CARE HOMES FOR OLDER PEOPLE
Clifton House Residential Care Home Clifton House 94/96 Clifton Avenue Hartlepool TS26 9QP Lead Inspector
Mr Paul Emmerson Key Unannounced Inspection 7th June 2007 9:30 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 Residential Care Home DS0000058542.V342498.R02.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 Residential Care Home DS0000058542.V342498.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Clifton House Residential Care Home Address Clifton House 94/96 Clifton Avenue Hartlepool TS26 9QP 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) 01429 223399 01429 890632 info@cliftonhousecare.com Finest Care Limited Susan Heel Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Clifton House Residential Care Home DS0000058542.V342498.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 8th June 2006 Brief Description of the Service: Clifton House is a care home for older people, registered under the Care Standards Act 2000, providing accommodation and care for up to 28 older people. The home has 28 single bedrooms. 14 bedrooms have en-suite facilities. Clifton House is located in a quiet road, close to local amenities and the town centre. Most of the people who live at Clifton House personalise their bedrooms with their own furniture and personal belongings. The home has a number of communal areas that are well used by residents. There are quieter areas should privacy be required. Although the home is situated over four levels, a lift gives access to all floors. From information provided by the home, the current charges range from £354 to £375 per week. The higher rate is charged for some of the bigger rooms upstairs. Additional charges include those for hairdressing £4.50, chiropody £10 and newspapers (at cost). Clifton House Residential Care Home DS0000058542.V342498.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 7 hours, on the morning and afternoon of Thursday 7 June 2007. In line with current CSCI policy on ‘Proportionality’, the inspection focused upon a number of key standard outcomes for the people who use the service. The inspector looked around the building and a number of records were examined. 10 people who live at Clifton House, 6 relatives / visitors, the home’s manager and 10 members of staff were spoken to. What the service does well: What has improved since the last inspection?
Management and staffing arrangements are much more settled. Administrative arrangements are better organised. Care reviews are being carried out with other health and social care professionals. Care planning arrangements in the home have been revised. A new care plan review recording tool has been written, which specifically seeks the views of the person receiving care, their thoughts and feelings. Much of the home has been redecorated and refurbished. Communal areas look attractive, feel comfortable and are pleasant places to sit. A number of bathrooms have been refitted and are better suited to meet the needs of the people who live at Clifton House. Building work has been carried out to provide an additional 8 en-suites. 14 bedrooms now have en-suite facilities. A new hot water boiler has been installed. A number of people spoken to on the day of the inspection commented that the home is looking much better. Clifton House Residential Care Home DS0000058542.V342498.R02.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Clifton House Residential Care Home DS0000058542.V342498.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Clifton House Residential Care Home DS0000058542.V342498.R02.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions to the home are well managed. People’s needs are assessed prior to admission. EVIDENCE: Some of the people spoken to during the inspection had moved in to Clifton House recently. They spoke positively about the home and how they have been made to feel welcome. One person said, “Clifton House was recommended”. A visitor said, “The social worker found the vacancy for us. When we were told it was Clifton House we were very pleased. We came to look around while (my relative) was in hospital. We had a choice of rooms. Everything was in place on her discharge from hospital”. A recently admitted person’s care plan documents were examined. These showed a pre-admission assessment had been carried out, which was being developed to inform the delivery of the person’s care. Assessment / care plan
Clifton House Residential Care Home DS0000058542.V342498.R02.S.doc Version 5.2 Page 9 information was also obtained from the local authority social services department and hospital discharge team. People who are thinking about moving into Clifton House are welcome to visit with relatives, have a meal and stay overnight if necessary. In this way people can get to know the home. Any move into Clifton House is on a six-week trial basis. At the six-week stage a formal review meeting is held to consider permanency. Clifton House has Statement of Purpose, Service Users Guide and Contract documents to provide information about the home. Clifton House Residential Care Home DS0000058542.V342498.R02.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal and healthcare needs are met. Appropriate care plans are prepared. Medicines are adequately dealt with. EVIDENCE: The inspector spoke to, and spent time in the company of, the people who live at Clifton House. These people are well cared for and comfortable in their home. The management and staff of Clifton House ensure that people’s health care needs are met. Where specialist intervention is required it is sought. Records confirm that contact with GPs and other health professionals is maintained. For example, a pharmacist from the local ‘Older Persons Integrated Needs Team’ has visited Clifton House and has carried out medication reviews. A person who lives at Clifton House said, “The staff are very good, pleasant, helpful.” Another person said, “If there’s a problem they sort it out. They took
Clifton House Residential Care Home DS0000058542.V342498.R02.S.doc Version 5.2 Page 11 me to see the doctor yesterday”. A relative spoken to on the day of the inspection said: “The staff seem alright. They’re always busy, but helpful”. The inspector looked at 4 care plans, which were all generated from initial assessments. Care plans are clear about people’s physical and emotional needs and describe the care required and being provided to meet such needs. People who use the service and/or their relatives are involved in formulating the care plan and they sign to agree it. Within the care notes there are specific documents for other health care professionals to enter their findings and record treatments that have been given. Since the last inspection of Clifton House, care plans have been reviewed and developed. They now better record mental health and nutritional needs. However, although most people are weighed regularly, it is recommended that the home should acquire, or access, weigh scales suitable for people who need to use a wheelchair, so their weight can also be monitored better. A new care plan review recording tool has been written, which specifically seeks the views of the person receiving care, their thoughts and feelings. The action taken to update care plans is acknowledged. The inspector observed, through the actions and responses of staff, that staff respect the privacy and dignity of the people who live at Clifton House. For example, staff were seen to knock before entering people’s bedrooms. People spoken to expressed general satisfaction with the manner and attitude of staff. The home uses a monitored dosage system to administer medicines. Policies, procedures and systems in place relating to the receipt, recording, storage, handling, administration and disposal of medicines are generally adequate. Since the last inspection of Clifton House, arrangements for the storage of medicines have been reviewed and more space has been created. However, although the home’s medicines trolley is kept locked when not in use, it also needs to be put away in a locked cupboard or kept secured to a wall. It was also noted that where people are admitted for short breaks, staff are putting medicines into weekly medi-packs – instead of administering tablets from the original containers. This secondary dispensing of medicines is potentially unsafe. All medicines must be dispensed from the container provided by the pharmacist who supplied them. Clifton House Residential Care Home DS0000058542.V342498.R02.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social needs are recognised and to some degree are provided by the home. There are open visiting arrangements. The rights of people who use the service are respected and choice is provided. Although meal choices are limited, meals are of a good standard. EVIDENCE: Until recently an activities co-ordinator was employed. However, this post is now vacant. It is acknowledged that entertainment is arranged. Care staff also provide activities wherever possible, and staff were seen to engage with the people who live at Clifton House in social interaction. However, due to the layout of the home and the need for care staff to carry out personal care tasks and support, it is suggested that more could be done to meet the social needs and expectations of the people who use the service. One person who lives at Clifton House said, “I’d like to get out more, there’s not much to do”. To ensure that the home can better meet the social and recreational needs and expectations of the people who live at Clifton House, it is recommended that the activities co-ordinator post should be filled as soon as possible.
Clifton House Residential Care Home DS0000058542.V342498.R02.S.doc Version 5.2 Page 13 Clifton House has open visiting arrangements. The inspector spoke to 6 visitors who provided positive feedback. A visitor said, “The staff are always very welcoming and offer tea and biscuits”. Although people spoken to gave mixed responses about their satisfaction, food served was seen to be of a good standard. One person spoken to said, “The food doesn’t always suit everybody, but I’ve no problems. If it’s there I’ll eat it, I’ll try anything”. To ensure that meals served meet people’s preferences, kitchen-staff visit the people who live at Clifton House on a daily basis to obtain their meal preferences / alternatives for the day. However, to ensure that any dissatisfaction is resolved, it is recommended that the current 3 week rotating menu should be reviewed and where necessary additional food alternatives provided. Clifton House Residential Care Home DS0000058542.V342498.R02.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has systems in place to respond to complaints. People who use the service are safeguarded from abuse. EVIDENCE: Information about complaints, how and who to make them to, is made available through information displayed on the home’s notice boards and in the home’s ‘Service Users Guide’. Any complaints are appropriately dealt with and are adequately recorded. People’s views are obtained through regular contact and an ‘open door policy’. From time to time ‘Residents Meetings’ are held, which provide an additional forum to discuss any concerns or potential difficulties. The home has a copy of the local authority’s ‘No Secrets’ guidance on abuse and the protection of vulnerable adults and its own policy and procedure to follow in the event of an adult protection issue. Procedures are in place to safeguard the financial affairs of the people who live at Clifton House. Staff have received ‘No Secrets / Protection of Vulnerable Adults’ training. Clifton House Residential Care Home DS0000058542.V342498.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clifton House is well maintained. The home is clean, tidy and free from offensive odours. EVIDENCE: Clifton House is located in a quiet road, close to local amenities and the town centre. The inspector looked around the building and saw that most people have personalised their rooms with their own furniture and personal belongings. The home has a number of communal areas that are well used by the people who use the service. There are quieter areas should privacy be required. Although the home is situated over four levels, a lift gives access to all floors. Since the last inspection of the home the lounge and dining room have been redecorated and refurbished. 2 of the home’s 4 bathrooms have been refitted,
Clifton House Residential Care Home DS0000058542.V342498.R02.S.doc Version 5.2 Page 16 a 3rd has been redecorated. Bathroom provision in the home is now much better suited to the needs of the people accommodated. Building work has been carried out to provide an additional 8 en-suites. 14 bedrooms now have en-suite facilities. A number of people spoken to on the day of the inspection commented that the home is looking much better. The work that has been done, and the significant financial investment into the home, is acknowledged. On the day of the inspection, the home was seen to be tidy and safe. All radiators have been guarded or have low surface temperatures. Where specialist equipment, such as pressure relieving mattresses, is required, it is obtained. However, issues raised by the fire officer in a recent visit must be addressed. In particular those relating to the fitting of automatic door closure devices to bedroom doors. In the previous inspection report, it was highlighted that in the late morning and early afternoon hot water taps run cool. Since the last inspection of Clifton House a new hot water boiler has been installed. Although further work is needed to completely resolve any problems in this area, hot water provision is now much better. The inspector looked around the building, which was found to be clean and free from odour. However, to enhance infection control, the home’s laundry arrangements should be reviewed to ensure that floors and other surfaces in the home’s laundry room can be kept clean. Clifton House Residential Care Home DS0000058542.V342498.R02.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient staff are employed. The home has a settled, well-trained and well-led staff team. EVIDENCE: From discussions with management and staff, and from an examination of duty rosters, sufficient staff are employed within the home. There is a settled staff team. Some staff have worked at Clifton House for a number of years and know the people who live there well. Agreed staffing levels for Clifton House are, in addition to the manager and ancillary staff: a senior care assistant and 2 care assistants throughout the day and 2 staff at night. These staffing levels are considered to be appropriate to meet the needs of the people currently accommodated. However, if occupancy levels rise staffing levels should be reviewed. Clifton House has 4 floor levels. When the home is full, and dependency levels are high, an additional member of staff may be required. In the past this person has been rostered on a morning to assist with personal care. Recruitment procedures within the home are generally safe. CRB (Criminal Records Bureau) disclosure checks are carried out for all staff. A copy of each person’s birth certificate and a photograph is kept in their personnel file; these
Clifton House Residential Care Home DS0000058542.V342498.R02.S.doc Version 5.2 Page 18 documents are copied when completing the Criminal Records Bureau disclosure. However, it was noted that 2 new staff have started work recently without POVA (Protection of Vulnerable Adults) checks being finalised. Although with adequate supervision it is permissible for new staff to start work before their full CRB check is returned, they must have full ‘POVA First’ check clearance before starting work. Attention is drawn to CRB Guidance produced by the Criminal Records Bureau, CSCI and the Department of Health. Applicants for employment complete an application form and 2 references are requested. A reference from the last employer is requested, plus another; any gaps in employment are explored. Each member of staff receives a contract of employment and a job description. Staff training is given a high priority. All but 1 (recently appointed) member of staff has or has nearly completed NVQ (National Vocational Qualification) training at level 2 or above. Core training such as in First Aid and Moving and Handling is arranged. Other courses are also held. For example staff are currently doing a ‘distance learning’ training course about nutritional needs. Activity in this area is commended. Clifton House Residential Care Home DS0000058542.V342498.R02.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clifton House is a well-run care home. Appropriate quality assurance systems are in place to identify and rectify any concerns. EVIDENCE: Since the last inspection of the home, the then acting manager has become registered with CSCI as ‘Registered Manager’. She has almost completed a ‘Registered Managers Award’ training course and is to start an NVQ level 4 course in care. The home is much more settled and is running well. People spoke highly of the manager. The home has a range of a policies and procedures. Appropriate systems are in place to ensure people’s health and safety is protected. For example, risk assessments are completed; about which staff have received related training.
Clifton House Residential Care Home DS0000058542.V342498.R02.S.doc Version 5.2 Page 20 The Statement of Purpose for Clifton House describes the aim of the home’s care, which is to provide a high standard of care to the people who use the service. Questionnaires have been sent to people who use the service and their families asking their views on the standard of care in the home. CSCI inspection reports are available in the hall area for people to read. People’s views are also obtained through regular contact and an ‘open door policy’. From time to time ‘Residents Meetings’ are held, which provide an additional forum to discuss any concerns or potential difficulties. A director of the parent company visits regularly. He talks to staff and the people who live in the home. He also meets with the manager. However, reports required under Regulation 26 of the Care Homes Regulations 2001 need to be completed and a copy must be available in the home. Clifton House Residential Care Home DS0000058542.V342498.R02.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 Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Clifton House Residential Care Home DS0000058542.V342498.R02.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. 1. Standard OP9 Regulation 13(2) Requirement To safeguard people who need medicines and to minimise drugs errors, all medicines must be dispensed from the container provided by the pharmacist who supplied them. Medication held in the home must also be kept secure. Although the home’s medication trolley is kept locked, when not in use it needs to be kept locked away or secured to a wall. Issues raised by the fire officer in a recent visit must be addressed. In particular those relating to the fitting of automatic door closure devices. To ensure the safe recruitment of staff, if new employees are required to start work before full CRB (Criminal Records Bureau) disclosure checks are completed, POVA First (Protection of Vulnerable Adults) checks must be carried out before staff start. Reports required under Regulation 26 of the Care Homes Regulations 2001 need to be completed and a copy must be available in the home.
DS0000058542.V342498.R02.S.doc Timescale for action 01/09/07 2. OP19 13 01/09/07 3. OP29 19 01/09/07 4. OP37 26 01/09/07 Clifton House Residential Care Home Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP8 OP12 Good Practice Recommendations The home should acquire, or access, weigh scales suitable for people who need to use a wheelchair, so their weight can be monitored better. To ensure that the home can better meet people’s social and recreational needs and expectations, it is recommended that the vacant activities co-ordinator post should be filled as soon as possible. Meal menus should be reviewed and where necessary updated in consultation with the people who use the service. The home’s laundry arrangements should be reviewed to ensure that floors and other surfaces in the home’s laundry room can be kept clean. 3. 4. OP15 OP19 Clifton House Residential Care Home DS0000058542.V342498.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Darlington Area Office 1 Hopetown Studios Brinkburn Road Darlington County Durham DL3 6DS 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
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