Inspection on 02/08/07 for Clifftop

This inspection was carried out on 2nd August 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Clifftop 03/10/06

Clifftop 20/03/06

Clifftop 30/08/05

Clifftop 16/02/05

Clifftop 22/06/04

Clifftop 04/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Clifftop 8 Burlington Road Swanage Dorset BH19 1LS Lead Inspector Debra Jones Key Unannounced Inspection 2nd August 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Clifftop DS0000026784.V347901.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. Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clifftop Address 8 Burlington Road Swanage Dorset BH19 1LS 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) 01929 422091 01929 424299 charrison@talk21.com Mrs Christine Harrison Mrs Patricia Pride Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Room Nos. 2 and 3 may be used as doubles. Date of last inspection 3rd October 2006 Brief Description of the Service: Clifftop Care Home is a large detached Edwardian property set in its own grounds, overlooking the sea, on a prominent cliff top position in a quiet residential area of Swanage in close proximity to the town and local amenities. The home has been registered to Mrs Christine Harrison since 1996 and is personally run by her, together with registered manager Mrs Trish Pride. Clifftop is registered to accommodate a maximum of 32 elderly persons in 28 single rooms and 2 double rooms. All rooms have en-suite facilities and there is a passenger lift serving all floors. The home caters for residents with varying general needs related to old age, but does not provide nursing care other than that which can be met by the District Nursing Service. There are attractive views of Swanage Bay from the communal lounges and some bedrooms. The current weekly charges at Clifftop range from £420 - £525. Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on 18 July 2007. Debra Jones was the inspector who carried out the visit. Patricia Pride (registered manager), Christine Harrison (owner) and staff at the home helped the inspector in her work. The main purpose of the inspection was to check that the residents living in the home were safe and properly cared for and to review progress in meeting requirements and recommendations made as a result of previous inspections. Most made at the last key inspection in October 2006 had been addressed by the brief ‘random’ visit made to the home in January 2007. The inspector was made to feel welcome in the home throughout the visit. A tour of the premises took place and a variety of records and related documentation was examined, including care records. Time was spent talking with residents and relatives in the communal areas. Three requirements were made as a result of this visit and one recommendation carried over from the previous report. Some good practice suggestions were discussed at the inspection and these are referred to in the report, intended to encourage improvement in an already well-rated service. The management of the home have demonstrated through their success in complying with previous requirements that there is capacity for the service to further improve. The following are comments from residents on the day of the visit. ‘There is nothing they could do better, they are always willing to do anything for you.’ ‘It is all I could wish for.’ ‘It is very free and easy here.’ ‘You can’t find fault.’ ‘They want us to be individual.’ ‘When you have an appointment they remind you and tell you that your taxi is arranged. It’s these little things that are very important. I appreciate it.’ ‘They are such nice people.’ ‘We don’t want for anything, it is excellent.’ Prior to the inspection the home submitted to the Commission their annual quality assurance assessment (AQAA). This gave information about the service and it’s performance. This document was also helpful in the planning of the inspection visit. The home also sent out comment cards on behalf of the Commission. Eight were returned by residents, 3 by relatives, 1 by a community mental health nurse and 4 by GPs, Comments were as follows: ‘I’m very lucky to be here.’ (a resident) Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 6 ‘I have been her just over a year now and am thankful I came. The management and carers all work hard and provide us with a very happy atmosphere and excellently provide us with all we need.’ (another resident) ‘They are excellent as they are.’ (a relative) ‘Very personal service. High level of care. Friendly attentive staff. Management alert our service if any problems.’ (community mental health nurse) What the service does well: What has improved since the last inspection? Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 7 Care plans are reviewed monthly and assessments and reviews are being undertaken in respect of bed rails and other furniture / equipment that restrict the movements of residents. The home now has a thermometer which they put with their medication to check that it is being kept at the right temperature. Wherever staff at the home make changes to the printed medication administration records they are signing to say that they have made the changes and are getting another person to countersign these changes to confirm their accuracy. Before any member of staff starts work at the care home the manager is now checking the Protection of Vulnerable Adults list, held by the Department Health, to ensure that they are suitable employees. Clifftop are now making sure that they are following the law when recruiting people from abroad. At this visit the home were able to show that the worker they had employed from an ‘accession state’ country was appropriately registered with the Workers Registration Scheme. The home evidenced that their staff are undergoing appropriate induction programmes. The home now has a quality assurance system in place and a written report on the outcome of their findings this year has been produced. The home now keeps a photograph of every resident in the home. What they could do better: Where residents have moving and handling needs and are receiving assistance there needs to be a moving and handling assessment and plan in place. Medication Administration Records must be fully completed whenever medication is given out and when there is a variable dose prescribed e.g. 1 or 2, the amount taken must be recorded. Before staff are employed to work at the home 2 written references must be received. Staff have access to a range of important training that equips them to do their jobs well, however the home is not meeting the Department of Health target of 50 of care staff having an NVQ at level 2 in care. In addition to the requirements and recommendations made in this report the following good practice suggestions are made that the home is urged to adopt and act upon. The home is encouraged to • Obtain the clinical triggers available on the CSCI website in respect of continence, dementia, falls and nutrition. Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 8 • • • • • • • • • • Introduce a sample signature sheet for staff administering medication. Put paper towels in the laundry as an infection control measure. Obtain the most up to date guidance from the Department of Health e.g. Essential Steps to Safe Clean Care and check that the home’s policy is consistent with the guidance. Add to their policies how staff in the home are to keep commodes and bottles clean. Keep an overview of training so that it can be seen at a glance what training all staff in the home have had and when refreshers are due. Provide dementia care training to enable staff to have a better understanding and better meet the needs of residents with this condition. Seek the views of other stakeholders e.g. relatives, visiting health professionals etc when carrying out the annual quality audit. Include the use of photographs of residents should any of them go missing in the missing person policy. Carry out a fire training session at night, as this is when most recent serious fires in homes have taken place. Obtain the latest guidance from the Medicines and Healthcare products Regulatory Agency guidance, which contains information on assessing the risk of such equipment and carrying out ongoing maintenance and safety checks. Also the home is asked to amend their statement of purpose to include that they are able to use rooms 2 and 3 as doubles and send a copy of this updated document to the Commission. 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. Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 9 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 Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 10 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 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A thorough pre admission procedure is in place and assessments are routinely undertaken to ensure that only residents whose needs can be met by the home are offered places there. EVIDENCE: Recently compiled pre admission assessments were seen. Prior to anyone moving to the home their needs are fully assessed by one of the registered people. The records indicated that the needs and circumstances of the person had been properly assessed. At the bottom of the pre admission assessment form the outcome of the assessment is recorded. The assessment is then copied to the person so that they can see what information has been recorded about them and the outcome of the assessment, thereby fully assuring residents that their care needs can be met. Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 11 The home is very clear about their limits and what level of need they can meet i.e. low and medium levels of dependency and only offer places to people who fall into these categories. Prospective residents are given the opportunity to visit the home as are their representatives, and residents can stay on a trial basis. One newish resident talked of how she had been to see a few homes before choosing Clifftop. She had been particular about what amenities she had wanted and these were on offer at this home. She had also wanted to bring some of her own furniture. She described how when she walked into Clifftop she had been ‘hit by the atmosphere.’ Prior to the visit the home sent comment cards out on behalf of the Commission to find out what people thought about the service. Two residents wrote about their experiences of first coming to the home. ‘The owner came and bought me here, let me see a room, helped me to move. No one could have done more.’ ‘We had the Cliff Top brochure at our request. My daughter then visited and was shown round and had a long talk. I chose which of the three en suite rooms I would like. I also visited another care home.’ All eight residents who returned comment cards to the Commission said that they had had enough information about the home to make their decision to move there. Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 12 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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to provide staff with the information they need to meet the health and personal care needs of residents. The principles of respect, dignity and privacy are put into practice. EVIDENCE: All residents have a care plan appropriate to their level of dependency based on a series of relevant assessments e.g. risk assessments, manual handling assessments, nutrition and skin assessments. A number were reviewed. A mini care plan is put in place when residents first move into the home. Files were well laid out. Plans were easy to read; informative about the needs of the resident and of how the home was to meet these needs. It was clear that reviews were being undertaken and plans updated with changes. Residents sign the care plans to show that they have been involved in their development and agree with what the home is going to help them with and how. Plans are currently reviewed monthly. Recently the home have been introducing more formal systems of involving residents and relatives in care Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 13 plan reviews. Some residents have said that they do not wish to be involved. The home is intending to establish by experience the regularity of inviting relatives to reviews. One plan seen was slightly out of date in respect of pressure area care and another resident who needed help from staff in respect of moving and handling did not have a moving and handling assessment on their file. Daily notes support and evidence the delivery of care to residents. These notes give a good picture of the daily lives of residents and the care that is delivered to them by staff in the home. Information from these notes feeds into the care plan reviews. A system is in place to alert staff to significant events or changes in care needs. When asked ‘do you get the care and support you need?’ 5 of the 8 residents who returned comment cards prior to the visit replied ‘always’ and 3 ‘usually,’ commenting ‘and with a smile.’ ‘100 care.’ ‘The carers are always kind.’ ‘The care and support is always there. But if at the time of need one couldn’t find the right person one has to be sensible and not expect miracles all the time!’ Two of the three relatives who responded by comment card said that they were ‘always’ informed of important matters in respect of their relative and consulted about their care where appropriate and the home gave the support or care to their relative that they’d expected or agreed. Evidence was available on file and through discussion with staff that GPs, district nurses, community psychiatric nurses, speech therapists and chiropodists are available to residents. Residents are able to choose their GP and a number of different GPs support residents living at Clifftop. Specialist services and advice are also accessed e.g. Parkinson’s nurses. Mrs Pride talked of how the home were to be hosting a regular Parkinson’s exercise clinic for one of their own residents and other people who live locally in Swanage. Seven of the 8 residents who returned comment cards said that they ‘always’ received the medical support they needed. ‘I have not yet seen my doctor as I have only been here 2 weeks. But all the necessary arrangements for my care and between my doctor are made.’ All 4 GP surgeries that returned feedback to the Commission prior to the inspection visit were positive about the home and the care delivered there. A mental health nurse also commented that the home ‘always’ sought advice and acted upon it to manage, improve and meet individuals’ health care needs. Residents said that they had confidence in the way the home looked after their medication for them. The home has a written policy and procedure regarding the receipt, recording, storage, handling, administering and disposal of medicines. Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 14 A local pharmacist supplies the medicines and provides computer generated Medication Administration Record (MAR) sheets. A number of medicines and administration records were reviewed. In all cases the number of tablets on the premises accorded with how many there should have been, given the date of the visit and the date the medicines were delivered to the home. However there were a few gaps where those administering medication had failed to sign when medicines had been administered. MAR sheets are completed at the time the resident has taken their medication, as should be the case. All handwritten entries / changes made to the printed MAR sheets were countersigned by another competent person to confirm that the changes made were correct. Very little medication is kept in cold storage. What is there is appropriately stored in a lockable box. The home is now checking the temperature of places where medication is kept to ensure that the medicine does not get too cold or too warm. Since the last inspection visit the home have re sited their medication trolley to an area of the home that is more constant in temperature whilst still being easily accessible to staff. Where residents are looking after their own medication assessments are in place confirming the suitability of this system. Facilities are made available for residents to keep their medicines locked away in their rooms. It is suggested that the home introduce a sample signature sheet for staff administering medication. Where there is a variable dose of medication e.g. where it is prescribed that the resident should take 1 or 2, the amount given was not noted. All bedrooms at Clifftop are being used for single occupancy, giving residents opportunities for privacy. All residents spoken with said that they were treated very well. Staff were seen to treat residents with courtesy, patience, kindness and respect. Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 15 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of activities is available for residents to participate in should they choose to. People are generally encouraged to make choices about their life style and to maintain contact with their family and friends. The meals in this home are wholesome and varied and are served in a pleasant environment. EVIDENCE: The inspector spoke to a number of residents and a visiting relative. All expressed satisfaction with the home, including the meal provision, activities and freedom of choice, including taking risks to remain independent. One relative commented when asked ‘what do you feel the care home does well?’ ‘Helps residents to feed and drink if they are unable to. Plenty of entertainment and provision of free taxis when needed.’ Clifftop provides organised activities such as exercise to music, sherry afternoons and group scrabble. There are also piano afternoons and occasional entertainers. Information about activities is displayed on the notice board. A Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 16 new, very large TV has been bought for the lounge to be used specifically for showing films as part of the new film club. This is going very well with residents enjoying popcorn and wine along with the film. Residents spoken to felt that their social needs were well catered for and that they could join in with what they wanted to, whilst at the same time enjoy more solitary activities such as reading and listening to music, watching TV. ‘At my age it’s good to sit and do nothing.’ Extra staff are on duty at the weekends specifically to spend time with residents, doing activities, playing games etc led by what people want to do. The home also organises trips out to places of interest, afternoon tea trips and to the cinema and theatre. Residents talked about how the night before about half of them had been down to the sea to watch the fireworks. ‘We had a wonderful night.’ Residents are free to come and go from the home as they please and talked of the use they made of the ‘free’ taxi service to town (paid for by the home). One resident talked of how they went out on their own to local clubs and tea rooms. Another had been out that morning and was late back for lunch. She talked of how great it was to come to home to the hot and delicious meal that had been saved for her. It was good to see that activities were not just confined to daytimes and weekdays such as the film club and card night. A hairdresser visits the home regularly. The library service was visiting on the day of inspection, residents popped out to the van to choose books. Mrs Pride talked of how they were trying to find out more about people’s social histories when they first come to the home to enable the home to respond through developing the activities programme and to better tailor their individual care. Of the 8 residents who returned comment cards 7 said that it was ‘always’ the case that there are activities arranged by the home that they can take part in and 1 said that this was true ‘usually.’ The home has a visiting policy. Residents records and the visitors book demonstrate regular contact with family and friends. Visitors are welcome at any time and residents can go out of the home whenever they wish, and for as long as they wish. Residents talked about the local trips they went out on with their families. A visitor spoke about how welcome they always felt when they came to the home. Mrs Pride talked of how at times they support residents when they choose not to see visitors. Residents are encouraged to pursue their own lifestyles within the home and make choices wherever possible. These include choosing when to get up and Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 17 go to bed, what to wear, what to eat or drink and to generally do as they wish during the day. Independence is further promoted by the free taxi provision allowing residents to go on local trips any time they wish, completely independently of staff or other residents. ‘We are at liberty to go where we want.’ (a resident) Many bring their own possessions into the home and personalise their bedrooms. Residents usually go to the dining areas for meals but can have meals in their own rooms if they wish or need. Mrs Pride and Mrs Harrison are currently looking at the home’s summer menu, intending to base it on the preferences of the residents. They talked of how they ‘ try to respond to needs and wants…we get anything they ask for ……the residents dictate what we do.’ Mrs Pride confirmed that there was no limit as far as the food budget was concerned. Residents are offered meal choices the day before. The manager said there was always scope for people to change their minds on the day. A cooked breakfast is always available in the morning. There is a choice of hot meals at lunchtime and a choice of hot and cold meals in the evening. Morning coffee and afternoon tea are served with biscuits and / or home made cake. On the day of the visit lunch was steak pie, cabbage, carrots and boiled new potatoes. The alternative was a smoked mackerel salad. Dessert was Dorset apple cake and cream. Where residents have special dietary requirements, such as diabetes, meals are adapted to suit their needs. Records are kept of what residents eat and these show the range and variety of meals and the alternatives that were made available for those who did not want what was on offer that day. Residents spoken with praised the food at the home ‘the main meal is excellent and well cooked.’ ‘There’s always a good choice.’ Two of the 8 residents who returned comment cards said that they ‘always’ liked the meals at the home, with 2 saying that they liked them ‘usually’ and 1 ‘sometimes.’ Comments included: ‘I’m always given a choice but sometimes would like the menu more varied.’ ‘Nobody can like every meal offered. The quality is always very good.’ ‘I have some food intolerances due to migraine. These can cause minor difficulties but are dealt with.’ Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 18 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a complaints procedure. Policies and staff training in abuse protect residents from harm. EVIDENCE: The complaints procedure is displayed on a wall near the dining room and includes information about who to contact and how long it takes for the home to respond to a complaint. No complaints have been received by the home or by the Commission for Social Care Inspection since the last inspection. The comment cards sent to residents asked the question ‘Do you know who to speak to when you are not happy?’ Of the eight who replied 7 said that this was ‘always the case’ and the other ‘usually.’ Six people said that they would know how to make a complaint, with one person commenting ‘no, I am not expecting to make one!’ A relative said ‘Never had any complaints about the care which is excellent.’ The home has an adult protection policy that shows that they are working to the Dorset guidelines, based on the Department of Health ‘No Secrets’ document. There is also staff training in this subject at the home from induction onwards. Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 19 Prior to any members of staff commencing employment at the home the Protection of Vulnerable Adults list is checked to ensure their suitability. Policies in place alert staff to the possibility of them being referred to the Protection of Vulnerable Adults list (held by the Department of Health) should they be dismissed for abusive practice. Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 20 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Continued investment in the upkeep of the home results in an attractive, wellmaintained, comfortable and safe environment for residents. EVIDENCE: A tour of the premises confirmed that Clifftop is well maintained. The home has a warm and homely atmosphere. It is well decorated throughout. Lounges and dining areas are comfortably furnished, with new dining tables and chairs having recently been bought for the dining room. There is a smoking area within the main lounge that meets the new regulations. There are splendid views of Swanage bay from the conservatory, garden and some residents’ rooms. Residents can enjoy walks around the gardens and plenty of seating is provided indoors and out. Some new swinging hammocks have recently been purchased. Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 21 The home is registered for 32 people. The home is permitted to use 2 rooms as doubles. At the inspection all rooms were being used for single occupation. All bedrooms have en suite facilities. There are also a number of communal bathing areas in the home. Aids and adaptations are available throughout the home e.g. raised toilet seats - and some residents with particular needs have their own personal equipment to assist with their independence. Residents are able to personalise their rooms with furniture and general belongings as they wish and in agreement with the home. All residents have a key to their bedroom door. There is a passenger lift in the home, enabling easy access between the floors. There are emergency alarm bells throughout the home – in each bedroom and in communal areas. Clifftop residents’ have all their laundry done on the premises and the home has suitable machines to launder clothes and bedding at appropriate temperatures. The laundry was clean and tidy. The home was advised to put paper towels in the laundry as an infection control measure. Residents praised the laundry service. ‘They like us to look clean and tidy.’ The laundry is good, things are nicely ironed and put into your drawers for you, we are really spoilt.’ The home has an infection control policy. They were advised to obtain the most up to date guidance from the Department of Health e.g. Essential Steps to Safe Clean Care. Once they have got hold of this they will need to check that their policy is consistent with the guidance. It is also suggested that the home add to their policies how staff in the home are to keep commodes and bottles clean. The home was clean and there were no unpleasant smells. One resident commented ‘I do like the cleanliness here, my bedroom is spotless.’ Six of the 8 residents that returned comment cards said that the home is ‘always’ fresh and clean, with the other 2 saying that this was the case ‘usually.’ One described the home as ‘spotless.’ Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 22 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient care staff are employed and deployed to meet the care needs of residents. Residents would benefit from more staff having National Vocational Qualification at level 2 in care so that care workers have the up to date skills and knowledge to look after them. EVIDENCE: Clear staffing rosters are in place that show who is on duty, where, when and what jobs they do. A record is also kept showing what was actually worked. The present roster shows that there are 2 care staff on duty at all times day and night with up to four care workers in total on duty at peak times. The night staff carry out some domestic tasks in addition to their care duties. Care staff are further supported by catering, laundry, domestic and maintenance staff to keep the home running. The Manager works in addition to the staff listed above. The Proprietor supports the manager and helps out at the home when the need arises. As stated above (Daily life and social activities- NMS 12-15) at times care staff come to the home specifically to socialise with residents and organise activities for them such as the very popular Sunday quiz. Residents spoke highly of the staff ‘they are excellent.’ ‘They show such kindness and humour, always ready to laugh. I really enjoy the repartee.’ Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 23 ‘They are always ready to help.’ Residents were asked are the staff available when you need them? Four who responded said ‘always’ with the other 4 saying ‘usually.’ Asked if staff listen and act on what you say all 8 said yes; commenting ‘Pleasantly.’ ‘100 efficient.’ The file was reviewed of the only member of staff to join the home since the last visit in January 2007. Most documents that should be on file were. Prospective staff complete an application form and are interviewed. The file included proof that the person was not on the Protection of Vulnerable Adults list, held by the Department of Health. The new worker was from an accession state country and the home had obtained confirmation from the Home Office of their registration on the Worker Registration Scheme. Only one reference had been received. This was from the person’s only previous employer in this country. Another personal reference was being sought. Nine care staff are employed at the home. Three have a National Vocational Qualification at level 2 in care, representing 30 , 2 of whom are about to finish their NVQ 3 in care. Another 2 staff are studying for the NVQ 3 who do not already have level 2. The Department of Health target is for 50 of care staff to have this qualification. Training records are kept on individual staff files showing when they have had training and in what areas they were trained. It is suggested that an overview of training be kept so that it can be seen at a glance what training all staff in the home have had and when refreshers are due. There was evidence to show that staff receive induction and foundation training to the industry standard ‘Skills for Care.’ Staff have training in a range of areas, including the core training that the home sees as essential for all staff, e.g. moving and handling, abuse, fire and food hygiene, first aid etc. As some residents in the home have dementia it is suggested that staff receive training in this topic to enable them to have a better understanding and better meet the needs of these residents. Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 24 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, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well organised and the daily management and running of the home centres round the care and contentment of residents. Good management practice, systems in place, and records kept, confirm the health and safety of people in the home. EVIDENCE: Patricia Pride, the manager, has a number of years of experience working in care and management along with appropriate qualifications. Mrs Pride keeps her practice up to date by doing training courses alongside her staff. One resident described her as ‘lovely, she works so well with her deputy, I have nothing but praise.’ Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 25 Another said ‘Trish (the manager) is at hand all the time, ask her anything, she doesn’t waste any time. You can’t put a price on it.’ Prior to this inspection the home completed an annual quality assurance assessment (AQAA), which they submitted to the Commission for Social Care Inspection. This identifies how the home have taken into account the views of residents and their supporters in the running of the home and sets out their plans for improvement over the next twelve months. The home sent out and made available comment cards for the Commission as requested before this visit. Comments came back from residents, relatives, a community mental health nurse and some GPs. They were all generally positive about home. In addition the home have employed an independent company to carry out a quality assurance audit. The report of this was available in the home and a copy was sent to the Commission. The report was very positive about the home and the service delivered to residents. Mrs Pride said that they intended to make this audit an annual event. The home does not routinely seek the views of other stakeholders e.g. relatives, visiting health professionals etc and were encouraged to do this from now onwards. A supervision system is in place and records are kept. The home is aiming to have at least 6 supervision sessions with each member of staff every year, but is not yet achieving this regularity. These sessions look at practice in the home and assist both the supervisor and supervisee to identify training needs. Staff training in mandatory areas, including fire safety, infection control, health and safety, moving and handling, emergency aid, and basic food hygiene, is ongoing. The home provides safe-keeping for money for some residents and keeps records of transactions and receipts of purchases, along with balances. The system for this was reviewed and found to be satisfactory. All records were available as requested at the inspection. An up to date insurance certificate was on display along with the home’s registration certificate. There were photographs of residents as required by law on files that were reviewed. Practices at the home are underpinned by a good range of policies and procedures. In discussion some suggestions were made in respect of policies and procedures e.g. including the use of photographs of residents should any of them go missing. Appropriate notifications about incidents and accidents are made to other bodies. Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 26 Examination of the fire records showed that appropriate procedures are in place to ensure the safety of residents and staff. Regular maintenance of the fire warning system, emergency lighting and fire fighting equipment is taking place. Routine checks are carried out at appropriate intervals. Staff fire training and fire drills are also carried out to ensure all are fully aware of what to do in the event of fire. It is suggested that a fire training session is carried out at night, as this is when most recent serious fires in homes have taken place. Dorset Fire and Rescue visited the home recently and have confirmed that they are satisfied with the fire risk assessment carried out in respect of Clifftop in February 2006 and that the matters arising from the self-assessment have been addressed. The risk assessment is due to be reviewed. Accident records were looked at. Accident forms seen were well completed. Records were clear about how staff came across accidents or if they had witnessed them, what they did and any follow up that was needed. Accident records are analysed quarterly and where appropriate measures are put in place to minimise further risks to residents and anyone working at the home. In addition equipment is regularly maintained. Information sent to the Commission prior to the inspection confirmed that the home is undertaking appropriate checks of equipment and facilities at appropriate intervals. Since the last key inspection the home have started regularly checking the bed rails in use at the home for safety, wear and tear. A record is made of these checks. The home were advised to obtain the latest guidance from the Medicines and Healthcare products Regulatory Agency guidance which contains information on assessing the risk of such equipment and carrying out ongoing maintenance and safety checks. Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 27 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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13 Requirement Where residents have moving and handling needs a moving and handling assessment must be in place and be regularly reviewed in order to keep the care plan up to date. Staff must sign to say when they administer medicines. Where a variable dose of medicine is given the amount given must be noted. 3. OP29 19 Prior to employing anyone at the home 2 written references must be obtained, including where applicable, a reference relating to the person’s last period of employment, which involved work with children or vulnerable adults, of not less than 3 months duration. 31/08/07 Timescale for action 31/08/07 2. OP9 13 31/08/07 Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 29 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 OP28 Good Practice Recommendations 50 of care staff at the home should be NVQ level 2 qualified in care. Clifftop DS0000026784.V347901.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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. 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