CARE HOMES FOR OLDER PEOPLE
Clifton House (77) 77 Brighton Road Coulsdon Surrey CR5 2BE Lead Inspector
Claire Taylor Unannounced Inspection 9th February 2006 12:30 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.V283234.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 House (77) DS0000025770.V283234.R01.S.doc Version 5.1 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.V283234.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6th October 2005 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.V283234.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second of the statutory two inspections that the Commission for Social Care Inspection is required to carry out each year. For a complete overview of the home’s standard of operation between these dates, this report should be read in conjunction with the inspection report carried out in October 2005.This visit was unannounced, began at 12.30pm and lasted four hours. Inspection time was spent talking to several residents and staff, one visiting relatives and the manager/ owner, Stephen Sparshott, who facilitated most of the inspection. They are all thanked for their time and assistance. A brief walk round the premises took place and various records were checked in relation to residents’ plans of care, the home’s operation and previous requirements/ recommendations. Due to a repeated concern highlighted at the last inspection, an immediate requirement was once again issued. The provider complied within the given timescale however. What the service does well: What has improved since the last inspection?
Clifton House (77) DS0000025770.V283234.R01.S.doc Version 5.1 Page 6 Over the last twelve months, the manager/ owner has taken action to address most of the areas identified for attention which has resulted in notable improvements in the home’s operation. Some outstanding issues do still need to be addressed however and have been highlighted in the next section. Following the October 2005 inspection, risk plans for residents have been reviewed to fully reflect their mobility needs and ensure that staff have up to date information on how to support them. The home undertakes a review of needs following the resident’s admission to check that the home can continue to meet their needs. Some further recreational activities have been introduced such as art and craft activities. The refurbishment of the upstairs bathroom has progressed further and two vacant bedrooms were in the process of redecoration. The hot water supply temperature had been adjusted to the correct limit and regular checks on all hot water facilities are now being carried out. Some double-glazed windows have been installed to the front of the house and essential repairs to the roof have been completed. What they could do better:
An immediate requirement was issued because the home had failed to fully address outstanding requirements concerning the vetting of staff. No CRB disclosure or POVA First check was available for one staff. A follow up visit was undertaken on the 24th February to check compliance and the registered provider had taken the required action. Records for the newest staff member revealed that the home had failed to complete all the required recruitment checks as required in the Care Homes Regulations 2001. Practices must therefore improve or the Commission may consider taking further enforcement action. Such lack of diligence may put residents at risk and staff must be employed correctly. The provider is also required to review and rewrite the home’s policies and procedures for recruiting staff. Some requirements remain outstanding from the previous two inspections and the registered provider must attend to these without delay. These are outlined as follows. Limited progress has been made with regards to the home implementing a quality assurance system and an annual development plan, with both involving service users. Further training for some staff who work nights must be prioritised as they have only attended limited courses and may therefore lack important skills and knowledge to meet the residents’ needs. Although an ongoing programme of refurbishment and redecoration was in operation, this must be documented. Sufficient numbers of staff are required to receive accredited training in the management of medication to further maximise safe practice. It would be good practice if the home kept records of all recreational activities that residents participate in to show that they are being provided with sufficient social stimulation. While the home has improved upon the provision recreational and social activities, residents would benefit from more engagement in community-based activities. This was a view shared by some of the relatives at the previous inspection. Clifton House (77) DS0000025770.V283234.R01.S.doc Version 5.1 Page 7 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 House (77) DS0000025770.V283234.R01.S.doc Version 5.1 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.V283234.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this home as it does not provide intermediate care. Residents’ needs are assessed prior to admission to ensure that the home can meet their needs and that staff are aware of how to support them. EVIDENCE: Pre-admission assessments are comprehensive and form the basis for care planning, which is reviewed regularly and documentation remains well kept. The assessment is usually completed with the resident, his/her relative or representative and with the relevant professionals that have been associated with the referral. Detailed information about the person, their medical and social history background and details of specific care areas such as nutrition, skin care, medication and mobility are included. In addition, the home completes a questionnaire to establish any personal preferences of the new resident. Three residents had been admitted to the home since the last inspection. Their records were checked and needs assessments had been completed. As previously required, the home had undertaken a review of needs following each resident’s trial period. This therefore helps to ensure that the home only admits residents whose care needs can be met appropriately. Clifton House (77) DS0000025770.V283234.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 and 9 Care planning is well organised and regular informal reviews ensure that staff are aware of each residents’ current needs. Overall, the arrangements for the management of resident’s medicines are appropriate but staff need to attend formal training to further maximise safe practice. Standards 8 and 10 were assessed as met at the October 2005 inspection. EVIDENCE: At the last inspection, it was highlighted how well the home had improved upon the care planning process. Residents care plans remain well organised and contain all the necessary information to guide staff to meet their needs. The three newest residents files were sampled and each person had a care plan drawn up from their needs assessment. Care plans address the health, personal and social care needs of residents and continue to be reviewed monthly. As previously required, risk assessments that seek to protect resident’s health and safety have been expanded upon. Risk plans are completed in respect of residents’ skin integrity, mobility, and nutrition (including weight monitoring). The home uses a monitored dosage system for medication, with most medication being delivered in blister packs by the dispensing pharmacist from “Boots”. Medicines are stored appropriately in a
Clifton House (77) DS0000025770.V283234.R01.S.doc Version 5.1 Page 11 locked cabinet; administration records were seen as up to date and accurate. Likewise, medication for return or disposal is accurately recorded in a book. Residents’ medication is reviewed regularly by their G.P. to ensure that the correct treatment regime is followed and based upon their needs. A pharmacist visits six monthly to audit medication storage and procedures; details of these visits were available and no areas of concern were identified following the most recent one (2nd February 2006). The manager advised that staff receive in house training on the administration of medication. Staff must achieve accredited medication training and a requirement was therefore set. The manager should arrange training through the supplying Boots pharmacy. Clifton House (77) DS0000025770.V283234.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): 12, 13 and 15 The home has improved upon the range of activities offered to provide more stimulation for the residents although links with the local community could still be enhanced. Meals are nutritiously balanced and offer a healthy and varied diet for the people who live there. Standard 14 was assessed as met at the October 2005 inspection. EVIDENCE: Social interests and hobbies are recorded within the residents’ care plans so that staff know what residents’ individual preferred activities are. As previously required the manager has made efforts to provide further stimulating activities for the residents and art and craft activities have been introduced. Bingo, newspapers, quizzes, exercise sessions, films and sing along sessions are among some of the other activities provided as well as entertainers who visit the home from time to time. Some residents said they really enjoyed the Christmas party. The home has made arrangements for one new resident to continue to attend her previous luncheon club since she transferred to the home. The general care provided by staff to residents was once again, observed to be sensitive and caring and staff consulted individuals about their preferences as appropriate. Monthly meetings are held for residents to discuss issues. As good practice, it is suggested that the staff note down all recreational activities that people take part in. In addition and repeated from
Clifton House (77) DS0000025770.V283234.R01.S.doc Version 5.1 Page 13 the last inspection, the manager should explore ways that the home could facilitate more community-based activities. Staff ask residents each day for their meal choices and food provisions are purchased on a daily basis. Food served during this inspection was hot, well presented and preferred choices catered for. I.e. the cook prepared an alternative dish of braising steak at the request of one individual. Staff served and assisted individuals appropriately and sensitively and there was a pleasant social atmosphere for residents during the lunch. Several residents commented that the ‘the food is excellent’ and confirmed that they were always offered meal choices. Clifton House (77) DS0000025770.V283234.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 The home’s practices generally safeguard residents although the vetting of employees is still not thorough to ensure that people living in the home are fully protected from abuse. Standard 16 was assessed as met at the October 2005 inspection. EVIDENCE: Procedures are in place for responding to suspicion or evidence of abuse, including whistle blowing and safeguarding service users financial affairs. All the care staff have either attended training on the protection for vulnerable adults awareness workshop or undergone adult protection awareness through the home’s induction training programme. The vetting of employees is still not secure and must be improved upon. This was highlighted at the last inspection and on this occasion, another staff member did not have a Criminal Records Bureau check. This issue has been discussed in further detail under staffing standards. Clifton House (77) DS0000025770.V283234.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): 19 and 25 Clifton House is clean, hygienic and comfortably furnished and residents live in homely and pleasant surroundings. The hot water supply has been adjusted to the required temperature to further safeguard residents and staff from avoidable harm. Standard 26 was assessed as met at the October 2005 inspection. EVIDENCE: As highlighted in the home’s previous inspection report, significant improvements have been made to the environment and the home presents as well furnished, clean and comfortable for the residents. There has been further progress with the refurbishment of the upstairs bathroom and two vacant bedrooms were in the process of redecoration. Double glazed windows have been installed to the front of the house and the manager reported that necessary repairs to the roof had been completed. Good standards of hygiene practice are well observed and as previously required, the hot water supply temperature had been adjusted to the correct limit. Records showed that checks on all hot water facilities were being carried out each week. Although an ongoing programme of refurbishment and redecoration was in operation, this must be documented and this requirement is therefore repeated.
Clifton House (77) DS0000025770.V283234.R01.S.doc Version 5.1 Page 16 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): 28 and 29 Failure to ensure that all staff are vetted correctly does not offer full protection to people living in the home and recruitment practices must be improved. Standards 27 and 30 were assessed as met at the October 2005 inspection. EVIDENCE: Three staff have trained and achieved the qualification of NVQ level 3 in care, one has completed the NVQ level 2 qualification with another staff currently studying towards level 2. This meets the required target set by the National Minimum Standards for 50 of the staff team to be trained to this level. At the last inspection, a serious concern was highlighted regarding the vetting of staff and an immediate requirement was issued. Although the registered provider dealt with the matter satisfactorily, the same shortfalls concerning recruitment checks were identified during this inspection. No CRB disclosure or POVA First check was available for one staff who has worked in the home since November 2004. Another immediate requirement was therefore issued with a follow up visit undertaken on the 24 February to check compliance; the registered provider had taken the required action within the given timescales. One new staff has been appointed since October 2005 inspection but the home had failed to carry out all the required recruitment checks. The new staff’s file revealed that there was no reference from their last employer, no employment history given on the job application form, no health clearance and also that their CRB disclosure had been completed by the previous employer. If staff are not vetted correctly this could potentially place residents at risk and both the manager and deputy were reminded of the necessary checks that must be undertaken before staff are appointed. Recruitment practices must therefore
Clifton House (77) DS0000025770.V283234.R01.S.doc Version 5.1 Page 17 be improved as a matter of urgency or the Commission may consider further enforcement action. The provider is required to review and rewrite the home’s policies and procedures for recruiting staff. Clifton House (77) DS0000025770.V283234.R01.S.doc Version 5.1 Page 18 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 and 38 Limited progress has been made by the home to establish a quality assurance system to show how they intend to make positive changes and monitor quality of care. Based on residents’ views, the home must therefore develop its quality monitoring systems further. Overall, health and safety practices are well observed to ensure that residents live in a safe environment but some staff must attend training in key health and safety topics. Standards 31 and 35 were assessed as met at the October 2005 inspection. EVIDENCE: At the two previous inspections, the home was required to implement a quality assurance system and an annual development plan. The home has designed questionnaires but these have yet to be offered to residents, their relatives and other interested parties. Once these are returned this information can be included in the annual development plan. This then can be used as the basis of a quality assurance system. As this has not commenced, the requirement is
Clifton House (77) DS0000025770.V283234.R01.S.doc Version 5.1 Page 19 repeated. The servicing and maintenance records for the home were verified at the last inspection and up to date. A selection of health and safety records was therefore sampled on this occasion. All accidents and incidents are recorded appropriately and clear safety notices are posted throughout the home. As previously recommended, a regular audit of accident records should be undertaken to identify if any patterns are emerging concerning falls and if particular residents are more prone to these occurrences. Fire drills are appropriately organised and fire alarms and equipment checked at regular intervals. A previous requirement concerned the lack of training for specific night staff in key health and safety issues. I.e. fire, moving and handling, food hygiene and infection control. This has yet to be addressed and must be attended to by the registered provider. All staff must be appropriately trained and up to date with current legislation in order that the residents’ health and welfare is better safeguarded. Clifton House (77) DS0000025770.V283234.R01.S.doc Version 5.1 Page 20 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 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X X X X 3 X STAFFING Standard No Score 27 X 28 3 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X X X 2 2 Clifton House (77) DS0000025770.V283234.R01.S.doc Version 5.1 Page 21 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 OP9 Regulation 18(1)(a&c ) 23(2)(b) (d) Requirement Staff must receive accredited training in the safe handling and administration of medication. The registered provider must develop and maintain a written plan for the home’s maintenance and redecoration programme. (Now outstanding from previous two inspections) The registered provider must ensure that staff identified at this inspection have applied for a CRB disclosure and have a POVA first check in place by 23/02/06 Immediate requirement issued and complied with by 23rd February 2006. The registered provider must ensure that all documentation required in Schedule 2 of the National Minimum Standards and regulations is obtained for all staff members and retained in the home. Timescale for action 31/05/06 2. OP19 31/03/06 3. OP29 13 (4c) 17(2) 23/02/06 4. OP29 17(2) 18(1) 30/04/06 Clifton House (77) DS0000025770.V283234.R01.S.doc Version 5.1 Page 22 5. OP29 13(6) 17(2) 19(4)(5) The home’s recruitment policy 30/04/06 and practices must be reviewed and rewritten to ensure that all necessary checks are undertaken prior to the appointment of new staff. The registered provider must ensure that they obtain an up to date CRB and POVA check for all new staff before they commence employment. Staff must not work unsupervised until such time that a valid CRB and POVA clearance has been received. The provider must seek the views of residents, their family members / representatives and other interested parties to ensure that the home is meeting its aims, objectives and stated purpose. Results of these surveys must be made available in the home. (Now outstanding from previous two inspections) A written annual quality assurance development plan needs to be developed for the home that is based upon the views of residents and other relevant parties. (Now outstanding from previous two inspections) All staff (i.e. night staff) must receive training in fire safety with records to evidence this kept in the home. (Now outstanding from previous two inspections) 30/04/06 6. OP29 17(2) 19(1)(b,c) 7. OP33 24 31/05/06 8. OP33 24 31/05/06 9. OP38 23(4)(d) (e) 30/04/06 Clifton House (77) DS0000025770.V283234.R01.S.doc Version 5.1 Page 23 10. OP38 17(2) (6a) All staff (i.e. night staff) must be 18(1) fully up to date with their training in key health and safety topics to ensure that residents needs are fully met and health and safety practices are adhered to. 31/03/06 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 OP13 Good Practice Recommendations The manager should explore ways that the home could facilitate more community-based activities. (Repeated from October 2005 inspection) The home should keep records of all social and recreational activities that residents participate in. 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) 2. 3. OP13 OP38 Clifton House (77) DS0000025770.V283234.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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