Inspection on 13/03/06 for Clifton Court

This inspection was carried out on 13th March 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Clifton Court 06/02/08

Clifton Court 11/12/06

Clifton Court 19/10/04

Clifton Court 19/04/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Clifton Court Lilbourne Road Clifton On Dunsmore Rugby Warwickshire CV23 0BB Lead Inspector Jackie Howe Unannounced Inspection 13th March 2006 09:30 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 Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 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. Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Clifton Court Address Lilbourne Road Clifton On Dunsmore Rugby Warwickshire CV23 0BB 01788 577032 01788 547915 di@cliftoncourt.freeserve.co.uk 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) Crosscrown Limited Diane Walmsley Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th June 2005 Brief Description of the Service: Clifton Court Nursing Home is a large care home situated in the village of Clifton upon Dunsmore, approximately 3 miles from Rugby town centre. The home was once a hotel, and is set in its own grounds with views across open fields at the back. The home is registered to provide care for 40 elderly persons over the age of 65years that require personal and nursing care. The home also provides shortterm respite care for service users in the same category. The accommodation is mainly single rooms, there are 3 double rooms all rooms are en suite. The accommodation is over 3 floors, which can be reached by stairs or passenger lift. As the home was once a hotel there is a large reception area with large lounges and dining areas on the ground floor. Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced. The Manager was present throughout the inspection and Managing Director and Operations Director were present during the afternoon. This report should be read in conjunction with the report of 28th June 2005 for a complete picture. This inspection focussed on a number of core standards and inspectors followed up on requirements made previously. The home was not full, with 29 residents. Inspectors looked around the home with the manager, spoke to staff and residents and with two directors. What the service does well: What has improved since the last inspection? Recruitment procedures have generally improved and most pre employment checks are being completed for new staff members, with the exception of retaining references. Records of training planned and undertaken have begun to be better organised. Systems for accurate recording and administration of medication have improved, as have the records for accurate wound care. Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 6 The home employs an activities organiser and evidence was seen that activities are taking place in the home. The manager said that the menus had been reviewed. What they could do better: 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. Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 7 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 Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 8 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 All residents are assessed prior to moving into the home and given assurances that their needs can be met by the home and the services offered. EVIDENCE: Since the last inspection the manager said that she had reviewed the assessment process, which is made prior to admission, so that the home can be sure that it can meet the needs of all the residents. Assessments read showed that elements required in the standards are addressed. The manager said that she was aware that some residents were coming to the home for terminal care and that this was often difficult to assess whilst in hospital. The manager felt that residents referred were now considerably frailer and often with clear care needs especially regarding tissue viability, which was a challenge for the home’s staff. A discussion was held about the value of photographing pressure sores so that the home can demonstrate where improvements are made. Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 9 Care management assessments and care plans are available and kept on file for those receiving local authority funding. Residents spoken with confirmed that they had been assessed prior to admission to the home. Most of the residents spoken with confirmed that they were happy living at Clifton Court and felt that the home met their needs. Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 10 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 Care plans have been developed and some elements are full and informative, however further detail is needed to provide the staff with all the necessary information so that they can successfully meet individual residents’ needs and provide personally tailored care. The residents’ health needs are assessed and set out in the individual plans. The administration of medication is generally well managed. EVIDENCE: Care plans are divided into two documents, one holds the assessments, risk assessments, and health care elements and is kept in the office; the other is kept in resident’s rooms and is a working document. This is reviewed by care staff monthly and covers areas of cleansing and bathing, moving and handling, continence and activities. Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 11 Whilst there was evidence that these had been reviewed by staff on a monthly basis, and care plans did identify that residents needed assistance, there was little information, which gave direction as to how each individual resident needed assistance in a person centred way. Better detail was needed to describe continence care and personal care such as bathing and toileting. Care plans rely on staff knowledge over and above what is written in the plan, and whilst the home has a core of consistent staff, one resident did say that they did not know the staff as they “change round so much”. A recommendation has been made. The community psychiatric team is supporting one resident who is described as having ‘challenging behaviour’. There were entries in the records to confirm that she had been assessed, but her individual care plan made no mention of her challenging behaviours, and how staff should care for her at different times. The monthly evaluations did not reflect changes in her behaviour. A recommendation has been made. A member of staff spoken with said that she had received in house training in dementia care but had not received training specific to caring for this resident. The manager said that the home’s team of nursing staff are competent to meet the health care needs of the residents, and receive training to ensure they are up to date with modern methods and nursing practices. Care plans read showed that the health care needs of residents were being addressed. Residents are weighed regularly and information was held related to special diets. The manager said that requirements made at the last inspection regarding medication had been met. Records related to the administration of medication were checked and were found to be accurate. Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 12 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): 13, 14 The home has few links with the local community and its location is such that shops, public transport and places of entertainment are not easily accessible. Service users are enabled to make choices about visitors but some said they were limited in exercising choice over daily living routines. EVIDENCE: The manager said that links with the local village are now limited. They receive the Parish newsletter so that local residents can keep in touch with village activities, and the local priest visits to give communion. Religious services no longer take place, as there was a lack of interest from residents. Two fetes are held each year, summer and Christmas, and the home hosts a bonfire / firework party in November which the manager said all residents attend and is enjoyed by everyone at the home. Visitors are free to visit whenever they choose. Security is maintained via the use of a keypad lock. Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 13 One visitor spoken with said that he felt welcome to visit his wife whenever he chose and was made to feel welcome by the staff, for example, being invited to Sunday lunch in the home. Two residents said that they would like to be offered more choice. One lady said that she would prefer to sit in her own room, rather than be brought to the lounge. She said that she could find her own way around her room and preferred to listen to music rather than the television, as she could not see it. ‘ I prefer to be in my own room as I know my way around and prefer to listen to my music, but they’ve brought me out today’. Another said that she was not given much choice over her diet. She said ‘I eat what I’m given, they don’t read out the menu’. Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 14 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): 18 Working and care practices observed indicate that residents are protected from abuse. EVIDENCE: The home has written policies and procedures in place designed to safeguard residents of the home from abuse. Staff are offered training in recognising and responding to abuse and a ‘whistle blowing’ policy offers staff guidance and protection as required. Recruitment procedures have improved and all new staff employed have the appropriate checks undertaken to ensure that they are suitable to work with vulnerable people. The manager said that she had had no reason to refer any of her staff to the (Protection of Vulnerable Adults) POVA register. Residents spoken with confirmed that they ‘felt safe’ at the home. The home does not currently hold a copy of the POVA multi agency policy for Warwickshire, or a copy of the DoH ‘No Secrets’ document. Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 15 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): 26 The overall environment is clean, but some of the décor and furnishings are looking dated and worn, some fixtures are in need of attention to ensure the safety of residents in the home. Service users are free to move around the premises and to personalise their own private rooms. EVIDENCE: A tour of the home indicated that whilst there is maintenance provision to the home, some areas, such as communal lounges, are looking tired and in need of updating. Carpets in some areas are worn and frayed. Fans were not working in a number of the bathrooms and toilets and there was an unpleasant odour in the sluices. The handles on some of the doors were broken, and a light was found hanging off the ceiling. This was fixed during the inspection. The toilet seat was broken in the staff / visitors toilet. Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 16 The home has separate laundry facilities, and a laundress is employed for six hours each day and five hours at the weekend. Equipment in the laundry meets the required standards. Hand washing facilities are provided around the home. Training is offered to staff on infection control, and the home has an infection control policy, which includes instruction on caring for people with MRSA. Most of the bedroom doors were closed, fire doors were held open by the ‘dorguard ‘ system, but one bedroom door was found wedged open by a heavy object. The manager said that all of the residents preferred their doors closed, apart from the one lady who had hers open. The practice of holding open doors without the provision of a fire safety device potentially puts residents at risk. Inspectors recommend that when residents choose to have their doors open, there is a safe means to achieve this. Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 17 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, 29, 30 The numbers, and skill mix of staff on duty meet residents’ needs. Staff are provided with training opportunities and generally this training is put into practice to enable staff to competently meet the needs of residents. Further improvement is needed to evidence safe recruitment practice. EVIDENCE: Staffing levels shown on the rota were 2 nursing staff with 5 care staff each morning and 2 nursing staff with 4 care staff in the afternoon. From 8pm onwards there are two carers and one nurse. This is a satisfactory minimum for the current 29 residents. When full, staffing levels are reported to be 2 nurses and six carers morning and afternoon. The rota shows that 12 hour shifts are a routine feature of the working patterns. The Registered Manager is shown on the rota covering early and late shifts. An activity coordinator is employed during the week from 9 till 3pm Whilst recruitment records were generally satisfactory for three of four staff files inspected. Thre was only evidence of one reference being taken up for a fourth staff member. The Manager assured inspectors that this had been obtained, and was satisfactory, but had been mislaid. A requirement and a recommendation were made last year and the Registered manager must improve systems to evidence that safe recruitment practice is now in place. Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 18 The home was nominated by their staff for imaginatively using the skills of staff with a disability and the home reached the finals of a national completion for employing people with a disability. There is a planned programme of training which showed a range of training in confidentiality, moving and handling, pressure area care. Fire safety, communication, personal hygiene, bereavement and continence. Action has been taken to meet a requirement about the coordination of training made at the last inspection. New staff are inducted using the TOPPS Induction standards. Three staff have NVQ 2 and a further 6 are enrolled to do this. 2 staff have NVQ 3 and two more are enrolled currently. Staff carrying out a variety of jobs in the home such as cleaning, cooking and administration have the appropriate qualifications to fit their role. The Manager said that responsibility for one to one professional supervision of staff is shared by senior nursing staff and senior carers. Records seen showed there are very brief notes of the discussion. It is recommended that the Registered Manager consider the headings in standard 36.3 as a basis for this formal recorded supervision. Issues such as performance and training needs should be linked with staff appraisal. The manager said that the home’s policy is to move staff from unit to unit, whilst keeping the nurse and senior carer as the stable element. This procedure ensures that all staff work in all areas of the home and have a knowledge of all residents. One resident said that she did not like the change round of staff. ‘ I don’t get to know the staff, they change round so much, I don’t like that you can’t make a relationship, and it’s difficult to make conversation…… staff never come up here’. Some staff, she felt she had a good relationship with, but those were the ones who did not change around. Staff need to be fully aware of the importance of building relationships with residents especially those who prefer to spend time in their own rooms which may result in them feeling isolated. Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 19 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): 33, 35, 38 The quality management systems in this home are satisfactory, with evidence that residents’ views are being sought and acted upon and service users interests are protected. A risk management system protects the interests of residents and is supportive of a safe environment. EVIDENCE: The manager and the owner undertake quarterly audits to regularly check the quality of the service. Audits undertaken include medication systems and pharmacy provision, infection control and resident falls. Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 20 An annual survey is also undertaken to establish the views of residents and their families. Information gained from these surveys is fedback via the twiceyearly newsletter. The home operates a Residents’ Fund account into which families make payments to meet costs over and above the weekly fee. Families are invoiced for costs such as activities and entertainments, chiropody, shampoos and toiletries and the hairdressers. Records for all transactions are maintained. Advocacy Alliance act for one resident. There was evidence of systems in place to ensure that the environment is safely maintained and risk assessments cover working practices. A fire safety risk assessment is in place. Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 21 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 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 x x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x 3 3 x 2 Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 22 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 12,13 Requirement The registered manager must ensure that care plans describe each residents current needs to ensure that staff have clear accurate information. The registered manager must ensure that recruitment procedures are robust and that staff files contain evidence of all information as specified in Schedule 2 of the Care Homes Regulations 2001. Timescale for action 31/05/06 2. OP29 19, 7 Sch 2 30/04/06 3. OP38 16, 23 Previous timescale of 30/06/05 not met. The registered manager must 30/09/06 ensure that the home is sufficiently well maintained with particular regard to the odours in sluice rooms, broken fixtures and fittings and frayed carpets. Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 23 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 OP7 Good Practice Recommendations The registered manager should ensure that personal preferences for daily routine are detailed in the care plan, to fully demonstrate how a resident’s individual needs are being met. The inspector recommends that the Tissue Viability procedures continue to be reviewed in line with NICE clinical guidelines on best practice. The inspector recommends that the manager obtains a copy of the DoH ‘No Secrets’ document and the Warwickshire multi agency policy on dealing with abuse. The inspector recommends that the documtation and organisation of staff training continue to be improved. The manager should improve the style of 1:1 supervision documentation of carers and nurses to include all aspects of care practice, philosophy of care in the home and career development needs. The Registered Manager should ensure that residents can choose to have their doors open and that that this is done safely. 2. 3. 4. 5. OP8 OP18 OP30 OP36 6. OP38 Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Clifton Court DS0000004223.V279118.R01.S.doc Version 5.1 Page 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!