Inspection on 01/04/08 for Clifton House (77)

This inspection was carried out on 1st April 2008.

CSCI found this care home to be providing an Adequate service.

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 House (77) 26/04/07

Clifton House (77) 27/06/06

Clifton House (77) 09/02/06

Clifton House (77) 06/10/05

Clifton House (77) 03/03/05

Clifton House (77) 13/09/04

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Clifton House (77) 77 Brighton Road Coulsdon Surrey CR5 2BE Lead Inspector David Halliwell Unannounced Inspection 1st April 2008 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 House (77) DS0000025770.V361380.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 House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clifton House (77) Address 77 Brighton Road Coulsdon Surrey CR5 2BE 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 8668 3330 020 8668 6667 clifton@sparshotts.freeserve.co.uk Mr Stephen Sparshott Mr Stephen Sparshott Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 16 26th April 2007 Date of last inspection Brief Description of the Service: Clifton House is a detached extended, residential property situated in Coulsdon that is registered with the Commission for Social Care Inspection to provide care and accommodation for up to 16 older people of either gender. The home does not provide nursing or intermediate care. Communal areas comprise of a spacious lounge/dining area, separate quiet room / visitors facility, a private telephone room and gardens with patio area that is accessible via steps or a ramp for wheelchair users. The property stands on a main road and there is ample off-street parking to the front. The home has the usual additional facilities such as toilets and bathrooms on each floor and a laundry, office and kitchen. There are twelve single and two double bedrooms and six of the single rooms and both the double rooms have en-suite facilities. The owner of the home is also registered as the manager for the service. The home’s philosophy of care is stated as Clifton House aims to provide its service users with a secure, relaxed and homely environment in which their care, well being and comfort are of prime importance Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 1star. This means the people who use this service experience adequate quality outcomes. This was an unannounced inspection visit undertaken by the Inspector responsible for Clifton House. The Inspection covered all the key standards and involved a tour of the home, a review of all the homes records and formal interviews with 2 members of staff and the Proprietor of the home. 4 residents were spoken with formally and more informal interviews were conducted with 2 other residents as a part of the tour of the home. 5 new requirements have been made as a result of this inspection; 4 of the previous requirements have not been met since the last inspection and are therefore repeated. 1 recommendation has been made and 2 recommendations are repeated. Feedback on these requirements and recommendations was given verbally to the Manager at the end of the inspection visit. The Inspector found the residents and staff very helpful and they are to be thanked for the assistance that they gave him over the course of this inspection visit. What the service does well: The home is able to demonstrate that it is assessing and meeting the needs of service users admitted to the home. The health care needs of residents are being well met. Prospective residents, their relatives and friends are able to visit and to assess the quality, facilities and suitability of the home. Residents are living in a safe, well-maintained environment, with access to safe, pleasant and comfortable facilities. Residents generally presented as well settled in their environment, and very satisfied with the communal and personal facilities provided. One relative told the Inspector that Clifton House is “just like a home from home”. Another said, “Nothing is hidden, staff respond well to any questions we might raise with them”. Another relative said, “This home is always happy and clean”. One resident told the Inspector “this is a very pleasant place to live. I am happy here”. Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 6 The home is being managed by the Proprietor in an open, professional and competent manner by Mr. Stephen Sparshott. What has improved since the last inspection? What they could do better: Specific areas identified in this report that require some attention are as follows: 1. Fridge and freezer temperatures should be checked daily and a record taken. 2. An electrical systems check was carried out in 2000 and is now required as each check is only valid for 5 years. 3. Regarding staff supervision: • A supervision-recording format should be used that covers the areas outlined in this report in sufficient detail to ensure a useful record is maintained for both the staff and the management. • That all senior staff who provide supervision should receive staff supervision training. • That all staff should be given a copy of their supervision record following the supervision meeting. 4. A fully operational quality assurance process should be established in order to ensure that the home is run in the best interests of the residents and of the staff. 5. All staff should be asked to review the key policies and procedures for the home and then to have a discussion in their supervision sessions over a period of time and then to sign to say that for each individual key policy and procedure that they have read and understood them and have had the chance to discuss them with their supervisor. 6. Documentary evidence required under Standard 29 of the National Minimum Standards be gathered for all the staff members at Clifton House and be held on the staff files for review and inspection. 7. The annual development plan for 2006 and 2007 needs to be updated especially in the light of the fact that some repairs identified in 2007 have yet to be completed. 8. The LFEPA’s second requirement regarding fire drills should be carried out as requested as soon as possible since the timescale given by the LFEPA was 18.3.08. 9. Refurbishments identified in this report including to the kitchen and to the 1st floor bathroom must be completed. Other areas include: The Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 7 bathroom on the ground floor needs some tiles to be replaced and the woodwork panel just beneath the hand basin also needs replacement. The ceiling in the hall outside the bedroom number 2 needs some repair following a flooded bedroom 5 on the 1st floor above it. In bedroom number 4, the wooden panel under the toilet cistern needs replacement, as it is rotted through. 10. All staff should receive a basic level of essential training as described from a recognised and external training agency. 11. Induction training should be recorded on each member of staff’s file identifying each element of the training received. 12. Staffing records for training must be clear, up to date and inclusive. 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 House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 8 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 House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 9 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): Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Residents may be assured that their needs will be thoroughly assessed and reviewed by their referring agencies, they may also be assured that their needs will continue to be fully assessed at Clifton House and that fully completed documentation will always be held on their files. Standard 6 is not applicable to this home as it does not provide intermediate care. EVIDENCE: Standard 3 – We examined 3 of the 15 resident’s files at this inspection and found on each file an assessment of needs had been carried out by the home. These assessments have been based on information supplied by the referring professionals, usually care managers, and by the staff’s own assessment of the persons needs. Since the last inspection the assessment format has been developed to expand the assessment of social care needs including the resident’s cultural and religious needs. The assessment tool provides a useful way of comprehensively ensuring all the residents or prospective residents’ Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 10 needs are taken into account at the assessment stage. This includes an assessment of the person’s health, risk factors, mobility and the compatibility of the person to ‘fit in’ with the current service users. The assessment is completed with the service user, his/her relative or representative and with the relevant professionals that have been associated with the referral. Religious and cultural needs are a part of the needs assessments seen in the resident’s files and all care plans are based on the information contained in the needs assessments. Evidence seen on the resident’s files indicates that internal care plan reviews are held every 2 months or earlier if resident’s needs change and that these reviews involve the residents, their relatives and families and the home’s care staff. This was confirmed by 6 residents, 3 staff and 3 relatives with who the Inspector spoke as a part of this inspection. Standard 6 - Intermediate care is not provided for at Clifton House so this Standard has not been assessed. Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 11 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): Standards 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. Residents can be assured that their health, personal and social care needs will be the central focus of their care plans and that these plans will be appropriately reviewed as and when required. Residents can also be assured that their healthcare needs will be met at Clifton House. Medication administration is being appropriately managed and properly recorded and stored, and residents are being protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Standard 7 – We examined 3 of the residents’ files and found that most of the documents required in respect of each resident under Schedule 3 were seen on these files. Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 12 On each resident’s file inspected an appropriate needs assessments had been drawn up. Care plans had been constructed from these needs assessments and the Inspector was impressed with the detail covered in these plans. All the care plans inspected were seen to be reviewed 2 monthly or earlier if the needs of the residents change, the date of the review being recorded on file. It was clear from the care plan records held on the files that all the appropriate people are usually involved in the care plan reviews including the resident and their relatives where appropriate or their representatives. The Inspector spoke to 3 relatives of one of the residents who also confirmed that their sister’s care plan is reviewed and that the resident is normally involved in the process. The Proprietor informed the Inspector that after the initial placement of a new resident an intermediate care plan is drawn up before the 6-week review. After the 6-week review, the care plan is revised and then reviewed bi-monthly. At the last inspection in 2007 evidence was seen by the Inspector that the Local Authority (LA) Care Managers usually reviewed a new placement 3 months or 6 months afterwards, however for the one new resident (since the last inspection in 2007) who was placed at Clifton House there was no evidence of any LA review of the initial LA care plan. This was similarly the case for other residents whose files were inspected and who have been living at Clifton House for several years. The Manager is recommended to request that the placing authorities carry out annual care plan reviews for every resident placed at Clifton House. On each of the 3 resident’s files inspected the Inspector saw risk assessments. These risk assessments covered essential areas for the residents such as the risk of falling within the home. These risk assessments were seen to have been reviewed and updated where appropriate. On 2 of the 3 residents’ files inspected, photographs of the residents were missing. This was the case at the last inspection, so it is now being made a requirement that the Manager ensures that a photograph of each of the residents is placed on their individual files. This is to ensure the correct identification of that resident and is particularly important for new or temporary staff that are or may be employed at Clifton House. Standard 8 – This standard concerns the healthcare of each of the residents. The Proprietor informed the Inspector that all the residents have access to a GP. The Inspector was told that all residents have access to health care professionals who visit Clifton House on a regular basis. The optician visits regularly, the dentist visits once every 6 months and the chiropodist also visits on regular basis. This information was also supported by 6 residents and relatives and by staff who the Inspector spoke to over the course of this inspection. Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 13 The Manager informed the Inspector that dietary needs of residents are not assessed as a matter of course unless they have any special dietary needs and then a nutritional assessment could be arranged. Standard 9 – The Inspector was provided with the agencies policies and procedures manual by the Proprietor and this file included an appropriate medication policy for the unit. He told the Inspector that the usual practice for the administration of medicines at Clifton House is for care staff to give the residents their medication. At a previous inspection a requirement was made to ensure that all care staff receive training on the safe handling of medication. Evidence was seen by the Inspector at the last inspection that care staff did receive this training. However the Proprietor is asked to ensure that new staff also receive the training if they are to administer medicines to the residents. In fact all staff who administer medications should receive refresher training every 2 or 3 years so as to ensure they are kept up to date with best practice. Inspection of training material at this inspection showed that a new member of staff has not yet received the training on the safe handling of medications. The Proprietor told the Inspector that this staff member does not yet administer any medications to residents. Staff who receive the appropriate training should be better able to ensure that the residents are protected by safe and appropriate practices. Appropriate records (MAR sheets) were seen to have been completed properly for the administration of medicines to residents. Together with the Proprietor the Inspector carried out a random stock take check of the medicines held in the home’s medicine cabinet and the levels of stock indicated on the MAR sheets. These tallied appropriately, confirming that the administration and storage practices staff are using are accurate and appropriate. Standard 10 - The Inspector spoke with 6 of the residents at Clifton House about the quality of the care they receive to meet their needs. The Inspector was impressed with the positive remarks they made about the care and support that they receive from staff at Clifton House. The Inspector was also impressed by the commitment of the 2 staff, formally interviewed by the Inspector, to maintaining the dignity and privacy of the residents wherever possible. All the residents receive personal care and some are helped with washing and bathing, dressing and toileting. Care staff interviewed showed the Inspector by their responses and comments their caring attitude towards the residents. All of the bedrooms have en suite toilet and washing facilities and this also helps residents to maintain a level of privacy that they welcome. Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 14 The Proprietor told the Inspector that the staff induction programme which all new staff has to work through covers the core standards of privacy, dignity, independence, civil rights, fulfilment and choice. Evidence of the induction programme being carried out for the latest staff recruit however was not seen by the Inspector on one of the staffing files inspected. Although that member of staff at interview did say that they had completed some induction training. The Proprietor is reminded that appropriate evidence of the induction process should be held on each member of staff’s training file. Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are likely to find that the lifestyle they experience at Clifton House matches their expectations and their preferences and satisfies their social, cultural, religious and recreational interests. Residents are encouraged to maintain contacts with their friends and families and service users are helped to exercise choice and control in their lives wherever possible. The meals and food provided to residents is well balanced, healthy and varied. EVIDENCE: Standard 12 – The Proprietor told the Inspector that a range of different entertainments and social activities are provided for the residents. These include: Jigsaws; painting and drawing; armchair aerobics; and there is an activities person who works one day a week at Clifton House and who organises exercises and appropriate activities for the residents such as carpet bowls, reminiscent talks, quizzes, bingo and sing songs. The Inspector noted that many residents said they enjoyed this input. Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 16 The Proprietor informed the Inspector that the resident’s religious and cultural needs are assessed as a part of their initial assessment and placement at Clifton House. A catholic and a C/E minister both visit the home weekly and residents are encouraged to attend the services if they wish to and staff will assist them to do so. 2 residents told the Inspector how they enjoy the opportunity to participate in these religious activities. Standard 13 – The Inspector was told by the Proprietor and the staff that there are no specific visiting hours and that as long as a resident wishes to see a relative then visitors are welcome at most times of the day. A record of visitors was seen and visitors can be entertained in communal areas as well as the resident’s own bedrooms where relatives, families and friends can be seen in private if they wish. Residents confirmed this with the Inspector and the Inspector spoke to 3 relatives who said, “visiting hours are as and when we want to come to see……….. We give the staff a call just to let them know we are coming”. Standard 14 – This standard explores issues relating to: managing financial affairs, advocacy, respecting of the right to personal possessions, and enabling access to information kept concerning a service user. One resident still has some control over their own affairs and the Proprietor told the Inspector that this is encouraged, where appropriate, and is assessed on admission to the home. At the last inspection the Inspector interviewed this resident who evidently enjoys maintaining a level of self-determination and independence. The Proprietor informed the Inspector that the home does not handle or control any of the resident’s finances and where residents are unable to do so for themselves, relatives deal with these affairs on their behalf. Standard 15 – As a part of the inspection the Inspector spoke with the Proprietor and discussed the menu planning and the food provided to the residents. He informed the Inspector that there is a rolling menu plan that is drawn up after consultation with the residents at the residents meeting, who are asked what they would like to eat. He also said that on most days he goes out and does the shopping himself and any special dietary requirements or individual daily requests are taken into account and provision is made in the menu plan and in the shopping purchased. At the start of this inspection the Inspector saw the Proprietor who had just returned from a shopping trip with fresh vegetables and food. The Inspector saw both the menu plan and the daily menus that provide a wide and healthy range of food for the residents. The Inspector was present for the lunch and was able to speak to the residents at these times about the food. They said that they like the food on offer to them and they confirmed that they do have a choice. Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 17 Care staff was seen to provide assistance to the residents when this was necessary and staff were seen to ask the residents before they offered any help to them. Meal times were seen to be unhurried and any resident who chose to eat in their bedrooms was enabled to do so. At the last inspection a requirement was made for the unfinished work in the kitchen to be completed. This included the tiling and grouting; the lighting unit that needed to be fully cleaned and the cooker hood and splash backs that still needed to be installed. The Proprietor told the Inspector at this inspection that this work had yet to be carried out however he agreed to ensure that it would be completed in the next 2 weeks. This work has now become essential in order to maintain the appropriate levels of hygiene required in the kitchen area. Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that the home will deal with complaints appropriately; information about the complaints procedure is readily available to all who may wish to express an opinion about the service. Residents can be assured that the processes in the home will protect them from potential abuse by staff or others. EVIDENCE: Standard 16 – The Proprietor showed the Inspector the complaints policy and procedure for Clifton House. This policy covers all the essential areas required for a complaints policy including a staged process with timescales and contacts for other agencies including the CSCI to contact in the event of dissatisfaction with the internal process of investigation. The Manager maintains a record of complaints and the Inspector saw this. No complaints had been recorded since the last inspection. A copy of the Complaints procedure and log record is kept on the residents’ notice board with a book available to document any complaints or concerns. After speaking with residents, it was clear that people who live in the home have great confidence that their concerns would be dealt with. This view was also reflected through reading the responses made by relatives on their comment cards. Those relatives present during the course of this inspection Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 19 told the Inspector, “The staff here respond positively to any concerns we raise, nothing is hidden and problems get resolved.” Standard 18 – Clifton House has an Adult Protection policy and the Proprietor showed the Inspector a copy of it. The policy is appropriate for the protection of the residents. At the last inspection 3 of the 8 staff had not yet been on training for the protection of vulnerable adults (POVA). Since then the Proprietor showed the Inspector evidence that those staff had since received POVA training. Following inspection of other staff training records it is clear that some other staff also received POVA training in 2005. The Proprietor will need to ensure that all the staff group receive POVA training at least once every 3 years. Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are living in a safe, well-maintained environment, with access to safe, pleasant and comfortable facilities. Residents generally presented as well settled in their environment, and as being very satisfied with the communal and personal facilities provided. EVIDENCE: Standard 19 – A tour of the premises was undertaken by the Inspector with the Proprietor as a part of this inspection and the home was seen to be clean and tidy in all areas. All areas of the home are accessible to wheelchair users and there is a lift that provides access to both floors of the building. There are at present no residents who use a wheelchair living at Clifton House. Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 21 The general condition of the home and of the facilities is good; communal areas and bedrooms are kept clean and odour-free. The Proprietor provides a ‘homely’ touch through supplementary decoration and ornaments / flower decorations and pictures hanging on all the walls. Refurbishments to the kitchen must be completed and this was referred to in the previous inspection report and also earlier in this report. Similarly completion of the refurbishments to the 1st floor bathroom must be completed, specifically the tiling and grouting and the cupboard doors. The bathroom on the ground floor needs some tiles to be replaced and the woodwork panel just beneath the hand basin also needs replacement. The ceiling in the hall outside the bedroom number 2 needs some repair following a flooded bedroom 5 on the 1st floor above it. The Proprietor said that bedroom number 5 is due for a complete refurbishment following the flood. In bedroom number 4, the wooden panel under the toilet cistern needs replacement, as it is rotted through. The Proprietor showed the Inspector the fire records for the home. The LFEPA last visited Clifton House in January 2008, 2 requirements were made. They were: 1. That fire doors should be kept clear so that the self closing mechanisms operate fully and correctly, and 2. For staff fire drills to be carried out when staffing levels are reduced e.g at night / evenings. The Inspector viewed the first of the 2 requirements as a part of the tour of the home and can report that this has been met as all fire doors were seen to be clear. The Proprietor told the Inspector that the second requirement regarding fire drills has not yet been carried out. This is now made a requirement and should be carried out as requested as soon as possible since the timescale given by the LFEPA was 18.3.08. At the last inspection the Inspector discussed with the Proprietor the need for an ongoing programme of refurbishment and redecoration. It was said that this should be documented to show how the home monitors the upkeep of the premises and makes improvements where necessary and this had been made a requirement. The annual development plan for 2006 and 2007 which had drawn up following a comprehensive assessment of needs in and around the home by the Proprietor had not been updated at the time of this inspection. It is strongly recommended especially in the light of the fact that some repairs identified in 2007 have yet to be completed that the Manager now ensures this useful management tool is maintained and updated as required and that all timescales are met appropriately. Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 22 Standard 26 – As already indicated above, the home was found at this inspection to be clean, tidy and free from offensive odours. The Inspector toured the unit together with the Manager and inspected all areas of the home. Several of the residents’ bedrooms were seen and were found to be clean and tidy and all the residents spoken to by the Inspector said that their bedrooms are decorated and furnished as they would wish. The Manager showed the Inspector the home’s infection control procedure, which seems to be effective. Staff interviewed confirmed that they are issued with appropriate clothing (disposable gloves and aprons, uniform jackets) and equipment for them to carry out their work appropriately. The laundry area is well laid out and there is an impermeable floor laid down to prevent water ingress and easy cleaning. Clifton House (77) DS0000025770.V361380.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While, generally, the home’s residents are being protected by caring and supportive staff, recruitment procedures need to be more robustly applied. Staffing records are not being properly maintained. Staffing records do not evidence that staff are being provided with the necessary induction and training and this may affect their ability to competently perform their work duties. EVIDENCE: Standard 27 – the Inspector asked for a copy of the staffing rota for Clifton House. The rota shows exactly who is working for the week. The Proprietor informed the Inspector that there are usually 2 care staff on duty for the am shifts and 2-3 care staff for the pm shifts. A senior member of staff is on duty during the day and on call at nights. There are always 1 waking night staff on duty and 1 on call. The rota provided supported this statement. Given that that there are 15 residents living at Clifton House at present the staff: resident ratio mix seems adequate to meet the needs of the residents. The Proprietor told the Inspector that no agency staff are used at Clifton House. Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 24 Standard 28 – (Please also see Standard 18 of this report) The Proprietor explained to the Inspector that now all the staff group have gained their NVQ level 2s. This means that the staff should now be better trained and able to ensure that the residents are in safe hands at all times. The Proprietor holds an NVQ level 4 qualification. The Proprietor explained that no agency staff are used in the home. Standard 29 – Clifton House does have a recruitment procedure that was inspected and seen to be appropriate for it’s purpose. As a part of this inspection the Inspector reviewed 3 of the home’s staffing files. The Proprietor told the Inspector that since the last inspection 1 new staff appointment has been made. Inspection of these 3 files showed that many of the recruitment documents that are required to be held on these staff files actually were not there. The Proprietor said that all applicants are interviewed, application forms completed; two written references gained and enhanced Criminal Record Bureau (CRB) checks undertaken. Documented evidence of the CRB checks was seen at this inspection, however other documentation regarding the recruitment process was not evidenced on staffing files seen by the Inspector in the office at Clifton House. With such a lack of evidence it cannot be said that this process is being properly implemented. Other records required for inspection include: a photograph of the staff member; an application form that includes both the applicants work and health histories; the position applied for; a start date; a job description; 2 written references; a valid enhanced CRB check carried out specifically for Clifton House; a contract of employment; evidence of qualifications; confirmation of identity; supervision and appraisal notes. It is suggested that a file / recruitment checklist system may help to address the lack of records being held on staffing files and ensure that documents are available for inspection. It is therefore now a requirement that documentary evidence required under Standard 29 of the National Minimum Standards be gathered for all the staff members at Clifton House and be held on the staff files for review and inspection. This will help to ensure that recruitment practices meet the required standards. Standard 30 – The Proprietor told the Inspector that the home has a programme of induction in place. He said it covers staff roles and responsibilities, and key policies and procedures, training to do with fire, manual handling, food hygiene and health and safety. The Proprietor said that staff induction is ongoing for up to a month with observation, shadowing from an experienced staff member and ongoing assessment. Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 25 However inspection of the new staff members file who started in July 2007 found no evidence of induction training. The same member of staff did however tell the Inspector that they had received this training although they found it difficult to remember what had comprised their induction programme. It is required therefore that induction training is recorded on each member of staff’s file and that it identifies each element of that training for future reference. With regards to staff competency it is important that all staff are familiar with the home’s policies and procedures. At the last inspection the Inspector asked the Proprietor if staff are given the opportunity to read and discuss these policies and procedures as a part of the supervision process and whether they are then asked to sign to say that they have read and understood the same policies. The Proprietor said that this practice had been carried out at an earlier date however on inspection it was found by the Inspector that not all staff had signed to say that they had read and understood all the home’s key policies and procedures. No further progress had been made at this inspection so in order for this process to be fully implemented and so as to benefit residents in that the staff will know and understand what the stated policies and procedures are, it is now a requirement that all staff are asked to review the key policies and procedures for the home and then to have a discussion in their supervision sessions over a period of time and then to sign to say that for each individual key policy and procedure that they have read and understood them and have had the chance to discuss them with their supervisor. If the timescale for this requirement is not met then enforcement action may be taken. At the last 2 inspections, concerns were raised to do with staff training and further concerns were again raised at this inspection. At the last inspection, training records showed that there were shortfalls in relation to basic essential training and the Proprietor was advised that he needed to address this problem if he is to ensure a competent and appropriately trained staff team able to best meet the needs of the residents at Clifton House. At this inspection the staffing records again did not evidence that staff have yet received the full level of necessary training referred to above. Discussion with the Proprietor indicated that some staff have received more training than the records alone demonstrate, so it is very important that staffing records for training received are clear, up to date and inclusive. This is now a requirement. Enforcement action may be taken if the timescales for requirements to do with staff training are not met. The Proprietor advised the Inspector that all the staff team have recently completed their NVQ level 2 training but are awaiting their NVQ certificates. Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 26 Staff interviewed by the Inspector confirmed that they had recently completed the NVQ level 2 training and are awaiting their certificates. As well as NVQ training, essential training for staff should include: • Safe handling of medication • Fire safety • Manual Handling • Health and safety • Managing aggression • Communication • POVA • 1st Aid • Infection control • Food hygiene Inspection of 3 staffing files identified that some staff have either not received this training or if they have if was more than 3 years ago. Identified shortfalls relate to fire safety, manual handling, food hygiene and POVA. Lack of attention to this part of the staff training can affect competency at the home. This training should be provided by a recognised and external training agency. Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 27 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): Standards 31, 33, 35, 36 & 38. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Prospective residents may be assured that the home is well run and managed by a person who is fit and able to be in charge of the day-to-day operations of the unit. They will benefit from the leadership and management approach taken in the unit. The quality assurances processes now need to be fully implemented so as to ensure that it is being run in the best interests of the residents and resident’s financial interests are safeguarded. Staff are supervised regularly however the process being used needs some regularisation and improvement. The health and safety of staff and residents is being promoted and protected. Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 28 EVIDENCE: Standard 31 – The Proprietor has been in the management role at Clifton House for over 2 years and holds the necessary experience and management qualifications to undertake this role. Standard 33 – The Proprietor told the Inspector that some further progress has been achieved since the last inspection with the quality assurance process for Clifton House. This is being carried out through formal and informal consultation with service users and from relatives and visiting professionals. Feedback forms have recently been issued to visiting relatives and professionals and the Proprietor has received some feedback. He explained to the Inspector that on receipt of all these questionnaires, a new feedback questionnaire would be given to the residents for completion by them with appropriate support as necessary. The Inspector suggested that the Proprietor could also use information from the complaints and accident records and from the residents’ weekly room safety checks. At the time of this inspection no analysis of this information had been carried out however the Proprietor agreed that this would be a useful tool for service improvement. It has taken a long time to establish a quality assurance process at Clifton House and the Inspector advised the Proprietor that by the next inspection this will need to be completed if enforcement action is to be avoided. It is a requirement that a fully operational quality assurance process is established within the given timescales in order to ensure that the home is run in the best interests of the residents and of the staff. The general feeling within the home was warm and congenial; both staff and management were open and communicative and little sense of anxiety was apparent with residents. Standard 35 – The Proprietor told the Inspector that Clifton House does not look after resident’s monies directly and therefore this Standard was not inspected. Standard 36 – The Proprietor informed the Inspector that all care staff receive formal supervision at least once every 3 months and informal supervision more often, sometimes on a daily basis. Some supervision records were seen by the Inspector in the staffing files inspected, however they did not reflect the frequency stated by the Proprietor and they had not been signed off by staff in agreement with the record made by their supervisor. The records were also Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 29 quite varied in their recording content, some not covering sufficient detail to form a useful record. The Inspector spoke with the Proprietor about this and confirmed that supervision sessions held with staff should include the monitoring and review of all aspects of care practices, the philosophy of care in the home and also career and training development needs. Areas of discussion should also cover the monitoring and review of any individual work objectives that the staff member is expected to carry out. The supervision record should detail any agreements made, revised work objectives, key areas of discussion and should be signed off by both the member of staff and the supervisor. Staff who are supervised should be given a copy of the supervision record which they may keep in their staff handbook file. The care staff interviewed confirmed that they receive supervision on a regular basis and that formally they receive supervision approximately once every 2 – 3 months and that they have informal supervision much more regularly. Staff said that they did not receive copies of their supervision records. It is a requirement that following the inspection of this standard that: • A supervision-recording format is used that covers the areas outlined above in sufficient detail to ensure a useful record is maintained for both the staff and the management if the need arises in the future. • That all senior staff who provide supervision should receive staff supervision training and that this should be completed within the next 6 months. This should help to ensure consistency in the delivery of supervision. • That all staff should be given a copy of their supervision record following the supervision meeting. Standard 38 - The Proprietor showed the Inspector the maintenance record for the home which details all the maintenance requirements and how and when they have been resolved. The home is maintained to a reasonable standard. Certificates were checked and seen by the Inspector for the following services that are installed in the home, certificates which state that these systems have been checked by appropriate professionals since the last inspection and found to be satisfactory and fit for purpose in that they help to ensure the safety of the residents. • Lift – 27.3.08 • Fire protection and alarm system – 4.12.07 • Fire extinguishers – 13.3.08 • Boiler and gas – 14.2.08 • Electrical systems check was carried out in 2000 and is now required as each check is only valid for 5 years. Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 30 Checks on the hot water outlets are also now being regularly checked and temperatures recorded. The records were seen and checked to 22.2.08. All recorded temperatures came within the prescribed limits. Fridge and freezer temperatures should be checked daily and a record taken. Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 31 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 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 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 2 X 2 Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 32 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 OP15 Regulation 16 Requirement Refurbishments (identified in this report including to the kitchen and to the 1st floor bathroom) must be completed. Other areas include: The bathroom on the ground floor needs some tiles to be replaced and the woodwork panel just beneath the hand basin also needs replacement. The ceiling in the hall outside the bedroom number 2 needs some repair following a flooded bedroom 5 on the 1st floor above it. In bedroom number 4, the wooden panel under the toilet cistern needs replacement, as it is rotted through. The LFEPA’s second requirement regarding fire drills should be carried out as requested as soon as possible since the timescale given by the LFEPA was 18.3.08. All staff should receive a basic level of essential training as described from a recognised and external training agency. Induction training should be recorded on each member of staff’s file identifying each Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 33 Timescale for action 01/06/08 2. OP19 23 01/05/08 3. OP30 18 01/06/08 element of the training received. Staffing records for training must be clear, up to date and inclusive. That all staff are asked to review the key policies and procedures for the home and then to have a discussion in their supervision sessions over a period of time and then to sign to say that for each individual key policy and procedure that they have read and understood them and have had the chance to discuss them with their supervisor. That the Quality Assurance process is fully established for the home. That following the inspection of this standard that: A supervision-recording format is used that covers the areas outlined above in sufficient detail to ensure a useful record is maintained for both the staff and the management if the need arises in the future. That all senior staff who provide supervision should receive staff supervision training and that this should be completed within the next 6 months. This should help to ensure consistency in the delivery of supervision. That all staff should be given a copy of their supervision record following the supervision meeting. That a new Electrical system check is now carried out. Documentary evidence required under Standard 29 of the National Minimum Standards be gathered for all the staff members at Clifton House and be held on the staff files for DS0000025770.V361380.R01.S.doc 4. OP30 18 01/06/08 5. 6. OP33 OP36 24 18 01/05/08 01/05/08 7. 8. OP38 OP29 13 19 01/05/08 01/05/08 Clifton House (77) Version 5.2 Page 34 9. OP38 16 review and inspection. Fridge and freezer temperatures should be checked daily and a record taken. 01/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP38 Good Practice Recommendations The registered provider should undertake a regular audit of accident records to identify if any patterns or trends are forming e.g. recurrent falls. (Repeated from October 2005 inspection) That for each staff member a training file is compiled which includes a list of training that each staff member has received and when; certificates which evidence that the training has been given and received; and a list of training needs identified through 1:1 supervision that should be provided for by additional training in the year ahead. The annual development plan for 2006 and 2007 needs to be updated especially in the light of the fact that some repairs identified in 2007 have yet to be completed. 2. OP38 3. OP19 Clifton House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 House (77) DS0000025770.V361380.R01.S.doc Version 5.2 Page 36 - 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!