Inspection on 09/01/08 for Clifton Gardens, 59

This inspection was carried out on 9th January 2008.

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 Gardens, 59 28/06/06

Clifton Gardens, 59 25/01/06

Clifton Gardens, 59 25/07/05

Clifton Gardens, 59 03/12/04

Clifton Gardens, 59 30/06/04

Clifton Gardens, 59 15/02/04

Clifton Gardens, 59 09/10/03

Clifton Gardens, 59 09/12/02

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Clifton Gardens, 59 Clifton Gardens, 59 Chiswick W4 5TZ Lead Inspector Ms Jean Bovell Key Unannounced Inspection 11:45 9th January 2008 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 Gardens, 59 DS0000032624.V348898.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. Clifton Gardens, 59 DS0000032624.V348898.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clifton Gardens, 59 Address Clifton Gardens, 59 Chiswick W4 5TZ 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) 020 8995 1955 020 8742 7322 London Borough of Hounslow Lorretta Mary Keating Care Home 35 Category(ies) of Dementia (21), Old age, not falling within any registration, with number other category (14) of places Clifton Gardens, 59 DS0000032624.V348898.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th June 2006 Brief Description of the Service: 59 Clifton Gardens is a purpose built home for older people. It is situated close to Chiswick High Road where there are shops, cafes, places of worship and a library. Chiswick Park and Turnham Green underground stations, and a number of bus routes are within walking distance. There is a health centre near to the home. The home is owned and managed by the London Borough of Hounslow. Accommodation is situated over two floors and is divided into five units. They are: Elmswood, Belmont, Savoy Lavender and Hoggarth. Belmont, Elmswood and Hoggarth units are dedicated for dementia care. The home also offers two intermediate and two respite care beds. Each unit has a lounge, kitchen and dining area. There is a designated room for smoking. Overall, there are thirty-three single bedrooms and one double bedroom at the home. All of the bedrooms are suitably fitted and furnished with en-suite toilet facilities in each bedroom within the dementia units. There are also four communal assisted bathrooms, one shower room and nine toilets. The offices and laundry are located on the ground floor. Pleasant grounds surround the building. There is a courtyard and a roof garden. The staff team consists of a Registered Manager, Assistant Manager, four senior Support Workers, a team of day and night Support Workers and a parttime Admin Assistant. There is a separate team of domestic and catering staff, a Business Support Manager and a Handy Person. Clifton Gardens, 59 DS0000032624.V348898.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out between 11:45 am and 6:10 pm On 9th January 2008. The Registered Manager, Deputy Manager, Duty Manager, eight care staff and 32 residents were at the home. During the course of the inspection, records that are being maintained at the home were viewed. A tour of the building was undertaken and observations were made. Ten residents, three relatives, five care assistants and one Senior were spoken with. A completed and comprehensive CSCI Annual Quality Assurance Assessment (self-assessment document), the most recent regulation 26 submitted in June 2007 and CSCI surveys returned from residents and care staff, were considered. The requirements that were made at the last inspection and all key Standards were examined. The Registered Manager and Deputy Manager were co-operative and provided appropriate assistance throughout the inspection. What the service does well: The care needs of prospective residents are fully assessed prior to admission into the home and separate cultural and religious needs are being met. Care plans are clearly detailed, reflective of residents’ participation and in the majority of cases, reviewed on a monthly basis. The health care needs of people are being met satisfactorily and medication administration sheets are accurately documented. The home has a job share Activities Co-ordinator and people are able to participate in regular indoor activities and monthly outings. Regular appropriate training is being delivered to care staff and they were observed being competent in meeting the needs of residents. Relatives and residents who were spoken with or responded to CSCI surveys reported that care staff members were ‘very kind’. Clifton Gardens, 59 DS0000032624.V348898.R01.S.doc Version 5.2 Page 6 Health and safety records were up-to-date and indicative people’s welfare being protected. Overall, the home was safe, calm and adequately maintained. The residents appeared well cared for, appropriately dressed and comfortable within their environment. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Clifton Gardens, 59 DS0000032624.V348898.R01.S.doc Version 5.2 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 Gardens, 59 DS0000032624.V348898.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is good. The care needs of prospective residents are being appropriately assessed prior to admission into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Inspector was informed by the Registered Manager that people who used the service were referred to the home by social workers based within community teams in Hounslow. It was evidenced on residents’ records that background history and written assessments of need were submitted at the point of referral. A needs led assessment is subsequently carried out by the home and is initiated with a visit to the prospective resident who may be living at home or a hospital in-patient. Clifton Gardens, 59 DS0000032624.V348898.R01.S.doc Version 5.2 Page 9 It was indicated that prospective residents, relatives, social workers and health care professionals – where appropriate - were involved in assessing and determining the suitability of the home in meeting separate identified needs. The home offers two intermediate and two respite care beds. Clifton Gardens, 59 DS0000032624.V348898.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual care plans are comprehensive and the health care needs of residents are being met appropriately. The people who use the service lack capacity to administer their own medication. Procedures regarding medication are satisfactory. EVIDENCE: Seven care plans were inspected at random. Residents’ participation in assessing changing personal, health care, social and dietary needs and putting Clifton Gardens, 59 DS0000032624.V348898.R01.S.doc Version 5.2 Page 11 into place action plans and set goals, was reflected. Risks in relation to moving and handling and, where appropriate, smoking, had been carried out. Apart from one case, care plans viewed were being reviewed on a regular basis. The changing healthcare needs of people were included within their separate care plans and met satisfactorily. Residents received access to healthcare professionals as required and were accompanied to medical appointments. One person was escorted to a GP appointment at the time of the inspection. Medicines were appropriately stored, administered and disposed of. Medication Administration Sheets were accurately recorded and signed. The Registered Manager confirmed that none of the residents had capacity to administer their own medication. The records were reflective of staff training on medication being delivered. Policies and procedures on medication were in place. All bedrooms contain lockable facilities. Bedroom doors are also lockable and people are provided with keys – if requested. Care staff were observed interacting with residents in a respectful manner and knocked on bedroom doors prior to entering. Concerns relating to gender appropriate carers were discussed with the Registered and Deputy Managers. The Inspector was informed that people were happy to receive personal care from carers who were not gender appropriate. However, written/signed consents to that effect was not evidenced. Clifton Gardens, 59 DS0000032624.V348898.R01.S.doc Version 5.2 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. 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. The religious and social needs of residents are being adequately met. Contact with relatives and/or friends are encouraged and facilitated. People are able to exercise choice and control over their lives – as appropriate. Varied and nutritional cooked meals are provided for lunch but appealing options are not being offered at supper. Cold drinks are not always readily accessible. EVIDENCE: Two part-time Activities Co-ordinators are employed at the home and a large activities room is included within the newly built unit on the ground floor. Separate social interests were identified within care plans and an Activities Clifton Gardens, 59 DS0000032624.V348898.R01.S.doc Version 5.2 Page 13 Programme was in place. It was indicated that organised activities included art therapy, bingo and regular outdoor trips. A hairdresser visits the home twice each week. Various paintings that had been undertaken by residents were on display. People were observed sitting in lounges, listening to music/dancing, chatting with relatives, watching television or resting in separate bedrooms. Others attended an art therapy session on the afternoon of the inspection. CSCI surveys were reflective of people enjoying participation in activities such as art therapy, music and dancing and bingo. However, one person indicated a desire to go ‘somewhere interesting’. The Registered Manager confirmed that Christian Church Services were held at the home on a monthly basis and that people were able to receive Holy Communion. Contact with relatives and friends/advocates is encouraged and facilitated. Three visiting relatives were spoken with at the time of the inspection. They reported being always welcomed by care staff who were considered ‘very kind’ to residents. People received choice in relation to cooked meals, activities, when to get up in the morning and retire at night, what they wore each day, hairstyles and make up. Individual choices and interests were also reflected in personalised bedrooms. The home employs a cook and a kitchen assistant and cooked meals are provided in the main kitchen. The menus were indicative of varied and nutritional meals being provided. However, residents’ comments in relation to meals included meals being ‘usually good’, ‘like home cooking’, ‘meat hard’, ‘so so’ and would like something other than ‘sandwiches’ for supper. One person reported needing ‘something to drink’ and that preferred juices were not always ‘available’. People were observed being offered a choice of fish fingers or sandwiches at the time of the inspection and one resident reported being hungry. Cold drinks were not seen to be placed so as to be easily accessible by residents. Clifton Gardens, 59 DS0000032624.V348898.R01.S.doc Version 5.2 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. 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. The complaints procedure is appropriately detailed and people are being protected from abuse. EVIDENCE: The complaints procedure was clearly detailed and included within the Statement of Purpose. However, a copy of the complaints procedure was not displayed and responses to CSCI surveys were not reflective of all residents being aware of how to make a complaint. The records indicated that following the last inspection no complaints had been made following the last inspection. Accident and incident forms were appropriately completed and included preventive action. The Inspector was informed by the Registered Manager that personal allowances were safeguarded at the home. Financial records relating to individual personal expenditure were examined and no discrepancies were detected. Clifton Gardens, 59 DS0000032624.V348898.R01.S.doc Version 5.2 Page 15 There was documented evidence that staff training on the Protection of Vulnerable Adults had been delivered. Clifton Gardens, 59 DS0000032624.V348898.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The main kitchen and a kitchenette on the first floor are not being well maintained. The changing/laundering of bed linen requires attention. The overall environment within the home is safe, calm and adequately maintained. Clifton Gardens, 59 DS0000032624.V348898.R01.S.doc Version 5.2 Page 17 EVIDENCE: The communal areas within the home were spacious, attractively decorated, comfortably furnished and suitable for shared and/or individual activity. Bedrooms were personalised and suitably furnished and fitted. It was, however, indicated on residents’ surveys that bed linen was not frequently laundered/changed nor were bedrooms frequently dusted. Although the main kitchen was clean and hygienic, general refurbishment was needed. Specifically, wall tiles in had become loose and replacement taps were required. Areas behind the sink in a kitchenette on the first floor also required attention. The surrounding gardens were adequately maintained and accessible to wheelchair users. The environment on ground floor dementia care units was pleasant and homely but a similar environment was not reflected within frail elderly units on the first floor. Overall, the home was found to be safe, clean and hygienic and adequately maintained. Clifton Gardens, 59 DS0000032624.V348898.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Permanent staffing levels are at a minimum and residents are not being supervised at all times. Care staff are appropriately trained and qualified for meeting the needs of residents. Original recruitment documents are filed confidentially in Human Resources but required recruitment information held at the home are satisfactory. EVIDENCE: The Inspector was informed by the Registered Manager that twenty-six care staff, three domestics, a cook and an assistant cook were employed at the home. At the time of the inspection, the Registered Manager, Deputy Manager, Duty Manager and eight care staff were on duty. Clifton Gardens, 59 DS0000032624.V348898.R01.S.doc Version 5.2 Page 19 Three of five care staff that were spoken with reported that one person, at times, was responsible for providing personal care to 6/7 residents within each unit. This often resulted in rushed situations and/or people being unable to have their needs met promptly and insufficient time for meaningful interactions. It was indicated on CSCI staff surveys that the home was ‘short staffed’ and that there was a significant number of Agency workers. The Registered Manager confirmed that there were two vacancies at the time of the inspection. Residents and relatives who spoke to the Inspector reported that individual staff members were ‘very kind’ and it was reflected on the majority of CSCI residents’ surveys that care staff were ‘always’ or ‘usually’ available when they were needed. However, people who required assistance were observed being left unsupervised while the sole care assistant in a frail elderly unit accompanied a resident to a medical appointment. This was raised with the Registered Manager who gave assurances that appropriate action would be taken. The Inspector was informed by the Registered Manager that sixteen care staff had achieved level 2 National Vocational Qualification and that three care staff were receiving NVQ training. Original recruitment documents were filed confidentially at the London Borough of Hounslow – Civic Centre. Written confirmation that required documents such as application forms, references, signed contracts/statement of terms and conditions had been received and CRB disclosure certificate numbers were within individual staff files held at the home and was seen by the Inspector. Training certificates and supervision records were also with files viewed. A training programme was in place and reflected that new care staff received induction training. Subsequent annual staff training included Dementia, Moving and Handling, Medication, Fire Safety, Food Hygiene, Infection Control, Health and Safety and the Protection of Vulnerable Adults. Care staff that were spoken with and those who responded to CSCI surveys indicated satisfaction with the training they received. Interactions observed between residents and staff were friendly and competent in meeting the needs of residents. Clifton Gardens, 59 DS0000032624.V348898.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager is appropriately qualified. Effective quality assurance has been undertaken. The personal allowances of residents are being safeguarded. The health, safety and welfare of residents and staff are protected. Clifton Gardens, 59 DS0000032624.V348898.R01.S.doc Version 5.2 Page 21 EVIDENCE: The Registered Manager had been in post as Acting Manager for twelve months prior to being registered in September 2007. She has obtained NVQ level 4 in care. Care staff reported that the Registered Manager was approachable and supportive. There was documented evidence that effective quality assurance had been undertaken. The home does not hold overall responsibility for the financial affairs of residents but personal allowances are being safeguarded at the home. Separate financial records were viewed at random and all were satisfactory. Health and safety records were up-to-date. These included water temperature, gas maintenance, portable appliances and fire safety checks. Tests for legionella were carried out. Environmental risk assessments had been undertaken. The records were indicative of staff training on Health and Safety, Food Hygiene and Infection Control being delivered. Clifton Gardens, 59 DS0000032624.V348898.R01.S.doc Version 5.2 Page 22 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 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 2 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Clifton Gardens, 59 DS0000032624.V348898.R01.S.doc Version 5.2 Page 23 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 OP10 Regulation 12(4)(a) Requirement The Registered Person must obtain written/signed agreements in relation to gender appropriate/inappropriate carers to ensure that people’s privacy and dignity are being upheld. The Registered Person must ensure that the main kitchen is refurbished. The Registered Person must ensure areas around the sink in a kitchenette on the first floor are made good. The Registered Person must make sure that resident’ bed linen are frequently changed and laundered to ensure that hygiene standards are being maintained. The Registered Person must make sure that residents are at all times supervised to ensure that their needs are being met. The Registered Person must make sure that the home is appropriately staffed to ensure that the welfare of people are safeguarded. DS0000032624.V348898.R01.S.doc Timescale for action 15/02/08 2. 3. OP19 OP19 23(2)(d) 23(2)(d) 30/09/08 27/03/08 4. OP19 16(2)(e) 30/01/08 5. OP27 18(1)(a) 25/01/08 6. OP27 18(1)(a) 25/01/08 Clifton Gardens, 59 Version 5.2 Page 24 This is re-stated from the last inspection. Previous timescale 30/07/06. 7. OP27 18(1)(b) The Registered Person must make sure that permanent staffing levels are sufficiently adequate to ensure continuity of care. 30/04/08 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 Gardens, 59 DS0000032624.V348898.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Gardens, 59 DS0000032624.V348898.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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