CARE HOME ADULTS 18-65
Clifton House 1 Grantley Road Boscombe Bournemouth Dorset BH5 1HW Lead Inspector
Trevor Julian Key Unannounced Inspection 8th September 2006 11:00 DS0000003930.V311186.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000003930.V311186.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000003930.V311186.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Clifton House Address 1 Grantley Road Boscombe Bournemouth Dorset BH5 1HW 01202 393385 01202 303620 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) www.together-uk.org Together Working for Wellbeing Mr Douglas Low Care Home 23 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (23) of places DS0000003930.V311186.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Five named adults (names known to CSCI) over the age of 65 years may be accommodated until such time as their assessed needs cannot be met by the home 1st November 2005 Date of last inspection Brief Description of the Service: Clifton House is situated in a quiet residential area of Boscombe and is close to all local amenities. It is a corner property with a pleasant rear garden and an outside laundry area. It is registered under the category mental disorder (MD excluding learning disability or dementia) for up to 23 male and female service users. The home has 21 single bedrooms and 1 double; none has en-suite facilities. There is a self-contained flat within the building, which can accommodate two service users assessed as suitable for more independent living. Clifton House is operated by Together an independent organisation that accommodates and supports individuals with enduring mental health problems. Residents receive 24-hour emotional and practical support from a team of experienced residential care workers. The registered manager Mr Low and a very experienced staff team undertake the day-to-day running of the home. In September 2006 the stated weekly charges, were £430. DS0000003930.V311186.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on Friday 8th September 2006 between 11:00 and 16:00. The home’s manager Mr D Low was on the premises throughout the visit. Before the visit the residents and others involved with the home were invited to complete surveys giving their views of the home. A good level of responses were received from the residents, care managers and community health teams. All were very positive and none identified any areas of concern. The purpose of the visit was to monitor the homes performance against key standards. Information was gathered through discussion with the residents, staff, visitors and management, a tour of the premises and a review of some care records and procedures. What the service does well:
The home continues to operate to a very good standard. One comment card from a healthcare professional stated. “Clifton House has impressed me as a well-run and effectively managed unit which works to promote independence for its residents”. The residents appreciate the relaxed atmosphere of the home and commented that although there were rules they were not restrictive. The home operates a clear admission process and, where possible, gives the prospective residents chance to decide if the home is suitable over several introductory visits. Care plans were comprehensive and included risk assessments and information on social and health needs. Although none of the residents were accessing advocacy services at the time of the visit the home had referred residents to an independent advocacy service in the past. The residents seen said they felt supported by their keyworker. Several residents visits local day centres for therapeutic activities. The home is located close to the main shopping centre and was accessible to all the residents. The home arranges a range of social activities for the residents. Some of the residents attend a local church. Residents said they enjoyed the food. One the day of the inspection most had made sure they were back in the home for lunch as a local shop was supplying fish and chips. The menus showed a good variety of items including fruit and vegetables.
DS0000003930.V311186.R01.S.doc Version 5.2 Page 6 The home arranged support from community healthcare teams as needed. The organisation had systems to record and investigate concerns and complaints from residents or visitors. None had been recorded by the home since the last visit; none had been reported to the Commission. Staff receive training in how to respond to allegations of abuse. The accommodation was maintained to a good standard and there had been ongoing refurbishment to the property between visits. The staff were trained to a good standard. Four people were working towards their NVQ level 3 and records showed that staff have access to a comprehensive training programme. The home had an appropriate recruitment procedure helping to ensure that only suitable candidates were appointed. The manager has NVQ level 4 in management and the registered managers award. The home has monthly group meetings to allow the residents chance to voice their views of how the home is being run. The organisation carries out monthly monitoring visits to ensure standards are maintained. Once a year an external organisation carries out a Quality Assurance survey and produces a report of the findings. The home provides a safe environment for the residents and staff. Risk assessments were in place to identify any hazards. Fire safety systems and training were up to date. Accident and incident reports were monitored to check for trends. 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. DS0000003930.V311186.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000003930.V311186.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home’s admission procedure allows the individual to make informed decisions about the suitability of the placement. EVIDENCE: The records of a recent admission to the home showed that he had been invited into the home on seven occasions before having to decide on the home’s suitability. The home used the Care Programme Approach (CPA) and the visits to assess the home’s ability to meet the individual’s needs. It was also used to develop the home’s care plan. Following admission the first six weeks were a trial period to allow the placement review to take place. One comment card confirmed that this had been the experience of one of the residents. Mr Low said the home preferred to take a “slow” approach to admissions but that they also had systems to manage any emergency placements. DS0000003930.V311186.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments involved the individuals to ensure they agreed with the plans put into place. Individuals at Clifton House are encouraged to make choices in their daily lives with support available from staff and other agencies. EVIDENCE: The care plans seen were comprehensive and of a good standard. There was evidence that residents had been involved in the care planning process and where a resident had declined to sign the care plan the reasons were noted. The care plans seen, included information on spiritual needs, basic nutritional assessments and individual risk assessments. The comment cards and discussions with staff and residents showed that the staff do respect the ideas and wishes of the individual. One person
DS0000003930.V311186.R01.S.doc Version 5.2 Page 10 commented that she has help from her key worker when she needed to make decisions. In the past, the home had arranged advocacy services for a resident. All the responses showed that the residents enjoyed a good degree of freedom and were able to make decisions about their lifestyles, while support and advice was available within the service or through the other agencies the residents’ were accessing. The home looked after personal allowances for most of the residents. A check showed there were records of expenditure and income but there were no transactions records. The manager reported that the issue had recently been identified and that an improved recording system was being introduced. The balances checked matched the recorded balances. DS0000003930.V311186.R01.S.doc Version 5.2 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 &17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to maintain activities, social interests and relaxation in order to assist them to gain fulfillment. Residents maintain links with their families and friends and are encouraged to seek support and friendship in the wider community. Residents’ rights are respected and they are encouraged to exercise as much control over their daily lives as their circumstances allow. Meals offer choice and variety to encourage a good nutritional intake. EVIDENCE: Residents said they regularly accessed the local community through visits to day centres sports centres and other activities. Many of the residents attend centres during the day to for therapeutic activities. Spiritual needs were
DS0000003930.V311186.R01.S.doc Version 5.2 Page 12 considered during the admission process and some people attend a local church. During the visit a number of visitors came to the home and residents said their friends and family were made welcome by the staff Residents said there were daily tasks in the home and these were assigned through rotas. Residents were able to lock their rooms subject to risk assessment; there was a clear ethos that the rooms were private and the staff and other residents respected this. The home benefits from several communal areas allowing residents some degree of choice about where they spend their time. Some people enjoyed spending quiet time in the secluded garden at the rear of the property. A smoking lounge was provided on the ground floor. The menu offers a range of meals with choices for each meal including fruit and vegetables. On the day of the visit most people were looking forward to fish and chips supplied by a local shop as the cook was on a day off. The care records identified one person with a poor appetite this was being monitored and healthcare professionals were involved in managing the situation. There were no specialist diets at the time of the inspection. Residents said the meals were good and there was always a good choice on offer. During the visit it was noted that the residents were able to access soft drinks at any time. At the last inspection it was noted that there was a risk of scalding from the water heater in the dining room this had been addressed. DS0000003930.V311186.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The views of the individuals are considered when the care plans are developed to ensure that they are supported in an appropriate manner. The home works with community healthcare teams to manage the health needs of the residents. The residents are protected by the home’s medication systems. EVIDENCE: The care plans seen had been developed with the individual residents and with input from healthcare professionals. One of the residents said that there were house rules but they were not excessive and were fair. Healthcare matters are referred to three local GP practices. One resident who had recently seen her GP confirmed this. Dental and optician appointments were arranged as required. One visitor said she was not sure if her relative had seen the dentist recently, however it appears that the resident had declined an appointment. Comment cards from GP’s, other healthcare
DS0000003930.V311186.R01.S.doc Version 5.2 Page 14 professionals and care managers indicated that there was good communication links with the home. The homes medication was well managed and safely stored. The home used a monitored dosage system supplied by a local chemist. The medication policy was signed and dated and reference books were available to the staff. All staff had attended a training course on how to use the system. DS0000003930.V311186.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had systems for responding to complaints and adult protection allegations. EVIDENCE: The home had procedures and systems for recording and responding to complaints from residents and visitors. Residents said they were able to raise concerns with their key worker and there were opportunities to discuss general issues in the monthly group meetings. There had been no complaints recorded within the past year. No issues or concerns had been passed to the Commission. The adult protection policy was last updated in May 2005. In addition, the home had policies for whistleblowing and dealing with violence and aggression. DS0000003930.V311186.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides the residents with a safe, clean and comfortable environment. EVIDENCE: The home was well maintained and there was evidence of ongoing repairs and refurbishment recently the self-contained unit had been refurbished and a new kitchen provided. Officers from Dorset Fire and Rescue Services and Environmental Health inspected the home in July 05 and April 04 respectively. Contractors regularly check the gas and electricity installations. The home has bedrooms on the first and second floor so mobility issues are considered during the admission process. The rooms seen had appropriate lock allowing privacy but can be accessed by staff in case of emergency.
DS0000003930.V311186.R01.S.doc Version 5.2 Page 17 Residents felt the home had a friendly and supportive atmosphere. A bath aid was available for those needing assistance getting to and from the bath. The home’s laundry is located outside and is away from food storage and preparation areas. The cleaner was on duty during the visit and the home was kept very clean and tidy. One resident said that he really appreciated her work as it created a good environment for them to live in. DS0000003930.V311186.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. For the benefit of the residents of Clifton House, competent and qualified personnel staff the home. EVIDENCE: The home benefits from having a stable and experienced workforce. The organisation has a local pool of relief workers who are used to cover staff absence, avoiding the need for agency staff. Four of the staff have started NVQ level 3. The training records show comprehensive training available to the staff which is accessed through discussion at supervision sessions. The manager has NVQ 4 in management and the Registered Managers Award. Staff described the organisation’s training as very good. Since the last inspection, two support workers have left the project. The recruitment process for their replacements was thorough and the required references and clearances were in place before they started work. New staff complete an induction programme.
DS0000003930.V311186.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed for the benefit of the residents and staff. Residents and visitors have the opportunity to express their views about how the home is operated. The health, safety and welfare of service users and staff are protected by suitable policies, procedures and practices at the home. This means that they can be confident of management support and guidance whilst living or working there. EVIDENCE: The home’s manager has the required qualifications and experience to manage effectively. The training records show that the manager undertakes regular DS0000003930.V311186.R01.S.doc Version 5.2 Page 20 training to keep abreast with current best practice. The organisation has a system of monthly visits to the home to monitor the standards. The home holds monthly resident meetings in order to seek their views on topical issues in the home. The organisation commissions an external quality assurance survey which is used to identify areas for improvement. The survey identified that residents would like a conservatory and plans were being developed to assess feasibility. Fire safety inspections and training were in place and up to date. The fire risk assessment was due for review in October 2006 and was not examined on this occasion. Safety equipment was regularly inspected by approved contractors. Accident and incident reports were monitored locally and by the organisation to check for trends. DS0000003930.V311186.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X X X X 3 X DS0000003930.V311186.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000003930.V311186.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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