins installed. There was a bathroom and shower room on the first floor and a shower room and separate toilet on the ground floor. Communal space was provided by a large lounge, additionally there was a large entrance hallway/lounge that had comfortable seating, a gas fire and a television. There was a large combined kitchen and dining room, which also had a settee and two easy chairs. A conservatory had been added to the rear of the house with gym equipment and another sitting TV area. The owner provides care and accommodation to five service users with a learning disability. The current scale for charging is £311 per week. A Handbook is available for prospective residents, and a summary of the latest Commission for Social Care Inspection report is included. Clifford House DS0000056548.V304201.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an inspection that looked at all the main key standards and took place over a one-month period. This included a visit to the home, surveys to and interviews of service users, relatives and social services professionals. The visit to the home was carried out over an afternoon. Documents examined included care plans, daily notes and safety and maintenance records. What the service does well: What has improved since the last inspection? What they could do better: Although some recommendations were made this should not detract from the overall good quality of care offered to residents at Clifford House. In particular a landline telephone should be installed to allow for communication with the home at all times. Clifford House DS0000056548.V304201.R01.S.doc Version 5.2 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. Clifford House DS0000056548.V304201.R01.S.doc Version 5.2 Page 7 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 DS0000056548.V304201.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home has robust and well-established procedures in place to successfully introduce new residents. EVIDENCE: Each resident is provided with a statement of terms and conditions prior to moving to the home. This sets out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the resident. The manager had produced a revised Statement of Purpose Guide for the home, which contains photographs of the home to illustrate the facilities. It also contains statements from residents of what it was like to live here. This is good practice and copies had also been sent to relatives to keep them informed. Files contain relevant paperwork, including social work assessments and reports from health care professionals prior to a person choosing to stay at the home. All those wishing to move in are invited and encouraged to visit the home to meet the staff and other residents and to enjoy a meal and spend some time in the Home. One resident described the introduction, which included a series of visits to the home prior to making a decision. Speaking to this person they said “My new bedroom is really nice and I like having the pets here. I like it here better than the other home”. Clifford House DS0000056548.V304201.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents care needs were well met, including promoting good levels of independence. EVIDENCE: The manager kept care plans which detailed the changing needs of residents, and made adjustments to the level of support that was required. This was assisted by a care plan which was up-to-date and in good detail. All five care plans were individual to each resident and reflected each persons interests and lifestyle which led to individualised weekly programmes and day services. One resident discussed their plan and the levels of support that she received from the manager. She stated that she had gained in confidence since entering the home, and relative comment cards referred to increase in confidence and maturity since living at the Home. Promoting independence was featured in the care plan and discussed with the manager who gave good detail on how this was being carried out to the benefit of the resident. Residents are empowered to be involved in setting goals while also making them aware of risks involved. This has led to the home achieving Clifford House DS0000056548.V304201.R01.S.doc Version 5.2 Page 10 a good balance between resident’s rights and their duty of care in ensuring well-being and safety. Encouraging residents control over all financial matters of their lives has improved and is an example of how the manager promotes new skills and independence. Residents had a better awareness and control over their own finances and now had information on what benefits they were receiving. There had been a move away from relatives giving personal allowances to ownership of bank accounts by residents. The manager had addressed this by assisting one resident to open their own bank account, and they had been very happy with this move. Clifford House DS0000056548.V304201.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s rights are promoted and each person has a good degree of control and choice in their life. EVIDENCE: Residents are assisted to have a good quality of life and access to a variety of life experiences through the approach of the home. They spoke of enjoying going to pubs, the cinema, night clubs and shopping trips as well as holidays abroad. Arrangements were made for individual support and time from the manager and staff, and residents spoke of choosing to do other things or stay at home if they wished. Residents were supported to maintain and develop relationships with the community and with family and friends. Interaction between staff and residents was observed to be positive, relaxed and of a warm nature. Menus are planned with residents on a weekly and daily basis and a communal evening meal is encouraged. Although there is a weekly big shop for the house where residents choose to take part, individual shopping is also encouraged to Clifford House DS0000056548.V304201.R01.S.doc Version 5.2 Page 12 develop independence and daily living skills. The meals in this home are good offering both choice and variety and catering for special dietary needs. Clifford House DS0000056548.V304201.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good systems have been developed to monitor individual’s health and medication, including established links with local health care professionals to ensure residents receive effective and timely health care. EVIDENCE: The manager makes sound judgements and keeps good records of medications that promotes the health and well-being of the residents. She recently persevered with healthcare professionals about the health needs of one residents, with the outcome being a significantly improved quality of life. MAR sheets, which record medication given were examined and were in good order. Medications are kept in a secure locked cupboard, and those that require refrigeration have a separate box for this purpose. Good health care records are kept and this includes communication from health care professionals. From these it was clear that regular visits were made to GPs, opticians, dentist and records and letters confidentially stored. The home has sensitively handled the ageing process, as appropriate for some people, and offered support to minimise any impact on independence. Clifford House DS0000056548.V304201.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents, and their families, know action will be taken to resolve any concerns and that their well being is safeguarded by the open approach of the home. EVIDENCE: The home has a satisfactory complaints system with residents being able to express their views on the home, and these are acted upon. Residents were observed freely expressing opinions to the manager, they said that they would feel able to speak to the manager, or staff about issues they had. All five residents have regular contact with other people outside the home with whom they can discuss any problems, for example each person has a link with a day centre or work placement. The manager is very keen that any support that residents need to fill in questionnaires seeking views on the home are filled in with the support of an independent advocate. Financial transactions on behalf of the residents were all documented and receipts and signatures gained to approve authorisation. The manager demonstrated a good awareness of different forms of abuse and the rights of the individual. She encourages the residents to have regular contact with day services and all residents have the contact details of the CSCI and a social worker. Clifford House DS0000056548.V304201.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a well kept and safely maintained home that is regularly up-graded to ensure a high standard is maintained and that the environment is comfortable and pleasant to live in. EVIDENCE: There was a good amount of communal space that allows for residents to have plenty of choice. This was provided by one large lounge, exclusively for service users use and additionally there was a large entrance hallway/lounge that had comfortable seating, a gas fire and a television. One resident in particular liked to have sole use of the conservatory to watch television. There was a large combined kitchen and dining room, which also had a settee and two easy chairs in, which was described by the manager as “the hub” of the house. The three bedrooms were above the national minimum standard and were decorated and furnished to a high standard. Since the last inspection hand wash basin had been plumbed into each bedroom, and two separate shower rooms created, one upstairs and one downstairs. Residents said they liked having the choice and being able to have toiletries kept in the vanity units of the hand basins within their own rooms. Clifford House DS0000056548.V304201.R01.S.doc Version 5.2 Page 16 The home would benefit from having a fixed landline telephone to promote contact and communication. Clifford House DS0000056548.V304201.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have benefited from increased flexibility provided by an additional member of staff. EVIDENCE: The relationship between Mrs Graham and the service users was observed to be open, warm and friendly. One resident said “ I get on really well with Oriel and she takes me lots of places”. A good relationship has been developed with neighbours and residents have developed positive relationships. In discussions with a neighbour they stated that from their observations they felt Mrs Graham was very caring and residents always appeared well cared for and happy. She also stated that they frequently went out. A part-time member of staff has been employed which allows for greater choice and flexibility for residents. One resident said that she had not wanted to go on a shopping trip with the other residents and had opted to stay at home with the new part time member of staff. All residents said that they liked this new member of staff and said she was kind. The new staff member has a nursing background and Mrs Graham had taken up references and a Criminal records bureau check. To ensure that residents are given appropriate care the manager must ensure that she provides training and a structured induction programme for this person. Clifford House DS0000056548.V304201.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in an efficient manner which is appropriate to a family style of living and residents are safe guarded by the systems Mrs Graham has put in place. EVIDENCE: The registered manager was judged to have the relevant experience, competencies and qualities to meet the needs of the service users, and has completed the Registered Managers Award, choosing the most relevant units in promoting independence and participation. She had also recently completed a four day First Aid course. The homes family domestic scale of living promotes open and warm relationships where residents freely express their views on a wide range of issues. On all inspection visit residents have engaged with the inspector in lively discussions about their lives and the home. Residents were observed having open and frank discussions with the manager in a warm and convivial Clifford House DS0000056548.V304201.R01.S.doc Version 5.2 Page 19 manner. The manager has collated views of residents into the Guide for the home to be given to prospective new residents. Mrs Graham runs the Care Home, with the assistance of one other member of staff, and the policies and procedures are appropriate to this setting. For example these included fire safety, handling of medications, complaints, protection of vulnerable adults. The Home complied with fire and environmental health department requirements. The fire log was examined and found to be in order. The manager had completed a course on basic first aid and food hygiene. The manager uses HSE forms to record and report accidents and injuries. All these measures demonstrate an efficient, well run home where the care and well-being of residents lead any administrative activity. Clifford House DS0000056548.V304201.R01.S.doc Version 5.2 Page 20 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 3 2 3 3 3 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 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 x 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Clifford House DS0000056548.V304201.R01.S.doc Version 5.2 Page 21 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 YA24 Regulation 16 Requirement The home must have a landline telephone Timescale for action 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Clifford House DS0000056548.V304201.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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