Inspection on 16/02/07 for Clifton Cottage

This inspection was carried out on 16th February 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

Clifton Cottage 19/09/08

Clifton Cottage 21/02/06

Clifton Cottage 06/07/05

Clifton Cottage 26/01/05

Clifton Cottage 04/05/04

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

CARE HOME ADULTS 18-65 Clifton Cottage 1 High Street Ryde Isle Of Wight PO33 2PN Lead Inspector Annie Kentfield Unannounced Inspection 16th February 2007 14:00 Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clifton Cottage Address 1 High Street Ryde Isle Of Wight PO33 2PN 01983 566316 01983 564008 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) Mr John Raymond Clewley Mrs Miranda Cruz Clewley Suzanne Diana Thornton Care Home 7 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (3) of places Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st February 2006 Brief Description of the Service: Clifton Cottage is a residential care home offering care and accommodation to up to seven residents with learning disabilities. It is located in a central, yet secluded, site in the centre of Ryde town and is close to all the local amenities including shops, cafes, and boat, bus and train routes. The property is a Grade Two listed building that offers single room accommodation on three levels. Communal areas include a large kitchen/diner, a sitting room, and a games room. Residents have access to a garden area and a small courtyard. The home does not have a lift and as a consequence would not be suitable for residents with mobility difficulties. The current scale of charges is £413.91 per week with additional and varying charges for chiropody, activities, holidays and transport. Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report details the results of an evaluation of the quality of the service provided by Clifton Cottage and brings together accumulated evidence of activity in the home since the last key inspection on 21 February 2006. Part of the process has been to consult with people who use the service and with relatives and health and social care professionals who visit the home. There were six responses to the care homes survey received from residents in the home; three responses from relatives and one response from a social services care manager. Included in the inspection was an unannounced site visit to Clifton Cottage by an inspector on 16 February 2007 between 2pm and 7pm. During the visit the inspector spoke with staff on duty, several residents in the privacy of their rooms, and also two relatives who were visiting the home at the time. The inspector toured the building with the manager and looked at a selection of records. Other information included in this report was supplied prior to the site visit in the form of a pre-inspection questionnaire, completed by the manager. The responses from the consultations were very positive. What the service does well: What has improved since the last inspection? What they could do better: There were no requirements or recommendations identified at this inspection. Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager ensures that the care needs of the people who live at Clifton Cottage will be met by undertaking a proper assessment prior to them moving into the home. Prospective residents are invited to visit the home before making a decision to move there. EVIDENCE: Most of the residents at Clifton Cottage have lived in the home for many years and some have lived there for over twenty years. The manager is clear about the level of care that can be provided and considers the needs of existing residents before new residents move into the home. Prospective residents are invited to visit the home and meet the other residents and then following an assessment of care needs, the resident will be invited to move into the home. The newest resident who had been invited to visit the home, stay for tea, and meet the other residents confirmed this process. The resident said they were a little nervous of meeting new people but felt it was the right thing to do and they were very happy that they had made the right choice to move into Clifton Cottage. Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 9 The home has a vacant room at present but the manager is aware that as the room is on the second floor, this will only suit a resident who is fully mobile and is able to negotiate stairs. Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to take control of their lives within the limits of their cognitive ability. There is a good level of independence in the home with few restrictions. While support is always on hand, residents generally make their own decisions and individual choices and these are recorded in the individual plans. EVIDENCE: Care plans were seen for two residents and these were comprehensive documents that gave staff clear information on what support was required and how and when this should be given, there was information on the residents’ routines in the mornings, afternoon and evenings and care plans were person centred, were written clearly and could be followed easily. Residents are involved in the care planning process as much as possible or as much as they want to be. Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 11 Recording was noted in the relevant sections of the care plan and was only undertaken when necessary. Normal daily routines were not recorded as it was felt that anything that was part of the individual’s daily routine was already well documented. Any changes to daily routines were recorded in the house diary, which then pointed staff to the relevant section of the care plan, where more detailed information was recorded. Residents are actively involved in the decision-making process in the home and they are consulted on all aspects of their lives and their wishes are respected and acted upon. It was very clear by observing the staff interacting with residents that they are able to make their own decisions and staff at the home respect their wishes and views. Each individual plan seen had risk assessments in place for identified risks. Residents are assessed for their ability to manage their own finances and the home provides a system of administration and safekeeping for those residents who need support. The integrity of the system was checked and found to be satisfactory. Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are encouraged and supported to be part of the local community and to be involved in appropriate activities. Service users benefit from support to maintain social contacts and daily routines at the home respect service users rights and responsibilities. Meals at the home are flexible and service users benefit from a healthy diet. EVIDENCE: Some of the residents have reached retirement age and some are younger but all pursue their own interests both in the home and in the community. There are day resources that some of the residents attend and there are opportunities for some training and work. Some of the residents invited the inspector to view their rooms and it was evident that residents have lots of opportunities to take part in activities of their choice and rooms reflected their particular interests. One resident has Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 13 requested some support in learning to read and staff are working with the resident who showed the inspector a magazine that had been bought that day. There is regular contact with the local community in the form of weekend group excursions, places of entertainment, local cafes and pubs. There is a people carrier that the home shares with another small home in Ryde and occasionally activities and outings are arranged jointly. In 2006 residents had several opportunities for holidays and one resident said they were looking forward to deciding where the next holiday would be. Decisions about holidays, activities and outings, and menus, are decided at the regular residents’ meetings. These are informal meetings that usually take place when residents are all together for a meal. On the day of the inspection some of the residents had gone to visit another resident who is in hospital, one of the residents was out with family and another resident was doing some painting with a member of staff and it was evident that the routines in the home are flexible and informal according to what residents decide. In the evening the residents had decided that they would like to have a take away meal but a meal was cooked for anyone who didn’t want this. Meals are provided in the kitchen/diner and residents are involved in choosing meals and shopping with the staff. Residents’ participation in the daily routines varies according to their skills assessment and risk assessments. Residents can access the kitchen at any time and help themselves to snacks, drinks and fruit with the only restrictions being when staff are cooking and space is limited. Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive personal support in the way they prefer and their physical, emotional and health care needs are met. The homes policies and procedures with regard to medication are safe. EVIDENCE: The home has clear policies and procedures in place for the receipt, storage and administration of medication. The home uses a monitored dose system and all staff at the home have undertaken training in medication administration procedures. The home has clear information for staff for administering when required medication. The inspector looked at the medication records and these were correctly maintained and the manager confirmed that she carries out regular checks on medication storage and records. There is a mix a male and female staff at Clifton Cottage to provide residents with flexible personal support as and when required. Discussion with the manager and care records confirm that residents are registered with a GP practice and have access to dentist, optician and specialist health care services including the Community Learning Disability Nurse and mental health services. Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 15 All residents have a health action plan. The manager and staff have a good awareness and knowledge of age related health problems and have supported residents to access equipment to aid mobility. The manager and staff are clear that support is provided to promote as much independence as possible in personal care. If residents are admitted to hospital the manager ensures that up to date information about all of the resident’s health and personal care needs, including communication needs, and medication, is available for the hospital staff. Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home treats residents’ complaints seriously and responds appropriately. Residents are protected by the home’s policies and procedures for protecting vulnerable adults. EVIDENCE: The manager confirmed that the home has a complaints procedure and that in the event of a complaint being made staff would make a record of the issue together with details of the action taken and outcome. Residents spoken with during the inspection said they were very satisfied and liked living at Clifton Cottage. Residents who responded to the consultation said they would speak to a member of staff if they had a complaint. There is a policy and procedure for staff to follow in the event of suspicion or allegation of abuse and a summary of the policy is on display. Adult protection awareness training is covered in the induction training for staff and in discussion with the staff on duty they said they were confident that they would know how to respond to any concerns. Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is homely and comfortable and all areas of the home are clean, hygienic and free from unpleasant odours. EVIDENCE: The inspector toured the building with the manager. Communal areas are spacious, bright and airy and all areas of the home are well maintained and comfortably and attractively decorated and furnished. The building is Grade 11 listed and as such presents some limitations for some of the older residents who are less mobile, as there is no lift or stair lift. There are two bedrooms and a bathroom on the ground floor but the living room is on the first floor. However, all of the residents are clearly very happy living in the home and for some of the residents it has been their home for over twenty years. The manager and registered providers are aware of the building’s limitations and are monitoring the ability of residents to continue to negotiate the stairs easily and safely. Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 18 All areas of the home are clean, tidy and there are no unpleasant odours. There are suitable hand washing facilities, laundry, and staff have access to gloves and aprons and there are infection control procedures and training. Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff at Clifton Cottage have the necessary skills and experience and training to meet the needs of the people who live there. Staff turnover is low and a robust recruitment procedure ensures residents are protected. EVIDENCE: All staff are scheduled to receive training and updates in first aid, food hygiene, manual handling and infection control, medication and fire safety. 72 of staff have achieved the National Vocational Qualification in care at level 2 or above and 3 staff are waiting to enrol for this. The newest recruits to the home are currently undergoing induction/foundation training. An evidence book was available to demonstrate progress made; the induction meets the nationally agreed induction training standards. The Ryde House Group ensures staff in all their homes undertake awareness training in service related subjects, e.g., autism and challenging behaviour, palliative and bereavement care. Courses are accessed as and when they become available. The inspector spoke to two members of staff who are very keen to develop their Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 20 professional skills and qualifications. The manager confirmed that training is planned in some of the units of the Learning Disability Framework Qualification (LDAF) and for further foundation training in palliative care from the Macmillan Service to be offered. Two support workers have been recruited since the last inspection. All recruitment records were found to be in good order. Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager has the experience and qualifications to run the home and meet its stated purpose, aims and objectives. The Ryde House group has an annual development plan for its homes. Clifton Cottage has a process of establishing residents/representatives’ views about the service. The health, safety and welfare of the residents and staff is promoted and protected. EVIDENCE: Comments received from residents, staff, relatives and visitors demonstrate that the management approach of the home is positive and caring. The registered manager is experienced and qualified and the management systems Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 22 in the home are effective and efficient. The home has an Investors in People Award. The manager has recently taken on the management of another small home and is confident that there are systems of responsibility and accountability in place to ensure that she can provide a good service to both homes. There is flexibility in the staffing arrangements so that staff from both homes know the residents well and there are senior staff in charge when the manager is not there. A representative of the group monitors the conduct of the home by carrying out monthly regulation 26 visits. This same individual is involved in regular reviews of policies and procedures. Clifton Cottage has recently had a complete review of all policies and procedures. Residents, relatives and care managers are included in the yearly care reviews and they provide opportunities to bring people together with the residents’ personal plans as part of the quality assurance process. Residents also have regular meetings to discuss the day-to-day activities in the home. In addition there is a key worker system for residents and regular review of individual plans with residents and their key worker. The manager confirmed that all environmental risk assessments are regularly reviewed and residents and staff are involved in regular fire drills. Fire safety records were up to date. The pre-inspection information supplied by the manager confirmed that all maintenance checks and tests of equipment required by regulation are in place and up to date. Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 24 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Clifton Cottage DS0000012477.V325800.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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