Inspection on 03/10/06 for Clifftop

This inspection was carried out on 3rd October 2006.

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 but made no statutory requirements on the home.

Other inspections for this house

Clifftop 02/08/07

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 Unannounced Inspection 3rd October 2006 10:30 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 DS0000026784.V315131.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. DS0000026784.V315131.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 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 DS0000026784.V315131.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 20th March 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 hygiene 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. DS0000026784.V315131.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 over 5 hours and was the anticipated key inspection of the year. During the inspection some records were looked at. The inspector walked around the building and met and chatted with a few residents and a relative in their rooms. The 5 requirements and 3 recommendations made at the last inspection were followed up to see if progress had been made. It had. Patricia Pride (Registered Manager) and her staff helped the inspector in her work. Prior to the inspection the home sent out comment cards on behalf of the Commission to people living in and interested in the service so that they could give feedback about their experience of the home. Eight were returned from residents, 1 from a relative, 4 from GPs, 3 from care managers and 3 from other health and social care professionals. All comment cards returned were positive about the staff and service provided at Clifftop and all said that they were satisfied with the overall care provided there. ‘What I really like about it is it’s atmosphere. They look after you and we look after each other.’ (a resident) ‘In the five months that I have been here I have settled in well and am happy here.’ (a resident) ‘My guardian angel found me this place. If I didn’t come here I’m sure I‘d be dead by now.’ (a resident) ‘My mother spent 4 weeks in Clifftop care home whilst my husband and I went on holiday. We were all apprehensive as she has never been in care before. We need not have worried. The care she received was first class. Her room was clean and very comfortable, food well prepared and ample in quantity and laundry prompt and efficiently undertaken. However the most important feature of this home is the friendly, caring atmosphere of the home and the individual kindness of all the staff.’ (a relative) ‘I find the staff and management very caring and sensitive to their needs.’ (Extend exercise teacher) ‘The best home in Swanage in my opinion.’ (a GP) What the service does well: A good admissions procedure is in place that ensures that only people whose needs can be met are offered places at the home. Prospective residents and their representatives have the opportunity to visit the home to see if they like it before they move in. DS0000026784.V315131.R01.S.doc Version 5.2 Page 6 A range of community health professionals support the care staff in looking after residents. Residents confirmed that they were treated with respect and kindness and their right to privacy was upheld. Residents are encouraged to exercise choice in their daily lives. Activities are on offer at the home that residents can join in with if they choose to. Visitors are always welcome at the home and residents are encouraged to maintain and develop relationships with people in the home, with their families and friends and the local community. Meals are varied and a choice is always available. The dining room is pleasant and comfortable. The complaints and adult protection procedures reassure residents and their representatives that the well-being and comfort of residents is important to the home and that any concerns raised will be properly investigated and resolved. The premises are comfortable and attractive, with a spacious lounge, a conservatory and a separate dining room. The home is kept clean and smells pleasant. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the needs of the residents. Residents can have confidence in the system in place to look after the small amounts of money they leave with the home management for safekeeping. Systems are in place and records kept, that demonstrate the homes commitment to keeping residents safe. What has improved since the last inspection? The home has improved their care planning documentation in respect of diabetic care and through undertaking nutrition and skin care assessments. The home has addressed the recommendations made at the last inspection in respect of medication and is now keeping a running balance of temazepam received in the home in order to account for it and they are keeping a list of each medicine prescribed for all residents and the reason for that prescription. The adult protection procedure and information about what to do if there is a suspicion or allegation of abuse of residents is now clearer for staff and is in line with the local adult protection guidance. DS0000026784.V315131.R01.S.doc Version 5.2 Page 7 What they could do better: Assessments and care plans are of a generally good standard but some areas for improvement have been identified e.g. evidencing that the plans and the assessments that underpin them are reviewed monthly and up to date. Also more robust assessments and reviews must be undertaken in respect of bed rails and other furniture / equipment that restrict the movements of residents. It would be good if the home had a thermometer where they keep 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 should sign to say they have made the changes and get another person to countersign these changes to confirm their accuracy. Before any member of staff starts work at a care home the manager must check the Protection of Vulnerable Adults list, held by the Department Health, to ensure that they are suitable employees. This has not been the case for recent employees at the home. The home must also make sure that they are following the law when recruiting people from abroad. At this visit the home were not able to show that the workers they had employed from ‘accession state’ countries were appropriately registered with the Workers Registration Scheme or were exempt from the scheme. 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 that 50 of care staff are qualified to NVQ 2 in care. The home also needs to have evidence to show that their staff are undergoing appropriate induction programmes while they are undertaking them. It would be good if the manager of the home had an NVQ level 4 in care. Mrs Pride has a qualification at this level in management already. The home needs to have a quality assurance system in place and produce a written report on the outcome of their findings annually. The home must keep a photograph of every resident in the home. Please contact the provider for advice of actions taken in response to this DS0000026784.V315131.R01.S.doc Version 5.2 Page 8 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000026784.V315131.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 DS0000026784.V315131.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 at least once during a 12 month period. 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. The admissions procedure enables prospective residents to make informed decisions about moving to the home and ensures 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 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. A new resident talked DS0000026784.V315131.R01.S.doc Version 5.2 Page 11 of how she had come to stay at the home for a couple of nights and decided she wanted to stay permanently. Mrs Pride said that the home writes to prospective residents following their pre admission assessment to say if the home can meet their needs or not but do not keep a copy of this letter. 6 of the 8 residents who returned comment cards said that they had enough information before they moved in to the home so they could decide if it was the right place for them. ‘Yes! They came over and brought me here and took me back to Bournemouth, gave me a choice of 3 empty rooms, helped me to move and even went back and cleaned my flat.’ Four of the 8 remembered getting a contract, 2 didn’t remember and 2 did not answer. ‘I don’t remember but I am sure if I should have I would have.’ DS0000026784.V315131.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning system in place ensures that staff have the information they need to meet the needs of the residents. The health needs of the residents are also well met with evidence of good support from community health professionals. The medication at this home is generally well managed promoting the good health and well being of residents. Residents are treated with dignity and their privacy is respected. EVIDENCE: Care plans seen were appropriate to the level of dependency of the residents. Plans were easy to read and informative about the needs of the resident and how the home is to meet their needs. 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. Care plans are backed up by risk assessments, manual handling assessments, nutrition and skin assessments, where needed, and residents are regularly DS0000026784.V315131.R01.S.doc Version 5.2 Page 13 have their weight monitored. It was not always clear when these assessments had been last reviewed. One care plan viewed was for a resident with diabetes. It was clear what the home were to do to and under what circumstances they would need to involve GPs / District Nurses. General information about the condition was also available for staff. It is suggested that the recommended regularity of visits to the optician, chiropodist are added to the care plan so that the home is aware when appointments should have been made. Another resident had been risk assessed as being in need of bed rails. Reference to this was made in their care plan. As bed rails are a form of restraint their use has to be carefully considered. The home currently gets the agreement of a relative for their use but not the consent of a professional e.g. care manager or district nurse. Information was also given to the home by the inspector as to the need to regularly check the rails for safety and put in place a maintenance schedule to check for wear. Care plans were seen to be updated when there had been changes but there was not the evidence to show that all plans are regularly reviewed at the recommended interval i.e. monthly. 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?’ Six of the 8 residents who returned comment cards prior to the visit replied ‘always’ and 2 ‘usually.’ ‘and with a smile.’ ‘the odd occasion is put right with a word to management. Staff ARE human.’ ‘I didn’t need a lot of assistance, but it was there when I did need it.’ (a resident who had stayed at the home for a short time.) When asked ‘do the staff listen and act on what you say.’ All said ‘yes.’ ‘If I ask for anything to be done it is done with a smile as though they were enjoying it.’ ‘I only have to ask.’ The relative who responded by comment card said that they were informed of important matters in respect of their relative and consulted about their care where appropriate. The GPs and community health professionals who returned comment cards said that if they gave any specialist advice this was incorporated into the care plan. Care managers said that there was a care plan for the person that they had placed at the home and that it was being followed and reviewed regularly. DS0000026784.V315131.R01.S.doc Version 5.2 Page 14 They also confirmed that they were notified of significant events affecting their client’s well being. ‘The home makes a real effort to provide individualised care and senior staff are very good at sharing information and showing a willingness to work in a collaborative way to ensure person centred care.’ (a health and social care professional.) Records are kept of the interventions of health professionals e.g. GPs, District Nurses etc. Residents are able to choose their GP and a number of GPs support residents living at Clifftop. Residents also have access to community services such as chiropodists, dentists and opticians. Specialist services and advice are also accessed e.g. advice re diabetes. The manager said that the home was well supported by local GPs and nurses. Where residents are in need of aids to help them around the home, or in and out of bed, residents have been assessed and aids made available to them e.g. hoists, pressure mattresses, pressure cushions, zimmer frames etc. Information provided about their use given by Occupational Therapists was seen on file. Five residents who returned comment cards said that they ‘always’ received the medical support they needed and 3 said this was the case ‘usually’. Medicines prescribed by doctors are safely stored and carefully administered to residents by staff who have received training in this work. The home is currently looking at alternative medicine administration systems with their pharmacist. Medication administration records (MARs) sampled were up to date and properly completed. Any allergies known are clearly recorded, and where there are none known this is noted. The quantities of medicines received were noted on the MARs. Medicines sampled accorded with the MARs. Where staff had made handwritten changes e.g. where medicines were discontinued these were not always countersigned by a person who had checked the entry for accuracy or dated as per good practice. The fridge where medicines are stored is regularly checked for temperature. At the last inspection it was recommended that a thermometer be kept in the medicine storage trolley, to ensure that the temperature does not become excessive. The home has not yet managed to obtain a suitable thermometer. It was also recommended at the last inspection that the home introduce a running balance for Temazepam, to ensure that amounts of this medicine received by the home could be properly accounted for. This had been done. They had also been asked to make a list of each medicine prescribed for each resident and the reason for this prescription. This had also been done. The home has a system for returning unused medicines to their pharmacist and appropriate records are kept. DS0000026784.V315131.R01.S.doc Version 5.2 Page 15 The home does not currently carry out self audits of medicines on the premises and it is suggested that they do this. A simple tool was provided. The inspector asked about their medication and if they felt confident in the home administering it to them. All said ‘yes’, commenting that it took a load off their mind to know someone else would remember it for them. One resident said ‘they do all my pills for me and watch me take them.’ Another said ‘it was part of the wonder’ of the home the way they looked after her medicines. ‘I wouldn’t remember if it was up to me.’ Residents confirmed that they were treated with respect and kindness and their right to privacy was upheld. All residents have a lockable area in their rooms for their use. The relative who returned a comment card said that they were able to visit in private. DS0000026784.V315131.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Residents’ lives are enriched by the social opportunities afforded by their visitors and the social activities available in the home. Visitors are made welcome at the home and can come whenever it suits the residents. Residents are helped and encouraged to exercise choice in their daily lives at the home and to retain as much independence and control over their lives as possible. The meals in this home are good offering both choice and variety and can be taken in the pleasant dining room. 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. The home organises some regular activities such as exercise to music and group scrabble. There are also piano afternoons and occasional entertainers. Information about activities is displayed on the notice board. DS0000026784.V315131.R01.S.doc Version 5.2 Page 17 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 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. The mobile library visits the home. 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. One resident spoken to had been to Swanage that morning and talked of how great it was to come to home to the delicious roast chicken dinner that was for lunch that day. Another resident talked of how much she liked the cats that belonged to the home and of other local cats that she enjoyed visiting her in her room. She was delighted that the home were going to fit a cat flap in her patio door so that in the winter the cats would still be able to visit her freely. A hairdresser visits the home regularly. Of the 8 residents who returned comment cards 2 said that it was ‘always’ the case that there are activities arranged by the home that they can take part in and 4 said that this was true ‘usually.’ ‘There is a seated keep fit class I try to join in. The two cats keep me company.’ Visitors are welcome at any time and residents can go out of the home whenever they wish, and for as long as they wish. The relative who returned a comment card to the Commission and one that was spoken to at the visit said that they felt welcome in the home at any time. Relatives are offered drinks and meals. The visitors’ book confirmed the number and range of visitors to the home. People are encouraged to make choices about how they live their lives at Clifftop. They can do as they wish, choose to eat what they like and join in with activities as it suits them. Preferences such as when they like to get up and go to bed are respected and staff are made aware of the choices residents make. Residents spoken to described the way that their needs and preferences were met by the home and of how nothing was too much trouble. ‘I couldn’t be freer. I am freer here than when I was living alone.’ Residents are offered meal choices the day before. 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. The manager said there was always scope for people to change their minds on the day. Morning coffee and afternoon tea are served with biscuits and / or home made cake. DS0000026784.V315131.R01.S.doc Version 5.2 Page 18 Currently Clifftop has some residents with diabetes residents and meals are adapted to suit their needs. The meals on offer on the day of inspection were roast chicken with stuffing, leeks, carrots and roast potatoes, or poached cod and sauce. Home made blueberry crumble and custard was for dessert. Supper was to be soup followed by a choice of kippers and salad or corned beef sandwiches. Yoghurts and ice cream are always available. A bowl of fruit and a plentiful supply of sweets are available in the main body of the home for residents to help themselves to. Most residents have their meals in the pleasant dining room but they can have their meals in t heir rooms should they wish or need to. Residents spoken to said that they chose where to eat their meals and that their choice was respected and acted upon. 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. Three of the 8 residents who returned comment cards said that they ‘always’ liked the meals at the home, with 5 saying that they liked them ‘usually.’ One commented ‘They give me 2 choices and if I don’t want either they make me something else.’ Those spoken to at the visit were very positive about the food and the choices they are offered. One talked of ‘having a fancy’ for some rare red meat, of how she had mentioned this and was delighted when a delicious rare fillet steak was served to her. DS0000026784.V315131.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A system is in place to deal with complaints that are made by residents and their representatives. The home’s adult protection policy and ongoing staff training demonstrates the homes commitment to understanding abuse and of protecting residents. EVIDENCE: The complaints procedure is displayed on a wall near the dining room and includes information about who to contact. Residents spoken to were clear about who they would complain to and that they felt confident in raising issues with management. They all said that they had nothing to complain about. No complaints have been received 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?’ Eight residents sent back cards. Six answered ‘always’ to this question, 1 answered ‘yes’ and 1 did not answer. ‘There’s the owner and I think 2 managers who go out of their way to solve my problems.’ In respect of knowing how to make a complaint 4 said yes ‘always’ and 4 ‘usually.’ DS0000026784.V315131.R01.S.doc Version 5.2 Page 20 One relative returned a comment card and said that they were aware of the complaints procedure but had not had to make a complaint. The home now 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. DS0000026784.V315131.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment is good providing residents with an attractive, comfortable and homely place to live. Bedrooms are decorated, furnished and personalised to suit the residents. Adequate facilities are available to meet the number and needs of the people living there. The home is kept clean and smells fresh thereby making daily life for all in the home more pleasurable. EVIDENCE: The home has a warm and homely atmosphere. It is well decorated throughout. Lounges and dining areas are comfortably furnished. There is a smoking area within the main lounge. Since the last inspection blinds have been fitted on the sea facing windows of residents’ bedrooms to help protect residents from the heat of the sun. DS0000026784.V315131.R01.S.doc Version 5.2 Page 22 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. The majority of bedrooms are single occupation and all bedrooms have en suite facilities. There are 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. The home was clean and there were no unpleasant odours. The laundry was clean and tidy. Residents praised the laundry service with one saying ‘I think she knows every garment we have by its first name!’ 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 resident spoken to at the visit described the cleanliness as ‘incredible.’ DS0000026784.V315131.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient, well trained care staff are employed and deployed to ensure that the needs of residents can be met. Recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home but not all checks that should be carried out prior to employment have been. The home does not meet the recommended standard for at least 50 of care staff to hold a National Vocational Qualification in care at level 2. 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. The Manager is addition to these numbers. Care staff are further supported by catering, laundry, domestic and maintenance staff to keep the home running. The Proprietor supports the manager and helps out at the home when the need arises. Residents were asked are the staff available when you need them? Four who responded said ‘always’ with the other 4 saying ‘usually.’ DS0000026784.V315131.R01.S.doc Version 5.2 Page 24 One commented ‘If I can’t get off the loo at night I can call any time and someone comes.’ One resident said that when she had been unwell recently she had been delighted by how often members of staff had called in to see her to see how she was. The relative who returned a comment card to the Commission said that in their opinion there were always sufficient numbers of staff on duty. The training records for four members of staff were seen and training was discussed with staff. When staff start working at Clifftop they are taken through an ‘orientation’ programme to familiarise themselves with the home. Mrs Pride said that they then worked through the skills for care induction programme. They hold their workbooks themselves and so these were not available to view. Ms Pride said she was aware of the October 2006 changes to the skills for care (industry standard) induction / foundation programme and was in the process of introducing it. Files showed the range of training that staff had undertaken. Ms Pride reported that in the last year staff had had access to training in first aid, medication, abuse, health and safety, food hygiene and manual handling. At present the Department of Health target of 50 of the care staff to hold an NVQ in care at level two has not been met. The home employs some care staff from overseas countries who have qualifications from their home countries i.e. nursing, that enable them to obtain permission from the Home Office to work in this country. Whilst the home office give this permission, considering that their qualifications are to NVQ standard 3, a UK verifier has not assessed their knowledge, skills or understanding related to their work tasks, and how these are applied in their workplace with the people who use the service. The files of the two latest members of staff to join the home were inspected. Most documents that should be on file were. However before a member of staff starts working at any home they must be checked against the Protection of Vulnerable Adults list, held by the Department of Health. This had not been the case for either of the two new employees whose files were reviewed. One had since had the outcome of their check but the other had not. Both new workers were from accession state countries but their staff files did not contain confirmation from the Home Office of their registration or exemption from the Worker Registration Scheme. DS0000026784.V315131.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. 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, contentment and safety of residents although a suitable quality assurance system is not in place. Not all records required by law to underpin the care of residents are being kept. EVIDENCE: Patricia Pride, the manager, has successfully completed her Registered Managers Award (equivalent to NVQ level 4 in management). Mrs Pride has a number of years of experience working in care and managing the home but does not have a qualification in care. DS0000026784.V315131.R01.S.doc Version 5.2 Page 26 The home sent out and made available comment cards for the Commission as requested prior to this inspection. Those that came back were generally very positive about home and demonstrated that residents have, and feel free to express, opinions. The home periodically issues ‘user satisfaction questionnaires’ to find out themselves what residents think. This was last done in September 2006 and some very positive responses have been received. E.g. ‘It is home not a home.’ The home does not routinely seek the views of other stakeholders e.g. relatives, visiting health professionals etc. Nor do they compile an annual quality report. The inspector alerted the manager to the recent changes to the Care Home Regulations in respect of ‘quality of care.’ The manager confirmed that it is still the case that the home only provides safe-keeping for small amounts of money for some residents and keeps records of transactions. The system for this has been checked at previous inspections and found to be satisfactory. The home is now reporting any untoward events at the home to the Commission for Social Care Inspection as required under regulation 37 of the Care Homes Regulations 2001. Further advice was given to the home as to what constitutes ‘events’ to be reported and a suggested pro forma was given to them for use. An up to date insurance certificate was on display along with the home’s registration certificate. There was not a photograph of each resident as required by law. In order to ensure a safe environment for residents to live in 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. Bed rails were discussed in respect of the need for them to be checked for safety, wear and tear and a record made of this check. Some fire records were seen. Those seen were up to date and showed that internal checks of fire safety equipment are being carried out. Staff receive regular fire training and clear records are kept. Fire drills and evacuations take place and reports are written about what happened. 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 and that the matters arising from the self assessment have been addressed. 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 DS0000026784.V315131.R01.S.doc Version 5.2 Page 27 records are analysed quarterly and where appropriate measures are put in place to minimise further risks to residents and anyone working at the home. Where residents are unable to use call bells regular checks are made to make sure they are safe when they are in their rooms. DS0000026784.V315131.R01.S.doc Version 5.2 Page 28 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 2 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 2 X 2 X 3 X 2 3 DS0000026784.V315131.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13 Requirement Where bed rails are in use all of the following should be in place – an assessment outlining why the equipment has to be used, how it is to be used and written permissions for its use given by family members and a professional outside the home e.g. district nurse/ care manager. Assessments must be regularly reviewed to make sure that the use of such equipment remains the best option to maintain the safety of the residents and that it is being used safely. Handwritten entries in medication instructions must be signed and dated by the writer and countersigned by a member of care staff who has checked the entry for accuracy, including where medication is discontinued. • Before any staff begin working at the home they Timescale for action 01/12/06 2. OP9 13 01/12/06 3. OP29 19 01/11/06 Page 30 DS0000026784.V315131.R01.S.doc Version 5.2 • must be checked against the Protection of Vulnerable Adults list. Proof must be kept of this check. Where staff are from ‘accession state’ countries the home must keep proof of their registration on or exemption from the Worker Registration Scheme established by the Government. 4. OP33 24 The home must establish a 01/12/06 quality assurance system and produce a written report annually which would include the findings of their consultation with stakeholders in the home. The home must have a photograph of every resident. 01/11/06 5. OP37 17 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 OP4 Good Practice Recommendations The home should keep a copy of the letter that is sent to prospective residents stating if their needs can be met or not by the home following the pre admission assessment. The home should have a system in place to evidence that they are reviewing care plans monthly along with the essential assessments that underpin the plans. A thermometer should be kept in the medicine storage trolley, ideally one that shows the minimum and maximum temperature that the inside reaches. 2. OP7 3. OP9 DS0000026784.V315131.R01.S.doc Version 5.2 Page 31 4. 5. 6. OP28 OP30 OP31 50 of care staff at the home should be NVQ level 2 qualified in care. The home should keep in the home evidence to show that staff are undertaking induction programmes. The manager of the home should have an NVQ level 4 in care. DS0000026784.V315131.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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. Extracts may not be used or reproduced without the express permission of CSCI DS0000026784.V315131.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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